Early Removal of the Etonogestrel Contraceptive Implant and Associated Factors Among Users at the Urban Family Planning Clinic in Siriraj Hospital, Bangkok, Thailand

Main Article Content

Nichamon Parkpinyo
Nalinee Panichyawat
Korakot Sirimai


Objective: To study the rate and reasons for the early removal of etonogestrel contraceptive implants and associated factors at the family planning clinic in Siriraj Hospital.
Materials and Methods:
This retrospective cohort study was conducted between May 2015 and December 2019 and contained 1,030 women who received the etonogestrel contraceptive implant. The medical records of demographic characteristics and clinical factors i.e., implant insertion date, implant removal date, reason for implant removal, contraceptive use before implant insertion and after implant removal, documented bleeding pattern and acceptability, were identified. 
The mean age of participants was 28.6 ± 6.9 years. About 21% of women (218/1030) prematurely discontinued their etonogestrel implant. A desire to become pregnant was the most common reason for early removal of the etonogestrel implant (32%). Meanwhile, the most common side-effect contributing to early removal was unscheduled bleeding. The associated variables of early etonogestrel implant removal were low BMI (p-value = 0.021) and unacceptability of bleeding pattern at one year (p-value < 0.001) and two years (p-value < 0.001) after insertion.
Early etonogestrel implant discontinuation rate was remarkable and the main reasons for it include a desire to become pregnant and bleeding side effects. Moreover, a lower BMI and unacceptability of bleeding problems also increased the likelihood of early removal of this contraceptive method.


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How to Cite
Parkpinyo, N. ., Panichyawat, N. ., & Sirimai, K. . (2021). Early Removal of the Etonogestrel Contraceptive Implant and Associated Factors Among Users at the Urban Family Planning Clinic in Siriraj Hospital, Bangkok, Thailand . Siriraj Medical Journal, 73(6), 399–405. https://doi.org/10.33192/Smj.2021.53
Original Article


1. Festin MPR. Overview of modern contraception. Best Pract Res Clin Obstet Gynaecol 2020;66:4-14.
2. Bahamondes L, Fernandes A, Monteiro I, Bahamondes MV. Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol 2020;66:28-40.
3. Ali M, Bahamondes L, Bent Landoulsi S. Extended Effectiveness of the Etonogestrel-Releasing Contraceptive Implant and the 20 µg Levonorgestrel-Releasing Intrauterine System for 2 Years Beyond U.S. Food and Drug Administration Product Labeling. Glob Health Sci Pract 2017;5(4):534-9.
4. Bhatia P, Nangia S, Aggarwal S, Tewari C. Implanon: subdermal single rod contraceptive implant. J Obstet Gynaecol India 2011;61(4):422-5.
5. Aisien AO, Enosolease ME. Safety, efficacy and acceptability of implanon a single rod implantable contraceptive (etonogestrel) in University of Benin Teaching Hospital. Niger J Clin Pract 2010;13(3):331-5.
6. Aziz MM, El-Gazzar AF, Elgibaly O. Factors associated with first-year discontinuation of Implanon in Upper Egypt: clients' and providers' perspectives. BMJ Sex Reprod Health 2018.
7. Nageso A, Gebretsadik A. Discontinuation rate of Implanon and its associated factors among women who ever used Implanon in Dale District, Southern Ethiopia. BMC Women's Health 2018;18(1):189.
8. Teunissen AM, Grimm B, Roumen FJME. Continuation rates of the subdermal contraceptive Implanon® and associated influencing factors. The European Journal of Contraception & Reproductive Health Care 2014;19(1):15-21.
9. Law A, Liao L, Lin J, Yaldo A, Lynen R. Twelve-month discontinuation rates of levonorgestrel intrauterine system 13.5 mg and subdermal etonogestrel implant in women aged 18-44: A retrospective claims database analysis. Contraception 2018;98(2):120-4.
10. Blumenthal PD, Gemzell-Danielsson K, Marintcheva-Petrova M. Tolerability and clinical safety of Implanon. Eur J Contracept Reprod Health Care 2008;13 Suppl 1:29-36.
11. Funk S, Miller MM, Mishell DR, Jr., Archer DF, Poindexter A, Schmidt J, et al. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception 2005;71(5):319-26.
12. Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. The effects of Implanon on menstrual bleeding patterns. Eur J Contracept Reprod Health Care 2008;13 Suppl 1:13-28.
13. Bahamondes L, Brache V, Meirik O, Ali M, Habib N, Landoulsi S. A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls. Hum Reprod 2015;30(11):2527-38.
14. Casey PM, Long ME, Marnach ML, Fleming-Harvey J, Drozdowicz LB, Weaver AL. Association of body mass index with removal of etonogestrel subdermal implant. Contraception 2013;87(3):370-4.
15. Casey PM, Long ME, Marnach ML, Bury JE. Bleeding related to etonogestrel subdermal implant in a US population. Contraception 2011;83(5):426-30.
16. Ireland LD, Goyal V, Raker CA, Murray A, Allen RH. The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. Contraception 2014;90(3):253-8.
17. Beesham I, Smit J, Beksinska M, Panday M, Makatini V, Evans S. Reasons for requesting removal of the hormonal implant, Implanon NXT, at an urban reproductive health clinic in KwaZulu-Natal, South Africa. S Afr Med J 2019;109(10):750-5.
18. Gedeon J, Hsue SN, Walsh M, Sietstra C, MarSan H, Foster AM. Assessing the experiences of intra-uterine device users in a long-term conflict setting: a qualitative study on the Thailand-Burma border. Conflict and Health 2015;9(1):6.
19. Salisbury P, Hall L, Kulkus S, Paw MK, Tun NW, Min AM, et al. Family planning knowledge, attitudes and practices in refugee and migrant pregnant and post-partum women on the Thailand-Myanmar border - a mixed methods study. Reprod Health 2016;13(1):94.
20. Srikanok S, Parker DM, Parker AL, Lee T, Min AM, Ontuwong P, et al. Empirical lessons regarding contraception in a protracted refugee setting: A descriptive study from Maela camp on the Thai-Myanmar border 1996 - 2015. PLoS One 2017;12(2):e0172007.
21. Desta M, Endale Z, Abuhay M, Kasaye H. Implanon discontinuation rate and associated factors in debremarkos town, northern Ethiopia, 2016. ARC Journal of Public Health and Community Medicine 2017;2(1):8-16.
22. Medhin T, Gebrekidan KG, Nerea MK, Gerezgiher H, Haftu M. Early Implanon discontinuation rate and its associated factors in health institutions of Mekelle City, Tigray, Ethiopia 2016/17. BMC Res Notes 2019;12(1):8.
23. Assavapokee N, Wattanayingcharoenchai R, Aimjirakul K. Three-Year Continuation Rate of Etonogestrel Subdermal Implant and Associated Factors. J Med Assoc Thai 2019;102(6):657-62.
24. Di Carlo C, Guida M, De Rosa N, Sansone A, Gargano V, Cagnacci A, et al. Bleeding profile in users of an etonogestrel sub-dermal implant: effects of anthropometric variables. An observational uncontrolled preliminary study in Italian population. Gynecol Endocrinol 2015;31(6):491-4.