MARISAA BUSY MOM
Discuss NEXPLANON with patients like Marisa:
- Is searching for a non-daily/non-monthly method
- Seeks a long-acting contraception to plan the timing of her children
- Wants a reversible contraceptive for when she’s ready for another baby
- Knows about the IUD* but may not be aware of the non-uterine option
†NEXPLANON must be removed by the end of the third year and may be replaced by another NEXPLANON at the time of removal, if continued contraceptive protection is desired.
In clinical trials, pregnancies were observed to occur as early as 7 to 14 days after removal of NEXPLANON
- A patient should restart contraception immediately after removal of NEXPLANON if continued contraceptive protection is desired.
- In clinical trials with IMPLANON® (etonogestrel implant) non-radiopaque, the etonogestrel levels in blood decreased below sensitivity of the assay by 1 week after removal of the implant.
NEXPLANON can be used by patients postpartum according to the following guidelines:
Not Breastfeeding:
- NEXPLANON should be inserted between 21 to 28 days postpartum.
- If inserted as recommended, back-up contraception is not necessary.
- If deviating from the recommended timing of insertion, the patient should be advised to use a barrier method until 7 days after insertion. If intercourse has already occurred, pregnancy should be excluded.
Breastfeeding:
- NEXPLANON should not be inserted until after the fourth postpartum week. The patient should be advised to use a barrier method until 7 days after insertion. If intercourse has already occurred, pregnancy should be excluded.
Use in Lactating Women—Risk Summary:
- Based on data from 38 lactating people who began IMPLANON® (etonogestrel implant) during the 4th to 8th week postpartum. See Data, below.
- Small amounts of contraceptive steroids and/or metabolites, including etonogestrel, are present in human milk.
- No significant adverse effects have been observed in the production or quality of breast milk or on the physical and psychomotor development of breastfed infants (see Data, below).
- Hormonal contraceptives, including etonogestrel, can reduce milk production in breastfeeding mothers. This is less likely to occur once breastfeeding is well established; however, it can occur at any time in some people.
- When possible, advise the nursing mother about both hormonal and non-hormonal contraceptive options, as steroids may not be the initial choice for these patients.
- The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for NEXPLANON and any potential adverse effects on the breastfed child from NEXPLANON or from the underlying maternal condition.
Data:
The amount of etonogestrel contained within breast milk was measured in 38 lactating people who began using IMPLANON during the fourth to eighth week postpartum.
The study evaluated IMPLANON versus another contraceptive, was not randomized and data were considered observational and exploratory; therefore, comparisons could not be made.
Based on the findings of this study, during the first months after insertion of IMPLANON, when maternal blood levels of etonogestrel are highest, about 100 ng of etonogestrel may be ingested by the child per day based on an average daily milk ingestion of 658 mL.
Based on daily milk ingestion of 150 mL/kg, the mean daily infant etonogestrel dose one month after insertion of IMPLANON is about 2.2% of the weight-adjusted maternal daily dose, or about 0.2% of the estimated absolute maternal daily dose.
Adverse reactions were not observed in breastfed infants exposed to etonogestrel through breast milk.
No adverse effects on the production or quality of breast milk were detected.