Bipolar affective disorder and attempted self-removal of Implanon.
ESC Congress Library. Gbolade B. May 28, 2014; 50585; A-170 Disclosure(s): The author has received from Organon Laboratories Ltd financial support to attend conferences and sponsorship of lunch for delegates attending our DFRSH theoretical courses.
Mr. Babatunde A. Gbolade
Mr. Babatunde A. Gbolade
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Abstract
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Objective:
To report a case of attempted self-removal of Implanon by a patient with bipolar affective disorder, consider the use of progestogen implants in such patients and review the literature.
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Method:
Case report and review of the literature


Case Report:
A 34-year-old woman, para 3+0, suffering from bi-polar affective disorder, was referred for localisation and removal of a deeply placed and impalpable Implanon in her left upper arm. She had a history of intolerability to the use of hormonal contraceptives. The Implanon had been inserted two months earlier by her healthcare provider, and she went back a month later experiencing severe mood swings which had been precipitated by a domestic situation. She felt that the presence of Implanon had worsened her bi-polar affective disorder. The severe mood swings had caused her to attempt removal of the Implant with a pair of scissors and a screwdriver. Examination of her left upper arm revealed several stab wounds where the Implanon was likely to be, and the arm was very swollen and slightly infected. She was treated with antibiotics and follow up a few weeks later showed that the infection and swelling had settled. Two months later, she requested removal of the implant because she wished to get pregnant and was referred because the implant was not palpable. Examination of her left arm revealed the healed scars of the attempted self-removal, but the implant was not palpable. Ultrasound scan revealed the implant to lie in the subcutaneous fat at a depth of 3 – 6mm below the skin surface. The implant was removed using the U-technique without any complications. Future method of contraception was discussed, but she declined using any as she was not in a relationship. However, she was aware of the need to use an effective contraceptive method if and when she started a new relationship.


Conclusion:
Emotional lability and depression are well recognised side effects of using progestogen-only contraceptive implants. Such side effects may be less well tolerated by women with pre-existing depression or psychiatric disorders. Women should, therefore, be screened for a history of depression or psychiatric disorder and suitable alternative forms of contraception provided if positive. Delays in removing Implanon in patients who become significantly depressed should be avoided as they may resort to self-removal as has been reported once.
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