Complications of nexplanon contraceptive implants and reasons for discontinuation, in Yenagoa, Nigeria

Background: Though nexplanon is a safe and effective contraceptive implant, the complications are often troublesome to warrant removal. This study intends to determine the complications of nexplanon contraceptive implant, and the reasons for removal. Methods: It was a retrospective cross-sectional study of 258 women, who used nexplanon contraceptive implants for a while and discontinued. Data collected was: bio-data, the duration of contraceptive use, rank of the inserter (nurse or resident doctor), rank of the remover, the complications experienced, and the reasons for implant removal. Results: The mean duration of nexplanon use was 30.95±14.34 months, majority (96.1%) were inserted, and (82.2%) removed by trained nurses. Insertion by resident doctor significantly resulted in more complications than by trained nurses, odds ratio=5.10 [1.06, 24.51], p=0.02. The complication rate was 50%, and vaginal bleeding (25.2%) was the most common. Others are: headache (8.9%), pain at the injection site (3.9%), Weight gain (3.1%), amenorrhoea (1.6%), mood swing (1.6%), and breast pain (1.2%). Regarding contraceptive failure, the pearl index was low (0.06). Women who inserted once significantly had more complications than those who inserted twice, odds ratio=0.46 [0.22, 0.77], p=0.03. Women who used it for a period of ≤36 months significantly had more complications than those who used it for a longer period, odds ratio=0.53 [0.30, 0.92], p=0.02. The commonest reasons for removal were: expired implant (41.9%), desire to get pregnant (31.8%), and heavy vaginal bleeding (21.3%). The removal rate (secondary to complications) was 26.4%. Conclusions: Nexplanon is an effective contraceptive implant with a very low failure rate. Irregular vaginal bleeding is the commonest complication, and the most common reason for discontinuation.