Efficacy, safety and acceptability of the use of 68 mg etonogestrel contraceptive subdermal implant for up to 5 years compared with up to 3 years: a systematic review
In brief
Studies found no pregnancies among 306 implant users in years 4-5
Across seven studies, no pregnancies were reported among 860 users in years 3-4 or 306 in years 4-5, and no important safety events emerged. Bleeding-related discontinuation was lower after year 3, but the studies were small and non-comparative, so evidence is low to very low certainty; larger studies are needed to confirm extended-use effectiveness.
- Journal
- BMJ sexual & reproductive health (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jessica Chen, Jen Sothornwit, Asantesana Kamuyango, Nancy Kidula, James Kiarie, Melanie Cedrone, et al.
- PMID
- 42778301
- DOI
- 10.1136/bmjsrh-2026-203332
Why clinicians should know about it
- Picked for Epidemiology (paper of the day, 25 September 2026): Systematic review of 5‑year efficacy and safety of etonogestrel implant
Abstract
BACKGROUND: Prolonging the use of the etonogestrel (ENG) implant beyond the currently approved duration of 3 years could offer substantial benefits including improved accessibility, reduced need for replacements and overall lower healthcare costs. The purpose of this systematic review is to examine the current evidence regarding the effectiveness, safety and acceptability of the use of the ENG implant for up to 5 years. METHODS: We searched PubMed, Embase, Scopus, Global Health, CINAHL, ClinicalTrials.gov, Global Index Medicus, Cochrane Central Register of Controlled Trials and International Clinical Trials Registry Platform from 1996 to 2024. Our study population included reproductive-aged women using the 68 mg single-rod ENG contraceptive implant. We included randomised controlled trials, retrospective and prospective cohort studies, case-control studies and conference presentations. Outcomes included those related to efficacy, safety and acceptability. The primary contraceptive efficacy outcome was Pearl Index between the third and fifth years of placement compared to that within 3 years. RESULTS: We identified seven relevant studies. No pregnancies were noted among 860 participants within years 3-4 or among 306 participants within years 4-5. No important safety events were identified. Discontinuation of the implant due to bleeding was higher in the first 3 years of use (20.6%), compared with years 3-5 (5.4%). Due to the non-comparative nature of the studies and the overall low sample sizes of the studies, evidence certainty was deemed to be low or very low using the GRADE criteria. CONCLUSIONS: Current evidence, despite its low certainty, does not carry signals of potential concerns with regard to extended use, with potential for benefit.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.