"Just Wear Dark Underpants Mainly": Learning from Adolescents' and Young Adults' Experiences with Early Discontinuation of the Contraceptive Implant

Study objective: Long-acting reversible contraception, including the contraceptive implant, is recommended for teens and young women. However, some young women discontinue the implant early, and we seek to better understand their experiences.

Design, setting, and participants: We conducted interviews with 16 young women ages 14 to 24 who presented for removal of the contraceptive implant within 6 months after placement at outpatient adolescent, family medicine, and obstetrics and gynecology clinics. We coded and analyzed transcripts to identify themes and develop a thematic framework.

Interventions and main outcome measures: We explored decision-making regarding placement and removal of the implant, differences between anticipated and experienced side effects, and recommendations for counseling.

Results: The participants reported experiencing significant side effects that led to removal, most often frequent or heavy bleeding or mood changes. These healthy young women were unprepared for these symptoms, despite remembering being told about possible side effects. Participants wanted more concrete examples of possible side effects, and personal stories of side effects experienced by others, rather than general terms such as irregular bleeding or mood changes. Few discussed problems with their providers; instead, they relied on the Internet or friends to help decide when to remove the implant. Nearly half of the participants did not start new contraception after removal, although they voiced a continued desire to avoid pregnancy.

Conclusion: We identified a need for more descriptive counseling about side effects experienced by individuals, and guidance on what to do about problems encountered after placement.