Alternative Insertion Site of Nexplanon: Description of a Case Report and Systematic Review of the Literature

Abstract

The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type of device are represented by social and psychiatric disorders, where the easy accessibility of the device becomes a negative feature. In these patients several cases of self-removal or damage to the device have been reported. We report the successful insertion of the Nexplanon® device into the scapular region in a young woman with a chronic psychiatric disorder. To verify the presence in the literature of other possible implantation sites, we performed a systematic review of the literature on Pubmed, Google scholar and Scopus from 2000 to 2021 using different combinations of the following terms: (Nexplanon), (contraceptive implant), (insertion). Two manuscripts with three cases were detected. Nexplanon® was implanted in the upper back. In all cases, there were no complications during the insertions and the follow up demonstrated no side effects with contraceptive efficacy. Our report and review is a further confirmation that the scapular region can become a valid insertion site, maintaining good efficacy and safety of the subcutaneous device.

The influence of factors associated with past reproductive histories on migraines in middle-aged premenopausal women: a nationwide population-based study in Republic of Korea

“…We previously reported that MHT increases the risk of migraine in postmenopausal women ( 10 ), indicating that the same hormonal factors that cause an interruption in the normal menstruation cycle may also increase the risk of migraine. Various routes of MHT, such as transdermal patches and etonogestrel implants, have been recently implemented ( 36 , 37 ). A previous study reported that the transdermal patch might improve menstrual migraine ( 38 ).…”

Misconceptions and beliefs around hormone replacement therapy after childhood hematopoietic stem cell transplantation: A qualitative study among women leukemia survivors

“…Daily combined pills or transdermal estrogens associated with oral progesterone can easily be prescribed [ 20 ]. Etonogestrel implant [ 21 ] is interesting in case of chronic diseases and social disorders only in case of proper ovarian function, but should not be prescribed in case of estrogens deficiency. Psychological support remains mandatory in all cases of POI.…”

“…implant [21] is interesting in case of chronic diseases and social disorders only in case of proper ovarian function, but should not be prescribed in case of estrogens deficiency. Psychological support remains mandatory in all cases of POI.…”

Major Depression and Panic Disorder Associated with Implanon Implant: A Case Report

“… 11 Furthermore, the existence of alternative insertion sites had been found to be useful to patients with psychiatric disorders and low compliance, hence the implanon is an effective and safe contraceptive device, not easily accessible by the user. 12 …”