WHO statement on progestogen-only implants

Publication date: 2014

WHO statement on Progestogen-only implants Progestogen-only implants consist of hormone-filled capsules or rods that are inserted under the skin in a woman’s upper arm Key facts The purpose of this Statement is to reiterate and clarify the existing (current) WHO position based on published guidance that is still valid. WHO monitors the evidence in this field closely and will update its guidance as and when new evidence becomes available. KEY FACTS ABOUT PROGESTOGEN-ONLY IMPLANTS Long-acting reversible contraceptives, including intrauterine devices and implants are the most effective methods of reversible contraception. These methods have multiple advantages over other reversible methods. Most importantly, once in place, they do not require daily or monthly dosing and their duration of contraceptive action ranges from 3 to 5 years. Progestogen-only implants consist of hormone-filled capsules or rods that are inserted under the skin of a woman’s upper arm. Current systems consist of one or two rods. Jadelle® is a two-rod system designed to deliver a steady daily dose of levonorgestrel over a period of five years. Sino-implant (II)® is identical to Jadelle but is approved for use over a period of four years. Implanon® a single-rod system—continually releases a steady dose of etonogestrel for a period of up to three years. Implants are registered in more than 100 countries, including the United States, Western European countries, as well as many middle- and low-income nations. In 2012, the United Nations Commission on Life-Saving Commodities for Women and Children endorsed contraceptive implants as one of its 13 Life- Saving Commodities. Primary mechanisms of action of the implants include thickening cervical mucus (making it difficult for sperm to penetrate) and preventing ovulation in about half of menstrual cycles. USE OF PROGESTOGEN-ONLY IMPLANTS BY WOMEN LIVING WITH HIV There have been concerns from recent publications regarding the effectiveness of progestogen-only implants among women living with HIV and on some antiretroviral drugs.1 However, compared with other hormonal methods, no significant differences in pregnancy rates have been observed with progestogen-only implants.2 1 Perry S et al. Implementing the Jadelle implant for women living with HIV in a resource-limited setting: concerns for drug interactions leading to unintended pregnancies. AIDS 2014,28:791-795. 2 Patel Rena C et al. Pregnancy rates in HIV-positive women using contraceptives and efavirenz-based or nevirapine- based antiretroviral therapy in Kenya: a retrospective cohort study. The Lancet HIV. Published online October 16, 2015. http://www.thelancet.com/journals/lanhiv/article/PIIS2352- 3018(15)00184-8 CURRENT RECOMMENDATIONS The latest WHO recommendations on the use of hormonal contraception for women living with HIV were issued on 24 July 2014. In this guidance, there is no restriction on the use of progestogen only implants for women living with HIV (Medical Eligibility for Contraception (MEC) Category 1). However, women living with HIV who take antiretroviral drugs (ARVs) can generally use progestogen-only implants (MEC Category 2) 3 3 For further information related to the 2014 recommendations for hormonal contraceptive use for women at high risk of HIV and women living with HIV, please consult this link: http://www.who.int/ reproductivehealth/topics/family_planning/hc_hiv_ statement/en/ Photo: Marcel Reyners/Photoshare WHO/RHR/15.20 © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published materi- al is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland E-mail: reproductivehealth@who.int www.who.int/reproductivehealth CONCLUSION Hormonal contraceptive methods, including implants are highly effective in reducing pregnancy risk in HIV- infected women, including those concurrently using ART. There is no evidence to support advising HIV- infected women on antiretrovirals, not to use implants. WHO recommends every individual is ensured opportunities exercise their human rights to make informed contraception choices, based upon a full range of emergency, short-acting, long-acting and permanent methods.4 4 Ensuring human rights in the provision of contraceptive information and services Guidance and recommendations. http://www.who.int/reproductivehealth/publications/ family_planning/human-rights-contraception/en/

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