Over the past weeks Implanon, the three-year contraceptive implant,
has been in the media spotlight. It was reported that 12-year old
Aboriginal girls were “temporarily sterilised” with Implanon in a
number of Queensland and Northern Territory remote communities (see,
for instance, Tim Dick in The Sydney Morning Herald, April 16, 2008).
This issue raises serious questions about health professionals
aiding and abetting sex under the legal age of 16. It also reminds us
that the law is often not enforced and males who have sex with underage
girls get away without prosecution. However, other than reporting that
some of these young girls were found with sexually transmitted
infections (STIs), Implanon itself was not queried for its medical
As Implanon is gaining widespread currency as the new “cool”
contraceptive for young women everywhere in Australia, it warrants a
closer look at what it is and what it does.
Implanon is a second generation progesterone-like contraceptive
implant. Its ingredient Etonogestrel is very similar to the Depot
progesterone in Depo Provera and Levonorgestrel in the discredited
Norplant (which caused blindness in women and was taken off the US
market in 2002 but is now making its comeback as Norplant-II in Europe).
Implanon consists of a 40mm single polymer rod that is injected
under the skin in a girl’s/woman’s upper arm where it can be felt. It
can migrate and may be hard to find if she wants to have the rod
removed before its three-year effectiveness has run out. Health
providers need to be instructed in both implantation and removal.
Implanon was approved in Australia in 2001 and has since become one
of the most favoured contraceptive options by reproductive choice
groups. In 45 years on: What now in Contraceptives?, a
widely-distributed free booklet available in GP surgeries published in
2007 by the National Council of Women in Australia, Implanon is listed
as the number one non-daily method.
Its advantages are described as:
- convenience - not having to remember to take anything;
- long duration of use;
- reliability; and
- fertility returns quickly upon removal of implant.
All points that may especially appeal to young girls and women who
have grown up with the “one stop-quick-fix-no-bother” approach to life.
Indeed, featured in the booklet as “Being a busy girl …”, is Biana
Dye, presenter of Nova radio, a station for the young. She is excited
about Implanon: “What a cool concept not having to worry about
contraception for three years.”
The only disadvantage the booklet includes is that the “menstrual cycle is altered and some women have irregular periods”.
Throughout the booklet, Implanon is then repeatedly mentioned as the
latest exciting contraceptive choice. Unfortunately, underplaying risk
and adverse effects does no service to girls and women. In June 2003,
the TGA (Therapeutic Goods Administration) mentioned in their Adverse Drug Reactions Bulletin
that they had received 130 adverse reaction reports, 37 of which
related to prolonged bleeding between two and 26 weeks. (33 of the 37
women had their implant removed.) Other well known adverse effects,
listed by the US FDA (Food and Drug Administration who only approved
Implanon in July 2006) include “increased or decreased bleeding
frequency including amenorrhea (no periods), headaches, acne and
emotional lability [mood swings]”.
The problems don’t stop there. As with the three-month injection
Depo Provera (also still widely administered to girls and women of all
ethnicities) there is the serious problem of potential bone mineral
density (BMD) loss. Because Implanon has only been on the market since
1998 (in Europe), it will be years before Implanon users will know
whether the oestrogen decreasing mechanism of this synthetic progestin
will significantly reduce BMD.
A 2007 study of the forearm bone density of 111 women, reported in Reproductive Health
Vol 4, No 11, comparing levonorgestrel (Norplant) and etonogestrel
(Implanon) is cause for concern. After 18 and 36 months of use, BMD of
the “distal radius” of the forearm in both groups was “significantly
lower” (Monteiro-Dantas et al.,) although the “ultra-distal radius”
appeared not to be affected.
It needs to be remembered that it took from the mid 1980s to 2004
for the manufacturer of Depo Provera to finally acknowledge BMD loss
from the three-month injectable drug and for the FDA to require them to
put a black box-warning on the product.
A similar time span of almost 20 years would make it another 10
years (to 2018) before it will be known more conclusively whether
Implanon leads to significant bone density loss. Like Depo Provera it
may only be partially recovered once the contraceptive is stopped. In
the meantime, thousand of users - including girls and young women who
are most vulnerable to bone loss - may jeopardise their long-term
health and risk higher levels of fractures from osteoporosis as they
get older. And they’re not even told that this “cool” contraceptive may
put them at risk.
In common with other progesterone-like contraceptives (including the
mini pill) Implanon is not recommended for women who smoke and those
with heart or liver disease and vaginal bleeding. Loss of libido during
the use of Implanon is another frequent problem not mentioned by its
enthusiastic promoters. So are problems with its removal. As one recent
I had it implanted when I was 18 (I had really adverse reactions
to the pill), and it has done something permanently to me - ever since
I have had no sex drive at all. Must be something to do with hormone
levels. I didn't get my period for the whole three years I had it in.
Anyway, I had it implanted in (state), and when I wanted it out I
couldn't find ANYONE who did it. I rang doctors, hospitals, family
planning clinics, and they all knew how to put them in, but not take
them out. So I thought I may as well wait until the three years was up
and I was in (another state).
As girls and boys are subtly and not so subtly steered towards
engaging in sex at a pre-teen age by various media messages, and,
unfortunately as rape and sexual abuse are rife (and not just in
Aboriginal communities), how to prevent a teen pregnancy becomes an
In general, the popular understanding is that there is a whole
cafeteria of safe contraceptive “choices” available and your doctor or
family planning clinic will help you select the one “that’s best for
you”. All hormonal contraceptives have side effects but at least if the
pill makes you sick, you can discontinue it and look for something
else. A plastic rod stuck in your arm is a different matter. Girls and
women deserve to be told that Implanon may make them very sick and
possibly reduce their bone density for good.
Dr Renate Klein, a biologist and social scientist, is a long-term
health researcher and has written extensively on reproductive
technologies and feminist theory. She is a former associate professor
in Women's Studies at Deakin University in Melbourne, a founder of
FINRRAGE (Feminist International Network of Resistance to Reproductive
and Genetic Engineering) and an Advisory Board Member of Hands Off Our Ovaries.
An opinion provided by OnlineOpinion.com.au
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