REMOVAL RATES OF SUBDERMAL LEVONORGESTREL IMPLANTS

This study attempted to quantify an achievable removal rate of subderm al levonorgestrel implants (SLIs) in an unselected population and deve lop strategies were increasing continuation. Over 16 months, 1,076 SLI s were inserted in eligible patients from a lower socioeconomic group at high risk for unintended pregnancy. Extensive preinsertion and post insertion counseling and follow-up care were given. Patients developin g problems were counseled and managed conservatively. If a patient req uested removal of the Norplant after this process, removal was done. T wenty-two removals occurred due to SLI-related problems, for a rate of 2.04%; no trends based on age or parity were found. The most common r easons for removal were bleeding/irregular menses (31.8%), headaches ( 18.1%) and hair loss (13.6%). An episode of thrombophlebitis, not thou ght to be caused by the SLI, led to one removal. Seventy-seven percent of removals occurred in the first six months, with peak rates in the fourth and fifth. Five patients became pregnant inadvertently within s ix months of removal. An extremely low removal rate and high continuat ion rate are possible in an inner city clinic population at risk for u nintended pregnancy. Acceptance will increase if the SLI can be mainta ined at least past six months. Extensive counseling, patient support a nd conservative medical management constitute a successful approach.