P040 Managing women requesting progestogen only implant in an integrated sexual health clinic

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IntroductionThe progestogen only contraceptive implant is widely recognised as a reliable and cost-effective form of contraception. However, there is evidence to suggest that irregular or unpredictable bleeding is responsible for 60% of implant removals and another complication being that of deep implants. Continuous low-dose progestogen predisposes to breakthrough bleeding because uterine blood vessels proliferate and become disordered, with a ‘leaky’ basement membrane. The best approach is to provide oestrogen, usually in the form of the combined oral contraceptive pill (COC). We aimed to determine the proportion of women who have documented evidence of a palpable implant at the time of insertion and the proportion of eligible women with unscheduled bleeding offered the COC.MethodsA retrospective case note review was performed on the electronic database for the period between 1 July 2016 and 31 January 2017. First 100 women who requested implant fitting and the first 100 women who requested implant removal due to unscheduled bleeding were recruited.ResultsOf the 100 women who had an implant fitted, 24% requested re-fitting. Palpable implants were documented in 76% of women. This was not documented in 24% of women, all of whom had another implant re-fitted. Of the eligible 100 women who requested removal for unscheduled bleeding and had no contra-indication for COC, only 49% had the offer of COC documented.DiscussionThis review has shown the need to improve documentation of implant palpation and to offer COC to eligible women which will reduce unnecessary early removals, thus ensuring cost-efficient provision of contraception. Other relevant demographic data will be presented.

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