ETONOGESTREL SUBDERMAL IMPLANT (IMPLANON) AS AN ALTERNATIVE TO THE COOPER INTRAUTERINE DEVICE AS A LONG-ACTING REVERSIBLE CONTRACEPTIVE IN THE IMMEDIATE POSTPARTUM PERIOD WITHIN THE UNIFIED HEALTH SYSTEM (SUS)

Abstract

The copper IUD Tcu 380 is a long-acting contraceptive widely used in the Unified Health System, constituting the main contraceptive method offered postpartum. However, there is resistance from obstetric professionals to its insertion in the immediate postpartum period due to high expulsion rates, which vary between 10% in the immediate period and 13-29.7% in the early period, compared to only 1.9% in the late period. Additionally, follow-up difficulties in Primary Health Care, including lack of qualified professionals and difficulty accessing control ultrasounds, compromise the method’s effectiveness. In this context, the need arises to evaluate long-acting contraceptive alternatives for the immediate postpartum period, highlighting the etonogestrel subdermal implant (Implanon), recently incorporated into the SUS by SECTICS/MS Ordinance No. 47 of 2025. This study aimed to reevaluate the contraceptive efficiency of the copper IUD in postpartum insertion and assess the viability of Implanon as an alternative in the immediate puerperium. This is a bibliographic review conducted between August 2024 and August 2025, using PubMed and Google Scholar databases, in addition to official repositories of the Ministry of Health, CONITEC, and municipal health departments. Publications from FEBRASGO, Fiocruz, and international organizations were also consulted. Results demonstrate that Implanon NXT® presents superior contraceptive efficacy and higher continuation rates over three years compared to the copper IUD. The implant releases etonogestrel continuously, preventing ovulation and altering cervical mucus, with decreasing hormonal release over the three years of use. FEBRASGO recognizes the safety of LARCs in the first 48 hours postpartum, and municipalities such as São Paulo and Porto Alegre have already protocoled the use of the implant in the puerperium. However, national implementation still faces barriers, as WHO maintains etonogestrel as category 3 for lactating women, recommending waiting 21-28 days postpartum. The discussion shows that, despite the implant’s advantages, including greater user satisfaction and no need for ultrasound follow-up, its implementation in the immediate postpartum requires specific protocols and professional training. It is concluded that the etonogestrel subdermal implant represents a promising alternative to the copper IUD in the immediate postpartum period, presenting advantages in terms of efficacy, continuation of use, and user satisfaction, requiring the creation of national protocols and pilot projects for its safe implementation in the SUS.