Original Study| Volume 30, ISSUE 3, P395-399, June 2017

Download started.


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

Published:January 06, 2017DOI:


      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.


      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.


      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.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Finer L.B.
        • Zolna M.R.
        Declines in unintended pregnancy in the United States, 2008-2011.
        N Engl J Med. 2016; 374: 843
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998
      1. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2012; 120: 988
        • Ott M.A.
        • Sucato G.S.
        Contraception for adolescents.
        Pediatrics. 2014; 134: e1257
        • Raine T.R.
        • Foster-Rosales A.
        • Upadhyay U.D.
        • et al.
        One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives.
        Obstet Gynecol. 2011; 117: 363
        • Aoun J.
        • Dines V.A.
        • Stovall D.W.
        • et al.
        Effects of age, parity, and device type on complications and discontinuation of intrauterine devices.
        Obstet Gynecol. 2014; 123: 585
        • Rosenstock J.R.
        • Peipert J.F.
        • Madden T.
        • et al.
        Continuation of reversible contraception in teenagers and young women.
        Obstet Gynecol. 2012; 120: 1298
        • Berlan E.
        • Mizraji K.
        • Bonny A.E.
        Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting.
        Contraception. 2016; 94: 81
        • Kavanaugh M.L.
        • Frohwirth L.
        • Jerman J.
        • et al.
        Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives.
        J Pediatr Adolesc Gynecol. 2013; 26: 86
        • Berlan E.D.
        • Pritt N.M.
        • Norris A.H.
        Pediatricians' attitudes and beliefs about long-acting reversible contraceptives influence counseling.
        J Pediatr Adolesc Gynecol. 2017; 30: 47
        • Gilliam M.L.
        • Warden M.
        • Goldstein C.
        • et al.
        Concerns about contraceptive side effects among young Latinas: a focus-group approach.
        Contraception. 2004; 70: 299
        • Clark L.R.
        • Barnes-Harper K.T.
        • Ginsburg K.R.
        • et al.
        Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women.
        Contraception. 2006; 74: 214
        • Schmidt E.O.
        • James A.
        • Curran K.M.
        • et al.
        Adolescent experiences with intrauterine devices: a qualitative study.
        J Adolesc Health. 2015; 57: 381
        • Amico J.R.
        • Bennet A.H.
        • Karasz A.
        • et al.
        “She just told me to leave it”: women's experiences discussing early elective IUD removal.
        Contraception. 2016; 94: 357
        • Glaser B.
        Basics of Grounded Theory Analysis.
        Sociology Press, Mill Valley, CA1992
        • Jaccard J.
        • Levits N.
        Counseling adolescents about contraception: towards the development of an evidence-based protocol for contraceptive counselors.
        J Adolesc Health. 2013; 52: S6
        • Bonny A.E.
        • Lange H.L.
        • Hade E.M.
        • et al.
        Serum adipocytokines and adipose weight gain: a pilot study in adolescent females initiating depo medroxyprogesterone acetate.
        Contraception. 2015; 92: 298
        • Leyland-Jones B.
        • Gray K.P.
        • Abramovitz M.
        • et al.
        CYP19A1 polymorphisms and clinical outcomes in postmenopausal women with hormone receptor-positive breast cancer in the BIG 1-98 trial.
        Breast Cancer Res Treat. 2015; 151: 373
        • Kalmuss D.
        • Davidson A.R.
        • Cushman L.F.
        • et al.
        Determinants of early implant discontinuation among low-income women.
        Fam Plann Perspect. 1996; 28: 256
        • Hoggart L.
        • Newton V.L.
        • Dickson J.
        “I think it depends on the body, with mine it didn't work”: explaining young women's contraceptive implant removal.
        Contraception. 2013; 88: 636