MHRA/CHM ADVICE (UPDATED FEBRUARY 2020): NEXPLANON ®
(ETONOGESTREL) CONTRACEPTIVE IMPLANTS: NEW INSERTION
SITE TO REDUCE RARE RISK OF NEUROVASCULAR INJURY AND
IMPLANT MIGRATION
There have been reports of neurovascular injury and
migration of Nexplanon ® implants from the insertion
site to the vasculature, including the pulmonary artery in
rare cases. Correct subdermal insertion by an
appropriately trained and accredited healthcare
professional is recommended to reduce the risk of these
events. Healthcare professionals are advised to review
the updated guidance from the manufacturer and the
statement from the Faculty of Sexual and Reproductive
Healthcare (FSRH) on how to correctly insert the
implant. Patients should be advised on how to locate the
implant, informed to check this occasionally and report
any concerns. An implant that cannot be palpated at its
insertion site should be located and removed as soon as
possible; if unable to locate implant within the arm, the
MHRA recommends using chest imaging. Implants
inserted at a previous site that can be palpated should
not pose a risk and should only be replaced if there are
issues with its location or if a routine replacement is due.
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→Appendix 1: etonogestrel
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▶Common or very common Abdominal pain. alopecia.
anxiety. appetite increased. breast abnormalities.
depressed mood. dizziness. emotional lability. fatigue.
flatulence. headaches. hot flush. increased risk of
infection. influenza like illness. libido decreased.
menstrual cycle irregularities. nausea. ovarian cyst. pain.
skin reactions. weight changes
▶Uncommon Arthralgia. constipation. diarrhoea.
drowsiness. dysuria. fever. galactorrhoea. genital
abnormalities. hypertrichosis. insomnia. myalgia.
oedema. vomiting. vulvovaginal discomfort
▶Frequency not known Abscess. angioedema. embolism and
thrombosis. haemorrhage. insulin resistance. neoplasms.
paraesthesia. seborrhoea
SIDE-EFFECTS, FURTHER INFORMATION The benefits of
using progestogen-only contraceptives (POCs), such as
etonogestrel, should be weighed against the possible risks
for each individual woman.
There is a small increase in the risk of having breast
cancer diagnosed in women using a combined oral
contraceptive pill (COC); this relative risk may be due to an
earlier diagnosis, biological effects of the pill or a
combination of both. This increased risk is related to the
age of the woman using the COC rather than the duration
of use and disappears gradually within 10 years after
discontinuation.
The risk of breast cancer in users of POCs is possibly of
similar magnitude as that associated with COCs, however
the evidence is less conclusive.
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Not known to be harmful, remove implant if
pregnancy occurs.
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Progestogen-only contraceptives do not
affect lactation.
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