Systematic review of efficacy with extending contraceptive implant duration

BACKGROUND: Extending contraceptive implant duration of use increases accessibility by maximizing the lifetime of devices. OBJECTIVES: To review the contraceptive efficacy during extended use of progestin implants. SEARCH STRATEGY: PubMed and EMBASE were searched for articles in any language, 1996–2017, utilizing terms for devices and contraceptive efficacy. SELECTION CRITERIA: Randomized clinical trials (RCTs), cohort studies, and case–control studies were included; abstracts, posters, and presentations were excluded. Studies evaluating Norplant and implants currently in pre‐marketing trials were excluded. DATA COLLECTION AND ANALYSIS: Titles and abstracts of articles were reviewed; those that met inclusion and exclusion criteria underwent full text review and data abstraction. MAIN RESULTS: The search identified 2951 articles; six met inclusion and exclusion criteria. Five studies evaluated the etonogestrel implant (Implanon), and one the levonorgestrel implant (Jadelle). One RCT randomized to method, not duration; the remaining studies were prospective cohort studies. Three studies analyzed efficacy among women beyond currently approved duration separately. All studies were of poor to fair quality by United States Preventative Services Task Force (USPTF) grading. Limitations include lack of generalizability and control of important confounders. CONCLUSION: These studies provide limited data for extended duration of contraceptive implants.