Initiating the contraceptive implant on the same day as mifepristone administration for medical abortion demonstrates high patient satisfaction and continuation rates, according to a pilot study. The research, conducted at Boston University Medical Center, suggests a feasible approach to immediate postpartum contraception.
The study enrolled 20 participants aged 18–45, with gestational ages of 63 days or fewer, who desired both medical abortion and the etonogestrel implant. The implant was placed within 15 minutes of mifepristone administration. Researchers assessed satisfaction with implant placement timing, one-year implant continuation, and abortion completion.
Key Findings
Of the 20 participants, 16 returned for follow-up, and all experienced complete abortions. At one year, 14 of the 16 participants (87.5%) reported satisfaction with the implant insertion timing and continued using the implant. The average age of participants was 25.6 years, with a median gestational age of 48 days.
Implications for Contraceptive Care
The findings suggest that initiating the contraceptive implant on the first day of medical abortion is acceptable to women and results in high continuation rates. This approach addresses the challenge of follow-up rates for medical abortion, which can be as low as 50%. By providing long-acting reversible contraception (LARC) at the first visit, clinicians can improve contraceptive access and adherence.
Addressing Concerns
There was a theoretical concern that the progestin in the implant might interfere with the actions of mifepristone. However, the study results indicated that concomitant administration did not decrease abortion efficacy. The median number of bleeding days was 15, consistent with prior studies of interval implant use and first-trimester medical abortion.
Study Limitations
The authors acknowledge that the study was a pilot with a small sample size. Further research with larger cohorts is needed to confirm these findings and assess the generalizability of the approach.
