Power J, French R, Cowan F
Margaret Pyke Centre, 73 Charlotte Street, London, UK, W1T 4PL.
Cochrane Database Syst Rev. 2007 Jul 18;2007(3):CD001326. doi: 10.1002/14651858.CD001326.pub2.
Implantable methods of contraception offer long-acting reversible contraception. Their uptake rate in comparison to other contraceptive methods, particularly in developed countries, has historically been low.
To assess the contraceptive effectiveness, tolerability and acceptability of subdermal implants in comparison to other reversible contraceptive methods.
Literature were identified through database searches, reference lists and individuals/organisations working in the contraceptive field.
All randomised and controlled trials comparing subdermal implants with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. Primary outcomes were pregnancy and continuation.
Quality assessment of studies and data extraction were completed independently by two reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors. Study authors and pharmaceutical companies were contacted to provide additional data.Data were collected on pregnancy rates, continuation, side effects and adverse events.
All nine identified trials compared different types of contraceptive implant. Eight, involving 1578 women, compared Implanon with Norplant , and one, involving 1198 women, compared Jadelle with Norplant. There was no difference between Implanon and Norplant for contraceptive effectiveness rates or continuation over 4 years. Both were highly effective methods of contraception with no pregnancies occurring in any of the trials during 26,972 and 28,108 women months of follow up respectively. The most common side-effect with Implanon and Norplant was changes in bleeding pattern. The pattern with Implanon was initially more variable, bleeding with both implants became less frequent with duration of use. After two years use the amenorrhoea rate was significantly higher with Implanon. The trials reported no significant difference in hormonal side-effects or adverse events. Implanon was significantly quicker to insert and remove than Norplant. There was no difference in contraceptive effectiveness and in continuation rates between Jadelle and Norplant. Jadelle was significantly quicker to remove than Norplant.
AUTHORS' CONCLUSIONS: Implanon, Norplant and Jadelle are highly effective contraceptive methods. No significant differences were found in contraceptive effectiveness or continuation. The most common side-effect with all implants was unpredictable vaginal bleeding. Time taken for removal of Implanon and Jadelle was less than that for Norplant.Although this systematic review was unable to provide a definitive answer on relative effectiveness, tolerability and acceptability of contraceptive implants in comparison to other contraceptive methods, it has raised issues around the conduct of contraceptive research.
可植入式避孕方法提供长效可逆避孕效果。与其他避孕方法相比，其使用率历来较低，尤其是在发达国家。
评估皮下植入物与其他可逆避孕方法相比的避孕效果、耐受性和可接受性。
通过数据库检索、参考文献列表以及避孕领域的个人/组织来识别文献。
所有比较皮下植入物与其他可逆避孕形式并报告育龄妇女预定结果的随机对照试验。主要结果是妊娠和持续使用情况。
两名评审员独立完成研究的质量评估和数据提取。设计了一份质量检查表以识别一般方法学和避孕特定因素。联系研究作者和制药公司以提供额外数据。收集了妊娠率、持续使用情况、副作用和不良事件的数据。
所有九项纳入的试验比较了不同类型的避孕植入物。八项试验涉及1578名女性，比较了依伴侬（Implanon）和诺普兰（Norplant）；一项试验涉及1198名女性，比较了杰德宫内节育器（Jadelle）和诺普兰。依伴侬和诺普兰在避孕有效率或4年持续使用情况方面没有差异。两者都是非常有效的避孕方法，在分别对26972名和28108名女性月的随访期间，所有试验中均未发生妊娠。依伴侬和诺普兰最常见的副作用是出血模式改变。依伴侬最初的模式变化更大，两种植入物的出血随着使用时间的延长都变得不那么频繁。使用两年后，依伴侬的闭经率显著更高。试验报告激素副作用或不良事件无显著差异。依伴侬的插入和取出比诺普兰明显更快。杰德宫内节育器和诺普兰在避孕效果和持续使用率方面没有差异。杰德宫内节育器的取出比诺普兰明显更快。
依伴侬、诺普兰和杰德宫内节育器都是非常有效的避孕方法。在避孕效果或持续使用情况方面未发现显著差异。所有植入物最常见的副作用是不可预测的阴道出血。取出依伴侬和杰德宫内节育器所需的时间比诺普兰少。尽管本系统评价无法就避孕植入物与其他避孕方法相比的相对有效性、耐受性和可接受性提供明确答案，但它提出了围绕避孕研究开展的问题。
