ABSTRACT
The Summary of Product Characteristics states that hepatic enzyme inducers may lower the blood levels of etonogestrel and there have certainly been associated failures. Women on short-term treatment are advised to use a barrier method in addition and for 28 days thereafter. There is also pressure on providers, when women arrive later in the cycle without ‘believable abstinence’ or full security about condom use, to insert the implant anyway. An extension of the concept is to recommend to Nexplanon requesters that they defer the insertion until they have achieved amenorrhoea through Depot medroxyprogesterone acetate injections, as many or as few as they need to have stopped all bleeding for 60 days – and insert the implant only after that. More important is an explicit ‘open-house’ policy, so the woman knows she can return at any time to discuss possible side effects and their treatment, without any provider pressure to persevere if the woman really wants the implant removed.
