Subdermal levonorgestrel implants. Three years' experience in Cairo, Egypt

To assess the efficacy, safety and acceptability of the subdermal levonorgestrel implant (SLI), a new, long-acting, low-dose, progestin-only contraceptive method for women.

A prospective, observational study conducted in the family planning clinic, Department of Obstetrics and Gynecology, Ain Shams University Hospital, Cairo, Egypt, as an advanced phase III clinical trial.

This paper describes three years' experience with the SLI in 350 women. The net three-year cumulative pregnancy rate was 0.98%. Menstrual disturbances, ranging from amenorrhea to menorrhagia, were the major side effects and were present in 25% of women during the third year. These disturbances resulted in 28 removals, 19 of which were because of amenorrhea. Medical complications, including headache, hypertension and non-insulin dependent diabetes; desire for pregnancy; and complications at the insertion site (such as infection, spontaneous expulsion of the capsules and arm pain) were the principal reasons for another 57 implant removals. So far, no gynecologic or breast lesions have developed, and weight changes were not noted. The continuation rate after three years was 65.5%.

The efficacy, safety and acceptability of the implant suggest that it will provide an important addition to the contraceptive armamentarium.