R.D. had a birth control implant placed three years ago this month. They are happy with their method and want to keep using an implant for birth control.
Do remove and replace this patient’s implant today?
While the implant is FDA approved for use for up to three years, good evidence shows that it’s highly effective at preventing for up to five years. And providers can recommend the use of approved medications in ways that are best for their patients, even if it is outside of the approved labeling, which is sometimes referred to as “off-label.” Evidence-based, off-label medications are used this way all the time—such as methotrexate which is FDA approved for choriocarcinoma but widely studied and used to medically manage an ectopic pregnancy, or misoprostol for labor induction, which is also widely studied but “off-label.”
Evidenced-based extended use of IUDs and implants is supported by the evidence and ACOG
Research shows that the copper IUD (Paragard), an IUD with 52mg of levonorgestrel (LNG 52mg IUD) such as Liletta or Mirena, and the implant (Nexplanon) are all effective beyond their FDA-approved durations of use. And extended use of the implant and these IUDs is supported by ACOG and AAFP.
Discussing extended use with patients
You can begin conversations about the discrepancy between the FDA approval and the evidence-based duration of effectiveness when you are placing IUDs and implants. At each visit, talk to your patient about how long they want to continue using their method. This is another opportunity to discuss the evidence-based duration of effectiveness. If they want their method removed at any point, their request for removal should be respected and their IUD or implant should be promptly removed for any reason at any time. For patients who have used their IUD or implant for the FDA-approved duration and want to continue using their method, you can safely recommend that they keep their method up to the evidence-based effectiveness. However, it is also reasonable to remove and replace (if desired) a patient's method of birth control after the FDA approved duration of use if that is their preference.
Back to our scenario – Do you remove and replace their implant today?
It depends on what they want!
After three years, R.D.’s implant is still effective as birth control and it’s reasonable for them to continue using it up to the evidence-based duration of effectiveness—5 years. However, patients may not feel comfortable continuing to use their method beyond the FDA-approved duration of use and that’s ok. If R.D. doesn’t feel comfortable continuing with their implant, you should replace it today.