A retrospective cohort of 2,014 etonogestrel or levonorgestrel implant initiators in 2016-2021 found one-year discontinuation at 3.83 per 100 person-years overall, 2.84 in adolescents and 4.16 in adults, with no significant difference. Sequential users had lower hazard (aHR 0.29), and abnormal bleeding was the leading reason. Single-centre findings should not diminish adolescent-specific services.
Key findings
- Discontinuation was 3.83 per 100 person-years overall, 2.84 for adolescents and 4.16 for adults, with no significant difference despite a lower adolescent trend. Sequential users had aHR 0.29 (95% CI 0.10-0.79; p=0.016). No other factor was significant, and abnormal uterine bleeding was the commonest reason.
Why this matters globally
Implants are highly effective, but continuation depends on side-effect acceptability and rights-respecting care. The data challenge assumptions that adolescents inherently discontinue early and support non-stigmatising bleeding management.
Thai researcher contribution
Obstetrics, data-management and social-work teams at Chulalongkorn University and King Chulalongkorn Memorial Hospital used a large service cohort to inform Thai adolescent care.
Limitations to consider
A retrospective tertiary-centre cohort may miss removals elsewhere. Implant choice and sequential use were not random; repeat users may be preselected for tolerance. Events were likely few despite the cohort size. Loss-to-follow-up, satisfaction, pregnancy and counselling quality were not described.
Verify the original sources
International Journal of Gynecology & ObstetricsRead the original article↗DOI: 10.1002/ijgo.71180