Epidemiology
Between 2002 and 2017, nearly 200,000 women in France received Essure® implants, making France the second highest user globally [PMID:42030014].
Diagnosis
Ultrasonographic imaging demonstrated distinct echogenic circular areas with posterior shadowing for individual capsules and a tubular appearance in longitudinal views, aiding in the precise localization of Norplant implants [PMID:7658506].
Management
This qualitative study underscores the necessity of comprehensive care pathways for both the implantation and potential removal of Essure® devices to address patient needs effectively [PMID:42030014].
MDA National applied the AS/NZS 4360: 1999 standard to manage risks, initially by restricting Implanon use and later by developing guidelines and checklists in collaboration with the RACGP [PMID:15257657].
The study showed that ultrasonography can help identify the depth, spatial relation, and orientation of Norplant capsules relative to the skin, thereby facilitating their removal [PMID:7658506].
Complications
Despite initial increases due to legal reforms and reimbursement, Essure® implant procedures declined significantly from 45,138 in 2013 to 20,325 in 2022, likely influenced by safety concerns [PMID:42030014].
After a 16-year follow-up period, no significant excess hazard of hysterectomy was associated with QS compared to IUD or TL [PMID:29683010].
The study found no significant excess risk of ectopic pregnancy among women using QS compared to those using IUD or TL over an average follow-up period of 16 years [PMID:29683010].
Almost 100 unintended pregnancies were reported to medical indemnity insurers following the introduction of Implanon in May 2001, highlighting a critical complication requiring immediate risk management [PMID:15257657].
Problems with locating and removing all six Norplant implants upon discontinuation are emerging complications, highlighting the need for improved localization techniques [PMID:7658506].
Prognosis & Follow-up
Over an average follow-up of 16 years, women using QS exhibited similar low incidences of hysterectomy and ectopic pregnancy as those using IUDs or undergoing TL [PMID:29683010].
Key Recommendations
The RACGP developed consent forms and checklists to enhance patient and practitioner awareness and reduce clinical risks, leading to the reinstatement of Implanon in general practice non-procedural categories [PMID:15257657]. (Evidence: Expert opinion)
References
1 Tengue J, Darlington-Bernard A, Michon T, Bernoud-Hubac N, Ter-Ovanessian B, Trunfio-Sfarghiu AM et al.. Care Pathways and Determinants in Essure® Contraceptive Implant Use and Removal: A Qualitative Study. Health expectations : an international journal of public participation in health care and health policy 2026. link 2 Jones JK, Tave A, Pezzullo JC, Kardia S, Lippes J. Long-term risk of hysterectomy and ectopic pregnancy among Vietnamese women using the quinacrine hydrochloride pellet system vs. intrauterine devices or tubal ligation for contraception. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception 2018. link 3 Wenck BC, Johnston PJ. Implanon and medical indemnity: a case study of risk management using the Australian standard. The Medical journal of Australia 2004. link 4 Glauser SJ, Scharling ES, Stovall TG, Zagoria RJ. Ultrasonography: usefulness in localization of the Norplant contraceptive implant system. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 1995. link