Head-to-head IUS comparison needed

I was excited to see an article about a subdermal etonogestrel implant (Nexplanon) in the August 2022 issue of Canadian Family Physician,¹ as this form of long-acting reversible contraception is less well known, having been approved in Canada in May 2020. Upon further reading, however, I found the takeaway points of increased amenorrhea (29% vs 9% [low-dose levonorgestrel intrauterine device]) as well as a fairly similar discontinuation rate (27% vs 20%)¹ to be misleading. The randomized controlled trial examined in this article compared Nexplanon with the Jaydess intrauterine system (IUS) (13.5 mg levonorgestrel),^2,3 which is no longer available in Canada and has a lower progesterone concentration of 13.5 mg compared with the Kyleena (19.5 mg)⁴ and Mirena (52 mg)⁵ options, which are available in Canada. Additionally, Jaydess is approved for contraception for 3 years compared with 5 years for the Mirena and Kyleena.

My hope is that providers counseling on contraception options take the article’s comparisons with a grain of salt. Better conclusions would be drawn when Nexplanon can be compared head to head with our standard Canadian progesterone IUSs. In fact, research comparing the implant with short-acting contraception options (pill, patch, ring) in terms of patient satisfaction, effectiveness, and bleeding profile is paramount, as it is often those who are not considering an IUS who decide on the implant, in my clinical experience.

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