BACKGROUND: Implantable methods of contraception offer long-acting reversible contraception. Their uptake rate in comparison to other contraceptive methods, particularly in developed countries, has historically been low. OBJECTIVES: To assess the contraceptive effectiveness, tolerability and acceptability of subdermal implants in comparison to other reversible contraceptive methods. SEARCH STRATEGY: Literature were identified through database searches, reference lists and individuals/organisations working in the contraceptive field. SELECTION CRITERIA: All randomised and controlled trials comparing subdermal implants with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. Primary outcomes were pregnancy and continuation. DATA COLLECTION AND ANALYSIS: Quality assessment of studies and data extraction were completed independently by two reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors. Study authors and pharmaceutical companies were contacted to provide additional data.Data were collected on pregnancy rates, continuation, side effects and adverse events. MAIN RESULTS: All nine identified trials compared different types of contraceptive implant. Eight, involving 1578 women, compared Implanon with Norplant , and one, involving 1198 women, compared Jadelle with Norplant. There was no difference between Implanon and Norplant for contraceptive effectiveness rates or continuation over 4 years. Both were highly effective methods of contraception with no pregnancies occurring in any of the trials during 26,972 and 28,108 women months of follow up respectively. The most common side-effect with Implanon and Norplant was changes in bleeding pattern. The pattern with Implanon was initially more variable, bleeding with both implants became less frequent with duration of use. After two years use the amenorrhoea rate was significantly higher with Implanon. The trials reported no significant difference in hormonal side-effects or adverse events. Implanon was significantly quicker to insert and remove than Norplant. There was no difference in contraceptive effectiveness and in continuation rates between Jadelle and Norplant. Jadelle was significantly quicker to remove than Norplant. AUTHORS' CONCLUSIONS: Implanon, Norplant and Jadelle are highly effective contraceptive methods. No significant differences were found in contraceptive effectiveness or continuation. The most common side-effect with all implants was unpredictable vaginal bleeding. Time taken for removal of Implanon and Jadelle was less than that for Norplant.Although this systematic review was unable to provide a definitive answer on relative effectiveness, tolerability and acceptability of contraceptive implants in comparison to other contraceptive methods, it has raised issues around the conduct of contraceptive research.

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Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods for preventing pregnancy

A systematic review of the literature was conducted for evidence on whether a policy of providing a wide range of contraceptive methods as opposed to the provision of a limited range improves health outcomes such as contraceptive uptake acceptability adherence continuation and satisfaction; reduction of unintended pregnancy; and improved maternal health and wellbeing Studies of all designs reviews reports policy documents commentaries opinion papers and position papers were included in a search of MEDLINE (via Pubmed Ovid MEDLINE and Old Ovid MEDLINE) All EBM Reviews POPLINE EMBASE Cochrane Central Register of Controlled Trials (CENTRAL) LILACS and Psyc Info A total of 6977 citations were identified Of these 3586 were duplicates leaving 3391 titles/abstracts for screening After more sensitive review by three authors (AG JS NM) 231 citations were included in the review Two authors (AG JS) independently extracted data from full reports or papers of all included studies In a few instances the full text could not be accessed and the study was assessed on the abstract only Not unsurprisingly this systematic review has failed to find large quantities of high quality evidence that increasing choice has a direct impact on the contraceptive outcomes of interest The best evidence retrieved is summarised in Table 1 (excerpt)

Systematic review of contraceptive medicines: "Does choice make a difference?" Final report.

Subdermal implantable contraceptives versus other forms of reversible contraceptives as effective methods of preventing pregnancy.

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Subdermal implantable contraceptives versus other forms of reversible contraceptives as effective methods of preventing pregnancy.