Describe why adolescents with Polycystic Ovary Syndrome (PCOS) chose the etonogestrel (ENG) contraceptive implant, determine the 12-month continuation rate and characterize factors related to discontinuation.
Setting, and Participants: Retrospective chart review of adolescents seen at a tertiary care children’s hospital between July 1, 2008 and August 30, 2019 with PCOS diagnosis confirmed per NIH criteria and ≥ 12-month ENG follow-up.
Demographic characteristics, reasons for ENG insertion and removal, and information on other hormonal/contraceptive therapies were collected. Patients were categorized as ENG continuers (use ≥ 12 months) or discontinuers (removed <12 months) and groups were compared.
Ninety-six patients met inclusion criteria (age 17.7±2.2 years, BMI 34.8±8 kg/m). Reasons for ENG were documented in 74% (51% contraception, 32% ease of use, 15% other, 13% estrogen avoidance). 27% had never been sexually active and 67% had prior sexual activity. Treatments prior to ENG placement included 74% combined hormonal contraception, 20% medroxyprogesterone acetate withdrawal and 17% depot medroxyprogesterone. 77% continued ENG at 12 months. Top reasons for discontinuation were bleeding (41%), concern for weight gain (23%) and mood changes (18%). No pre-implant characteristics were independently predictive of continuation, although 100% of patients with type 2 diabetes (N=11) continued. Patients who sought additional care including phone calls (41% vs 12%, p=0.006) and clinic visits (64% vs 20%, p<0.001) were more likely to discontinue.
ENG implant was well tolerated in adolescents with PCOS and was similar to published 12-month continuation rates.
Copyright © 2020. Published by Elsevier Inc.