Levonorgestrel Implant: Contraception Guidance

Therapeutic action

Hormonal contraceptive, progestogen.

Indications

Long-acting contraception.

Forms and strengths, route of administration

• Set of two flexible rods containing 75 mg of levonorgestrel, with a sterile applicator.
• To be inserted subdermally into the inner side of the non-dominant arm, 6 to 8 cm above the elbow crease, under local anaesthesia and aseptic conditions.

Dose

The implant may be inserted at any moment of the cycle if it is reasonably certain the woman is not pregnant, including when switching from another form of contraception.

Use condoms for 7 days following insertion if it is inserted more than 7 days after the start of menstruation, more than 28 days postpartum if not breastfeeding, or more than 7 days after an abortion.

Duration

As long as this method of contraception is desired and well tolerated, for a maximum of 5 years, or 4 years in obese women, after which it no longer provides contraception and must be changed.

Contra-indications, adverse effects, precautions

• Do not administer to patients with breast cancer, severe or recent liver disease, unexplained vaginal bleeding, or active thromboembolic disorders.
• May cause menstrual irregularities, amenorrhoea, menometrorrhagia, breast tenderness, headache, weight gain, itching, acne, mood changes, abdominal pain, gastrointestinal disturbances, and allergic reactions.
• Enzyme-inducing drugs such as rifampicin, rifabutin, efavirenz, nevirapine, lopinavir, ritonavir, phenobarbital, phenytoin, carbamazepine, and griseofulvin reduce the effectiveness of the contraceptive.
• Pregnancy: contraindicated.
• Breast-feeding: no contra-indication.
• Fertility returns rapidly after removal of the implant.
• The duration of action of the levonorgestrel implant is longer than that of the etonogestrel implant, but the etonogestrel implant is easier to insert and remove.
• Follow the manufacturer's instructions for insertion and removal.