70. Determination of Satisfaction With the Use of the Subdermal Etonogestrel Implant “Implanon” as a Contraception Method, Its Side effects and Reasons for Discontinuing the Same, Compared With Other Hormonal Methods of Contraception in Young Women in a Rural

In Ecuador, teen pregnancy is a major public health concern with a rate of 81 per 1000. For this reason, a family planning prevention agenda has incorporated the use of long-term reversible hormonal contraception. We retrospectively determined Ecuadorian adolescents' satisfaction rate with the use of a subdermal etonogestrel implant, its side effects and reasons for discontinuation, compared with other hormonal methods of contraception over two years. An observational analytic cross-sectional study was performed in the Subcentro de Salud de Tumbaco, a public rural ambulatory health clinic near Quito. We compared the percentage of satisfaction, side effects and reasons for discontinuing the method in 196 adolescents using the subdermal etonogestrel implant “Implanon” versus 103 adolescents using other hormonal methods of contraception (injection method: norethisterone enanthate + estradiol valerate “Mesygina”, medroxyprogesterone acetate “DMPA”/combined oral contraceptive pill [OCP] or progesterone pill).The clinical records of 299 adolescent women 12 to 19 years of age, from January 2012 to December 2013, were reviewed. Implant users were statistically more satisfied, than users of other hormonal contraceptive methods (99% vs 60.2%, P = < 0.0001). Both groups showed adverse effects in less than half the users. In both groups the most frequent side effect was headache (25.5% vs 19.4%). Implant use was associated with bleeding irregularities: amenorrhoea (61.2%) and infrequent bleeding (23%); while the main bleeding pattern related with the users of other hormonal methods of contraception was frequent and prolonged bleeding (54.4%). Continuation of use was higher in the implant group than in users of other hormonal contraceptive methods (98.5% vs 83.5%,. P = <0.0001). Three (1.5%) out of 196 adolescents using the implant method during this period discontinued its use, two of them because of desire for pregnancy, and one because of bleeding irregularities. In the group using other hormonal methods of contraception the most common reason was lack of compliance in use of the selected method (9.7%), followed by probable pregnancy from misuse or inconsistent use (3.9%). Implant users were more satisfied with their contraceptive method regardless of the side effects, even when it was associated with an unpredictable bleeding pattern. Continuation of the method was higher than with use of other hormonal contraceptive methods. The subdermal contracptive implant is well accepted and tolerated among adolescent women, with a low discontinuation rate. As teen pregnancy is a public health problem in Ecuador, the use of safe, reversible, long lasting, and, more importantly, tolerable contraception in this population is vital to reduce the prevalence of unplanned pregnancies.