Reasons and Associated Factors of Early Discontinuation of Implanon: A Follow-up Study from Lahore, Pakistan

Background: Family planning is needed at this time when the world population is rapidly increasing. Etonogestrel sub-dermal implant is a highly effective long-acting and reversible sub-dermal contraceptive implant. Despite its success and enhancement in usage, it is stopped by a proportion of users prior to its expiration date. Objective: To ascertain the frequency of discontinuation of Implanon during one year period and uncover its reasons and associated factors among women consulting obstetrics and gynecological clinics for contraception methods and opting for Implanon among the available options. Methodology: This prospective observational study was conducted in Services Hospital, Lahore. All of the women who underwent Implanon insertion from July to December 2020 were enrolled in the study. The outcome variable is early discontinuation of the inserted implant within one year of its insertion. Results: 350 women receiving sub-dermal Implanon for contraception purposes were included in this study. Their median age and BMI were 28(IQR= 25.8-31) years and 24.3 (IQR=23.6-25) Kg/m2 respectively. The early discontinuation rate was 49.1%. Reasons for removal were menstrual problems (100%), headache (19%), weight gain (12%), pain in the arm (5%), desire to conceive (1.7%) and spouse death (0.3%). Younger age, increasing body mass index, rural residence and shorter marriage duration were found to be significantly associated with early removal. Conclusion: This study found a high early discontinuation rate. Premature removal was most commonly caused by menstrual issues. Early removal was independently predicted by an early age, length of the marriage, rising BMI, and residence in a rural location. An awareness campaign should be created specifically for rural areas to address their concerns and reduce the early discontinuation rate. Further research should be conducted to understand the menstrual problems in women undergoing implanon insertion.