Table 1 Table describing salient features of included studies
Author, country and year | Type of study | sample size | Comparator (s) | Effectiveness | Effect(s) reported frequency (percentage) | Continuation rate reported | Follow-up period | Reference number |
|---|---|---|---|---|---|---|---|---|
Study design: cohort study | ||||||||
 Abraham M et al., USA, 2015 | CHOICE cohort study | n = 6106 | Cu-IUD, Age and parity | NA | NA | ENG implant continuation rate varied from 83 to 92% at 1 year and from 59 to 72% at 2 years. Nulliparous female were more likely to discontinue their LARC method among implant users adjusted HR 1.89, 95% CI 1.35–2.64 | 1, 2 years | [53] |
 Peipert et al., USA, 2011 | CHOICE cohort study | n = 5087 | LNG IUS, Cu-IUD and Etonogestrel implant | NA | NA | Continuation rate at one year for ENG implant was 83% | 1 year | [63] |
 Neil O callahan et al., USA, 2013 | CHOICE cohort study | n = 9256 | LNG IUS, Cu-IUD and Etonogestrel implant | NA | NA | 24-month continuation rate for implant was 69% | 2 years | [72] |
 Grunloh et al., USA, 2013 | CHOICE cohort study | n = 6167 | LNG IUS, Cu-IUD and Etonogestrel implant | NA | NA | Discontinuation rates was 6.9% for the implant | 6 months | [59] |
 Vickery et al., USA, 2013 | CHOICE cohort study | n = 427 | DMPA, LNG-IUS, Cu-IUD, ENG-implant | NA | No difference in weight gain | NA | 1 year | [45] |
 Agostini et al., France, 2018 | Retrospective cohort study | n = 42,365 | COCs, progestin-only oral contraceptives, Cu-IUD, LNG-IUS and ENG implant | NA | NA | 83.6% for the ENG implant | Up to 2 years | [54] |
 Berenson et al., USA, 2014 | Retrospective study | LNG-IUS (n = 79,920) or ENG implants (n = 7374) inserted | LNG-IUS and ENG implant | 98.821% for ESI and 98.8713% in LNG-IUS | The most frequent complications with both methods were related to abnormal menstruation, which was more likely to occur among ENG implant users | 14.82% of ENG implant users discontinued within 1 year of insertion | 1 year | [38] |
 Bitzer et al., Switzerland, 2004 | Retrospective study | n = 1183 | None | NA | Side-effects (visit 1) included infrequent bleeding (28%), amenorrhea (33%), prolonged bleeding (15%), and metromenorrhagia (frequent and heavy bleeding) (16%). Other reported side-effects at visit 1 included dizziness (12%), acne (11%), mood swings (8%) and headache (5%) | Implanon was removed prematurely in 235 women − 24% |  | [41] |
 Chiles et al., USA, 2016 | Retrospective cohort study |  > 1.7 million women, aged 14–40 years | LNG IUS, Cu-IUD and Etonogestrel implant | NA | NA | Among women who selected the implant, 32.0% continued their method at 36 months | 3 years | [57] |
 Sara e casey, Democratic Republic of Congo, 2017 | Retrospective cohort study | n = 548 | Implant, IUD, Injection and Pill | NA | NA | Discontinuation rate at one year for LARC users(IUD and implant) was 13.9% | 1 year | [42] |
 Thamkantho et al., Thailand, 2008 | Retrospective clinic based study | n = 166 | None | 0 pregnancy in 1 year of use | 30.3% had regular menstrual flow for a few months alternately with no menses for a few months; prolonged menstrual bleeding most common | NA | 1 year | [33] |
 Teunissen et al., Netherlands, 2014 | Retrospective consecutive cohort design | n = 230 | None | NA | NA | The continuation rate after 12 months was 72%; after 24 months, 53%; and after 36 months, 25%, with all women concerned having a new implant placed | 1, 2, 3 years | [69] |
 Sznajder et al., USA, 2016 | Retrospective cohort data | n = 160 (12–24 years age) | LNG-IUS and ENG implant | NA | NA | Dis-continuation rate at one year for ENG implant was 22.68% | 1 year | [68] |
 Howard et al., USA, 2017 | Retrospective cohort study | Retrospective cohort study based on billing records from a large multispecialty private practice in Las Vegas, Nevada | None | NA | NA | There was a progressive decrease in the 12-month continuation of implant from 2013 (95.7%) to 2015 (57.7%) | 1 year | [61] |
 Aisien et al., Nigeria, 2010 | Prospective Longitudinal | n = 32 | None | 100% | Oligomenorrhea: 18 (56.3%) Menorrhagia: 1(3.1%) and Combination: 13 (40.6%) Headache: 4 (12.5%) and Reduced libido: 3 (9.4%) | Continuation rate at 1 year for ENG implant was 93.8% | 12 months | [27] |
 Weisberg et al., Australia, 2014 | Prospective Longitudinal | n = 349 | LNG-IUS and ENG implant | NA | NA | 47% of implant users discontinued within three years | 3 years | [70] |
 Rominski et al., Ghana, 2018 | Pilot longitudinal study | – | Implant, IUD, Injection and Pill | NA | NA | Continuation rate at one year for ENG implant was 95% | 1 year | [65] |
 Arribas et al., Spain, 2009 | Prospective | n = 356 | None | 100% | NA | Continuation rates were 91.0% at 1 year, 74.7% at 2 years and 65.1% at 2 years and 9 months | 1, 2, 2 year 9 months | [28] |
 Boas et al., Brazil, 2016 | Prospective cohort study | n = 213 healthy women | None | NA | Increase in weight (63.3–66.1) and BMI (24.7–25.7) and a decrease in TC (172–161.5), TG (75–69.5), and LDL (100.5–98.5) (p > 0.05). Of the metabolic variables, FBG (85–88) and HDL (53–46) had significant differences (p < 0.002) | NA | 1, 2, 3 years | [47] |
 Guazelli et al., Brazil, 2010 | Prospective study | n = 47 | None | NA | Increase in mean hemoglobin, hematocrit and indirect bilirubin concentrations and of the HDL-C/TC and HDL-C/LDL-C ratio. Decrease in mean TC level as well as LDL-C, very low-density lipoprotein cholesterol, TG, SGOT and SGPT | NA | 1 year | [46] |
 Hidalgo et al., Brazil, 2006 | Prospective study | n = 344 | LNG implant, Cu-IUD | NA | Implanon, Jadelle and Cu-IUD, 12-month ovarian cyst incidence rates were 26.7%, 14.6% and 1.2%. They regress spontaneously and do not require further treatment | NA | 1 year | [52] |
 Iversen et al., Denmark, 2018 | Prospective cohort study | n = 1,879,227 | Hormonal contraception | NA | Use of progestogen-only products was not associated with ovarian cancer risk | NA | 20 years | [50] |
 K Gezginc et al., Turkey, 2007 | Prospective study | n = 80 | None | 100% | Amenorrhoea, infrequent bleeding and frequent bleeding were reported by 33(41.25%), 19 (23.75%) and 14 women (17.5%) | 25% discontinuation in the study period of 2 years | 2 years | [29] |
 Lidegaard et al., Denmark, 2012 | Prospective cohort | n = 1,626,158 | OCP, LNG-IUD, Vaginal Ring, Patch and Implant | NA | No significant increase in the risk of thrombotic stroke or myocardial infarction | NA | 15 years | [51] |
 Modesto, Brazil, 2014 | Prospective cohort | n = 150 | Cu-IUD, ENG-implant | NA | No significant differences on BMD. Increase in body weight (p 0.001) and an increase of 2% in the percentage of body fat, when compared with Cu-IUD users. Increase in lean mass (p = 0.020) | NA | 1 year | [44] |
 Morch et al., Denmark, 2017 | Prospective cohort study | n = 1.8 million | OCP, LNG-IUD, Vaginal Ring, Patch and Implant | NA | As compared with never users of contraception, relative risk of breast cancer among implant users was 0.93 (0.48–1.79) | NA | Average of 10.9 years | [49] |
 Winner et al., USA, 2007 | Prospective cohort | n = 7486 | DMPA and PPR (Pill, patch, ring) | 0.27 per 100 participant-years in LARC as compared to 0.22 in DMPA and 4.55 in PPR | NA | NA | 3 years for first 5090 participants and 2 years for those after | [34] |
 Birgisson et al., USA, 2015 | Observational Cohort | n = > 9000 | LNG IUS, Cu-IUD and Etonogestrel implant, Patch, Pill and Ring | Combined LARC (LNG-IUS, Copper- IUD and implant) failure rate at 1, 2 and 3 years was 0.3%, 0.6% and 0.9% as compared to 4.8%, 7.8% and 9.4% among short acting contraceptive users | NA | 12 and 24 month continuation rate was 83% and 68% | 1, 2 years | [39] |
 Cea Soriano et al., UK, 2014 | Prospective Observational study | – | Cu-IUD, LNG-IUS and DMPA injections | NA | NA | 13.2% of ENG Implant users discontinued in first year of use | 1 year | [56] |
 Short et al., 4 EU countries, 2012 | Prospective Observational study | n = 311 | LNG-IUS and ENG implant | NA | NA | Continuation rate at 1 year for ENG implant was 86% | 1 year | [67] |
Randomised controlled trial | ||||||||
 Apter 2016 | RCT | Multicentre RCT n = 766 | LNG-IUS and ENG implant | The PIs for LNG-IUS and the ENG implant were 0.9 (95% CI 0.2–2.6) and 0.0 (95% CI 0.0–1.2), respectively | The incidence of adverse events was 84.3% and 79.5% in the LNG-IUS 8 and the ENG implant groups, respectively. In LNG-IUS users: Dysmenorrhea (33.5%), uterine spasms (16.2%), procedural pain (13.6%), headache (11.3%), and acne (9.9%). In ENG implant users, acne (15.5%), headache (12.3%), dysmenorrhea (12.3%), nasopharyngitis (9.2%), and cervical dysplasia (8.9%) | The 12-month discontinuation rates were 19.6% and 26.8% in the LNG-IUS 8 and ENG implant groups, respectively | 1 year | [35] |
 Flores et al., Mexico, 2005 | Multicenter trial | n = 417 | None | The Pearl Index score was 0 | NA | The continuation rate at the end of 3 years was 61.4% | 3 years | [25] |
 Bahamondes et al., Multicentre-seven countries, 2015 | Open parallel group RCT | n = 2963 | Copper IUD-380A, LNG-implant and ENG implant | 0.4 per 100 woman years (CI 0.1–1.4) in ENG implant; 2.8 ( CI 1.3–6.0) in Cu-IUD | ENG implant: Amenorrhea: 38.9%, irregular bleeding: 86.0%, heavy bleeding: 35.38%, prolonged: 56.18%; acne: 45.23%; headache: 59.6% and lower abd pain: 50.35%; dizziness: 44.52% and PID: 1.21% Copper IUD: Amenorrhea: 8.65%, irregular bleeding: 38.93%, heavy bleeding: 49.85%, prolonged: 42.95%; acne: 32.23%; headache: 53.24% and lower abd pain: 61.17% dizziness: 39.96% and PID: 2.68% | Method continuation rates for ENG implant at 2.5 years was 69.8 (95% CI 66.8–72.6) | 2.5 years | [37] |
 Hubacher wt al, USA, 2016 | randomized patient preference trial | n = 916 | OCP, DMPA, IUD and implant | Implant and IUD (combined) was 0.7 (0.0–4.7) OC: 6.1 (4.3–8.6) DMPA: 4.6 (0.2–12.2) | NA | At one year, probability of continuation of implant was 77.5% (70.2–84.8) | 1 year | [36] |
 Oderich et al., Brazil, 2010 | Nonrandomized, open-label, prospective controlled tria | n = 40 | Cu IUD and implant | NA | Carbohydrate metabolism was not modified | NA | 6, 12 months | [48] |
 Study design: cross-sectional study | ||||||||
 Nageso et al., Ethiopia, 2018 | Cross-sectional study design | n = 711 | None | NA | NA | Early Implanon discontinuation rate in this study was 23.4% | 1 year | [73] |
 Gupta et al.,Papua New Guinea, 2017 | Cross sectional study | n = 860 | None | 0.992 | Irregular bleeding n = 178, 20.6% but only 7% (n = 13) said the bleeding was bothersome | 97% (n = 836) still had the device in situ after 12 months | 1 year | [30] |
 Medhin TG et al., Ethiopia, 2019 | Cross sectional study | n = 229 | None | NA | NA | Discontinuation: early Implanon discontinuation rate was 38%, 95% CI (32%, 44%).Discontinuation rate was (2.6%) within 6 months, (15.7%) 1 year, (19.7%) in 2 years and (62%) in 3 years | At 6 months, 1, 2 and 3 years | [71] |
 Smith et al., USA, 2018 | Pilot study | n = 29 | COCP, Progestin-only contraceptive, non-hormonal or no contraceptive | NA | Progestin-only-contraceptives users have a potential of developing depressive symptoms and have attenuated beta arrestin-1 protein levels in peripheral blood mononuclear leukocytes | NA | Unclear | [76] |
 Yildizbas et al., Turkey, 2007 | A pilot study | n = 41 | None | NA | 34.1% had amenorrhea; 58.5% had some type of abnormal bleeding. Mood change in 17.1% and acne in 26.8% | NA | 6 months | [40] |
Study design: retrospective chart review | ||||||||
 Peterson et al., USA, 2019 | Retrospective chart review | n = 544 | None | NA | NA | Discontinuation rate at one year for ENG implant was 16% | 1 year | [64] |
 Romano et al., USA, 2019 | Retrospective chart review | n = 197 | Non-users of implant | NA | ENG implant users weight gain + 3.6 (± 7.8) kg vs + 3.1 (± 5.9) kg for controls (P = 0.43). Overall regression analyses showed no group differences among cases and controls | The mean duration of ENG use was 24.5 (± 9.3) months with 21.8% of users (43/197) discontinuing the method early (before 3 years) | 20 months | [43] |
 Mutihir et al., Nigeria, 2010 | Retrospective review | n = 669 | None | 98.51% | NA | 95.5% at the end of second year | 2 years | [31] |
 Smith et al., UK, 2002 | Retrospective record review and postal survey | n = 190 | None | 100% | NA | Continuation rates were between 84 and 88% at 6 months and 67% and 78% at 12 months | 6, 12 months | [32] |
 Berlan et al., USA, 2016 | Retrospective chart review | n = 750 adolescents | None | NA | NA | 77 (10.3%) had the device removed prior to 12 months of use | 1 year | [55] |
 Griffith et al., Australia, 2016 | Mixed method study; retrospective chart review | – | Cu-IUD, MPA injection, COCP and ENG-Implant | NA | NA | Etonogestrel continuation rates at 1, 2 and 3 years were 87% (95% CI 81–92%), 72% (95% CI 64–78%) and 51% (95% CI 41–60%) respectively | 1, 2, 3 years | [58] |
 Casey et al., USA, 2010 | Retrospective review of medical records | n = 151 | None | NA | 39 (25.2%) women had abnormal bleeding | Implant removal rate was 25.2% (mean interval, 9.8 months) | 90 day reference periods. No fixed follow up | [74] |
 Harvey et al., Australia, 2009 | Retrospective chart | n = 767 | None | NA | NA | Continuation at 6 months after insertion was 94%. 74% continued at 1 year, 61% continued at 1.5 years and 50% continued at 2 years.1.2% continued beyond 3 years | Every 6 months up to 3 years | [60] |
 Sanders et al., USA, 2017 | Retrospective chart review | n = 1008 | LNG-IUS and Cu-IUD-T380A | NA | NA | Two-year continuation rate 75.9%( 68-mg Etonogestrel implant) | 2 years | [66] |
 Lakha et al., UK, 2006 | Case notes Review | n = 324 | None | NA | NA | Continuation rates were 89% (CI 84–91) at 6 months, 75% (CI 69–79) at 1 year, 59% (CI 52–63) at 2 years and 47% (CI 40–52) at 2 years and 9 months | Every 6 months upto 3 years | [62] |
 Agrawal et al., UK, 2005 | Case note-based study | n = 106 | None | 100% | NA | The continuation rate at the end of 1 year was 69.8%, at 2 years was 44.1% and at 3 years was 30.2% | 1, 2, 3 years | [26] |