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Contraception - Management
When can the progestogen-only implant be inserted?
- Provided that it is reasonably certain that the woman is not pregnant, the progestogen-only implant can be inserted at any time, but the need for additional contraception varies.
- Women receiving a first implant or switching from another hormonal method of contraception:
- Ideally, insert within days 1–5 of the menstrual period.
- If inserted outside this time, or if the woman is amenorrhoeic, additional contraceptive cover is needed for 7 days.
- If switching from a progestogen-only injectable, the implant should be inserted no later than the time when the next injection is due.
- Switching from a copper intrauterine device (IUD) or a levonorgestrel-releasing intrauterine system (LNG-IUS):
- Insert the implant and remove the IUD or LNG-IUS at least 7 days later.
- Postpartum:
- No method should be started before day 21 unless there are good reasons to do so.
- If the implant is inserted before day 21, problematic bleeding can occur.
- Hormonal methods can be started on day 21 without the need for any additional contraception.
- If the method is started after day 21 then additional contraception (such as condoms) should be used for 7 days.
- Post-abortion or post-miscarriage:
- Insert immediately after abortion or miscarriage (at any stage of gestation).
- If started on the day of abortion (surgical, or the second part of a medical abortion; induced or spontaneous; less than 24 weeks gestation), no additional contraceptive method is required.
- If started more than 5 days days after abortion or miscarriage, an additional contraceptive method is required for 7 days.
Clarification / Additional information
- Unlicensed and licensed uses of the progestogen-only implant that are recommended by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC), are compared in Table 1 [FSRH, 2008a].
Table 1. Licensed and unlicensed recommended uses of the progestogen-only implant.
Time of insertion | Licensed use as in the Summary of Product Characteristics | Evidence-based use outside the terms of the product licence |
|---|
First use | Initiate between days 1 and 5 of the menstrual cycle. | Can start up to and including day 5 without using an additional contraceptive method. Start after day 5 if it is reasonably certain the woman is not pregnant; an additional contraceptive method should be used for the next 7 days. |
After abortion or miscarriage | Start immediately after a first-trimester abortion. After a second-trimester abortion, start between days 21 and 28. If started after day 28, an additional contraceptive method is required for 7 days. No advice is given for miscarriage. | Start on the day of a surgical abortion or second part of a medical abortion (induced or spontaneous < 24 weeks); no additional method is required. If started > 5 days after abortion, an additional contraceptive method is required for 7 days. |
Postpartum or breastfeeding | Start between days 21 and 28; there is no need for additional contraception. | Insert up to day 21 postpartum, immediate contraceptive cover. If started after day 21, advise condoms or abstinence for 7 days. Can be started before day 21 but problematic bleeding can occur. |
|
Basis for recommendation
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