A qualitative study of the reasons for low patient safety incident reporting among Indonesian nurses / Um estudo qualitativo das razões para baixa notificação de incidentes de segurança do paciente entre enfermeiros indonésios / Un estudio cualitativo de las razones de la baja notificación de incidentes de seguridad del paciente entre las enfermeras de Indonesia

ABSTRACT Objectives: to investigate the reasons for low patient safety incident reporting among Indonesian nurses. Methods: this qualitative case study was conducted among 15 clinical nurses selected purposively from a public hospital in Lampung, Indonesia. Interview guidelines were used for data collection through face-to-face in-depth interviews in July 2022. The thematic approach was used to analyze the data. Results: in this present study, seven themes emerged (1) Understanding incident reporting; (2) The culture; (3) Consequences of reporting; (4) Socialization and training; (5) Facilities; (6) Feedback; and (7) Rewards and punishments. Final Considerations: these findings should be considered challenges for the patient safety committee and hospital management to increase patient safety incident reporting, particularly among nurses in the hospital.

RESUMO Objetivos: investigar os motivos da baixa notificação de incidentes de segurança do paciente entre enfermeiros indonésios. Métodos: este estudo de caso qualitativo foi conduzido entre 15 enfermeiros clínicos selecionados intencionalmente de um hospital público em Lampung, Indonésia. Utilizou-se roteiro de entrevista para a coleta de dados por meio de entrevistas presenciais em profundidade em julho de 2022. A abordagem temática foi utilizada para análise dos dados. Resultados: neste estudo, emergiram sete temas: (1) Compreender a comunicação de incidentes; (2) A cultura; (3) Consequências da notificação; (4) Socialização e treinamento; (5) Instalações; (6) Comentários; e (7) Recompensas e punições. Considerações Finais: esses achados devem ser considerados desafios para o comitê de segurança do paciente e a gestão hospitalar para aumentar a notificação de incidentes de segurança do paciente, principalmente entre os enfermeiros do hospital.

RESUMEN Objetivos: investigar las razones de la baja notificación de incidentes de seguridad del paciente entre las enfermeras de Indonesia. Métodos: este estudio de caso cualitativo se llevó a cabo entre 15 enfermeras clínicas seleccionadas intencionalmente de un hospital público en Lampung, Indonesia. Se utilizó un guión de entrevista para la recolección de datos a través de entrevistas presenciales en profundidad en julio de 2022. Se utilizó el enfoque temático para el análisis de datos. Resultados: en este estudio surgieron siete temas: (1) Comprender la notificación de incidentes; (2) La cultura; (3) Consecuencias de la notificación; (4) Socialización y capacitación; (5) Instalaciones; (6) Comentarios; y (7) Recompensas y Castigos. Consideraciones Finales: estos hallazgos deben ser considerados desafíos para el comité de seguridad del paciente y la gerencia del hospital para aumentar la notificación de incidentes de seguridad del paciente, especialmente entre las enfermeras del hospital.

The effect of tranexamic acid for treatment irregular uterine bleeding secondary to DMPA use.

OBJECTIVE: Evaluate the efficacy of tranexamic acid and placebo for controlling irregular uterine bleeding in depot-medroxyprogesterone acetate (DMPA) users. MATERIAL AND METHOD: A double-blind, placebo-controlled study was conducted on 100 DMPA users attending the Family Planning Clinic King Chulalongkorn Memorial Hospital. All users had abnormal bleeding. They were randomly divided in two groups; a group of 50 received tranexamic acid, 250 mg four times a day for 5 days and another group of 49 received placebo in the same manner. One subject dropped out from the study. Total day of bleeding/spotting and percentage of women in whom bleeding was stopped were analyzed at the end of weeks 1 and 4. RESULTS: The percentage of subjects in whom bleeding was stopped during the first week after initial treatment was significantly higher in the tranexamic acid group than the placebo group (88% vs. 8.2%, p < 0.001). During the follow-up period (4 weeks after initial treatment), a bleeding-free interval of > 20 days was found in 68% of subjects treated with tranexamic acid and 0% treated with placebo(p < 0.001). The mean number of bleeding/spotting days were also significantly different between the groups (5.7 +/- 2.5 vs. 17.5 +/- 7.2 days, p < 0.05). CONCLUSION: Tranexamic acid was more effective than placebo in short-term treatment of irregular uterine bleeding/spotting associated with DMPA use.

Efficacy of celecoxib on controlling irregular uterine bleeding secondary to Jadelle use.

OBJECTIVE: To evaluate the efficacy of celecoxib and placebo for controlling irregular uterine bleeding in Jadelle users. DESIGN: Randomized double blind placebo controlled trial. SETTING: Family Planning Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: Forty Jadelle users with irregular bleeding were randomly allocated into two groups. Twenty users received celecoxib 200 mg once a day for five days and the other twenty users received the placebo in the same manner The participants were requested to maintain their daily record of bleeding, adverse effects, and satisfaction. RESULTS: The percentage of the subjects whom bleeding was stopped within 7 days after initial treatment was significantly higher in the celecoxib group than in the placebo group (70% vs. 0%; p < 0.001). The mean duration of bleeding-free interval was significantly longer in celecoxib than placebo group (24.0 +/- 1.65 days vs. 10.0 +/- 6.50 days; p < 0.001). The mean duration of bleeding days was significantly shorter in celecoxib than placebo group (5.0 +/- 1.65 vs. 19.0 +/- 6.50 days; p < 0.001). Patients satisfaction in celecoxib group was significantly higher than the placebo group (80% vs. 30%; p < 0.001). There was no detectable adverse effect in both groups. CONCLUSIONS: Celecoxib was more effective than placebo in the short-term control of irregular bleeding in Jadelle users. The mechanism of nonsteroidal anti-inflammatory drugs (NSAIDs) for the reduction of endometrial bleeding is likely from COX-2 inhibition.

A clinical study of transdermal contraceptive patch in Thai adolescence women.

OBJECTIVE: To study cycle control, compliance and safety of a transdermal contraceptive patch in adolescent Thai women. MATERIAL AND METHOD: Fifty-eight healthy women were assigned to receive 3 cycles of contraceptive patch (ethinyl estradiol 20 microg and norelgestromin 150 microg/day). All participants aged 16-20 years were invited to participate from the family planning clinic at King Chulalongkorn Memorial Hospital. Data were collected on adverse effects, perceived advantages and disadvantages, body weight, blood pressure, patch detachments and compliance. Data were analyzed using mean, percentage and student's t-test. RESULTS: The participants' average age was 19.4 years, height 158.8 cm, weight 51.8 kg, BMI 20.8 Kg/m2. The most location of patch application was the abdomen and the most adverse event was breast tenderness (31.0%) followed by application site reaction, nausea vomiting and headache respectively. The breast symptom was mild in severity. The participants reported decrease in dysmenorrhea and shorter duration of bleeding. There were no significant changes in body weight and blood pressure. The improvement of their facial acne was reported. There were no pregnancies during use and the adhesion of the contraceptive patch is excellent. Partial patch detachment was reported in only 6.9%. No completed patch detachment was found. CONCLUSION: The present study found an overall positive impression of a new transdermal contraceptive patch. The good compliance and few side effects were demonstrated. The adhesive patch contraceptive was excellent.

Effect of oral contraceptives on risk of cervical cancer.

OBJECTIVE: To assess the risk of oral contraceptives on the occurrence of cervical cancer. MATERIAL AND METHOD: A hospital-based case-control study was conducted. Sixty women patients with histologically confirmed invasive cervical cancer and 180 healthy women as the control group who attended the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were recruited. Information about the use of oral contraceptives and other cervical cancer risk factors were obtained from personal interviews. The risk factors were evaluated by using odds ratio (OR). RESULTS: 60 women with invasive cervical cancer and 180 healthy controls were interviewed by the investigators. Compared with non-users, patients who had ever used or currently used oral contraceptive had an increased risk of cervical cancer (OR 1.45; 95% CI 0.79-2.64). However the risk was not statistically significant. Considering the duration of use, patients who had used oral contraceptives for 3 years or less did not have an increased risk of cervical cancer (OR 0.78; 95% CI 0.39-1.77). Nevertheless, the odds ratio of oral contraceptive pill use for more than 3 years was 2.57 (95% CI 1.22-5.49) which was statistically significant. CONCLUSION: Long-term use of oral contraceptive might be a cofactor that increases the risk of cervical carcinoma. Further investigations should be conducted to confirm this risk. However, Pap smear has to be done routinely in long-term oral pill users.

Comparison of cycle control and side effects between transdermal contraceptive patch and an oral contraceptive in women older than 35 years.

OBJECTIVE: To compare menstrual patterns and side effects between transdermal contraceptive patch and oral contraceptive use in Thai women over 35 years old. DESIGN: Open labeled randomized control trial. SETTING: Family Planning Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: Ninety-six women above the age of 35 years old were randomized to receive either transdermal contraceptive patch (n = 48) or oral contraceptive (n = 48). The patch regimen was three consecutive 7-day patches (21 days) followed by 1 patch-free week per cycle; the oral contraceptive contained with ethinyl estradiol (EE) 30 microg and levonorgestrel 150 microg. RESULTS: There were no statistically significant differences between the two groups in terms of cycle length. The mean duration in the transdermal contraceptive group was longer than the COC group with statistically significant difference. More patients in the COC group experienced spotting than the transdermal contraceptive group. Neither amenorrhea nor pregnancies occurred in both groups. CONCLUSION: Transdermal contraceptive patch provides reliable contraceptive efficacy. It also provides good cycle control equal to COC in Thai women aged above 35 years old. However, a higher incidence of minor adverse effects such as breast tenderness and nausea were demonstrated when compared to oral contraceptive containing with ethinyl estradiol (EE) 30 microg and levonorgestrel 150 microg.

Sexual function during the postpartum period.

OBJECTIVE: To study the characteristics of sexual function during the postpartum period STUDY DESIGN: Cross-sectional descriptive study. MATERIAL AND METHOD: From May 2006 to July 2006. Eighty women, who attended the family planning clinic at King Chulalongkorn Memorial Hospital, were enrolled in the present study. All subjects were interviewed by the investigators with a questionnaire about general characteristic and Female Sexual Function Index questionnaire (FSFI) to determine their sexual function. RESULTS: Twenty-eight (35%) women had sexual intercourse within the six weeks postpartum period before they attended the family planning clinic. In this group, 18 women (35%) had vaginal deliveries and 10 women (34.5%) had cesarean deliveries. No statistically significant difference was demonstrated in terms of route of delivery (chi2 = 0.005, p-value = 0.57). Women without episiotomy resumed sexual intercourse more than women with episiotomy (66.7% and 25.6%, chi2 = 6.76, p-value = 0.015). There was no association between route of delivery and sexual function including sexual desire, sexual arousal, sexual lubrication, sexual orgasm, satisfaction, pain, and FSFI score. CONCLUSION: Resumption of sexual intercourse in the postpartum period was quite high. However, route of delivery was not associated with resumption of sexual intercourse and female sexual function in postpartum period. More women without episiotomy had resumption of sexual intercourse than the others. Sexual demand of the partner is the influencing factor to resumption of sexual intercourse during the post partum period. Counseling about sexuality and contraception after birth should be a regular practice in the hospital.

Effect of a new oral contraceptive with drospirenone on vital signs, complete blood count, glucose, electrolytes, renal, and liver function.

OBJECTIVE: To evaluate the effect of a new oral contraception formulation with drospirenone (Yasmin) on vital signs, complete blood count, glucose, electrolytes, and renal and liver function. MATERIAL AND METHOD: An open-label non-comparative clinical trial was conducted. One hundred women who were planning to use oral contraception for at least six months were recruited. The subjects received a blister pack which contained 21 tablets of 3 mg drospirenone /30 tg ethinyl estradiol for the first four cycles (1 cycle = 28 days). Cycle 5 and 6 blister packs were dispensed during the visit in cycle 4. Heart rate and blood pressure of each subject were checked at baseline and each visit. Serum from each subject was collected and sent for complete blood count, glucose, electrolytes, and renal and liver function tests at baseline and at cycle 6. Mean differences in these tests at cycle 6 compared to baseline were assessed. RESULTS: Ninety-two of the 100 subjects (92%) completed the present study. There was no significant change in heart rate, blood pressure, complete blood count, glucose, electrolytes, and renal and liver function tests at cycle 6 when compared to baseline. CONCLUSION: Oral contraception formulation with drospirenone (Yasmin) is well tolerated and has good contraceptive efficacy. It is safe, as it has no effect on heart rate, blood pressure, complete blood count, glucose, electrolytes, and renal and liver function.

A double blind randomized control trial, comparing effect of drospirenone and gestodene to sexual desire and libido.

BACKGROUND: Oral contraceptive is the most commonly used method of fertility control. Yasmin is a combination of a novel progestogen with anti-androgenic and anti-mineralcorticoid activities (3 mg Drospirenone (DRSP) and 30 microg ethinylestradiol (EE)). It has been shown in many clinical trials that Yasmin is an efficacious oral contraceptive, lacking undesired effects as with other oral contraceptives such as weight gain. However the effects of Yasmin on sexual desire and libido have not been intensively investigated so far OBJECTIVE: Investigate the effects of Yasmin on sexual desire, libido and changes in the free androgen index (FAI) compare to Meliane (75 microg gestodene + 20 microg ethinylestradiol). MATERIAL AND METHOD: The authors' report the results of a double blind randomized controlled study using a translated version of the Female Sexual Function Index questionnaire (FSFI) for the assessment of the sexual function. The free androgen index was calculated from measurements of testosterone and sexual hormone binding globulin. RESULT: The result shows statistically significant improvements regarding sexual desire, arousal and overall satisfaction in the Yasmin group. Additionally, an increased frequency of orgasms in the Meliane group was reported. Statistically significant differences between the two treatments regarding changes in the FSFI score and changes in the free androgen index have not been observed. CONCLUSION: The novel oral contraceptive containing drospirenone (Yasmin) and the non-anti-androgenic progestin containing oral contraceptive (Meliane) do not show unfavorable effects on sexual response and libido.

The use of levonorgestrel - IUD in the treatment of uterine myoma in Thai women.

OBJECTIVE: This study was designed to evaluate the potential usefulness of the levonorgestrel-releasing intrauterine device (LNG - IUD ; Mirena) in treating women with uterine myomas. DESIGN: Prospective before-and-after (comparing) study. SETTING: Department of Obstetrics and Gynecology King Chulalongkorn Memorial Hospital. SUBJECTS: Sixteen women with uterine myomas who intended to receive treatment with the LNG IUD. INTERVENTION(S): Clinical and ultrasound examinations were performed prior to and at 1, 3 and 6 months after the LNG IUD insertion. MAIN OUTCOME MEASURES: Myoma and Uterine volume, menstrual blood loss assessed with pictorial blood loss assessment charts and hematocrit. RESULTS: Use of the LNG IUD was associated with a statistically significant reduction in the total myoma volume, average uterine size and marked reduction in menstrual blood loss. After 6 months of use, the median total myoma volume decreased from 19.82 mL to 11.63 mL (p < 0.05), median pictorial blood loss assessment chart score declined from 89 to 3 (p < 0.05). Hematocrit level increased over 6 months of use. The most common side effects were bleeding disturbances (68.8%). No pregnancies occurred during the study. CONCLUSION: The LNG IUD was associated with a profound reduction in myoma and uterine volume. For women with myomas of this size, the LNG IUD provides effective medical treatment of bleeding.

A clinical study of transdermal contraceptive patch in Thai women.

OBJECTIVE: To study cycle control, compliance and safety of a transdermal contraceptive patch in Thai women. MATERIAL AND METHOD: Sixty-nine healthy women were assigned to receive 3 cycles of contraceptive patch (ethinyl estradiol 20 microg and norelgestromin 150 miccrog/day). All participants aged 18-45 years were invited to participate at the family planning clinic at King Chulalongkorn Memorial Hospital. Adverse effects, perceived advantages, and disadvantages were collected. RESULTS: The participants averaged 22.4 years old, height 158.9 cm, weight 52.5 kg, BMI 20.7. The most common location of patch application was abdomen and the most adverse event was application site reaction (29%) followed by breast tenderness, nausea vomiting, and headache. The breast symptom was mild in severity. The participants reported decrease in dysmenorrhea and shorter duration of bleeding. Only 1.1% had breakthrough bleeding. There were no significant changes in body weight and blood pressure. Improvement of their facial acne was reported. There were no pregnancies during the use and the adhesion of contraceptive patch was excellent, partial patch detachment was reported at only 14.4%. No complete patch detachment was found. CONCLUSION: The study found an overall positive impression of new transdermal contraceptive patch. Good compliance and few side effects were demonstrated. The adhesive of the contraceptive patch was excellent.

Effects of biphasic oral contraceptives containing desogestrel (Oilezz) on cycle control facial acne and seborrhea in healthy Thai women.

OBJECTIVE: To demonstrate the effects of a new biphasic oral contraceptive (Oilezz) on cycle control as well as mild to moderate acne and facial seborrhea of healthy fertile Thai women. MATERIAL AND METHOD: The trial is a prospective, open, non-comparative, single center study. Fifty healthy, fertile Thai women with mild to moderate facial acne were recruited to study a specific drug (Oilezz) for 6 months. RESULTS: At the beginning, 66% of the subjects had mild acne and 34% had moderate acne. Significant improvements in facial seborrhea grades (as indicated by Sebutape assessments) were found after the first cycle. These improvements increased steadily and were much larger after the sixth cycle. There were no statistically significant changes in body weight or blood pressure during the study. No serious adverse events were reported. There were no mood changes, migraine, rash, abdominal discomfort, malaise, nausea and decrease in libido during the study period The premenstrual symptoms at initiation were 21 cases (42%). The symptoms were 4 (8%) with headache, 8 (16%) with breast tenderness, 5 (10%) with dysmenorrhea and one (2%) with bleeding irregularity. These symptoms were improved in the third and the sixth cycles. The percentage of women with spotting or bleeding increased after first cycle, compared with baseline and gradually decreased during subsequent cycles. After the sixth cycle of treatment, all subjects had improvement of acne. 80% of cases recovered from acne and there were only 20% had mild acne. CONCLUSION: Facial seborrhea and acne improved significantly with Oilezz. It is good to control cycle without change in body weight and blood pressure. Therefore, Oilezz can be used for treatment of seborrhea and acne and as a contraceptive.

Effects of Jadelle used in Thai women aged between 20 and 45 years in King Chulalongkorn Memorial Hospital.

OBJECTIVE: To study the menstrual patterns and side effects of Jadelle use in Thai women aged between 20 and 45 years. STUDY DESIGN: Prospective descriptive study. SETTING: Family Planning Clinic, Department of Obstetrics and Gynecology, King Chulalongkorn Memorial hospital. MATERIAL AND METHOD: A prospective clinical trial study was conducted at the Family Planning Unit, King Chulalongkorn Memorial Hospital in June 2005. The study duration was 6 months. The data was obtained from each patient S medical record. The descriptive statistics was frequency, percentage, mean, SD and 95% Confidence Interval (CI). The statistical analyses were performed by using the paired t test for comparison of means before and after 6 months of Jadelle used. RESULTS: A total of 59 women were recruited in a 6-month clinical study. Their mean age was 29.07years. Most acceptors had completed secondary school. No accidental pregnancy occurred throughout the 6 months of use in the present study. The most common menstrual pattern was amenorrhea followed by irregular bleeding. The major side effect was irregular bleeding. There was no significant change in body weight, body mass index, and systolic-diastolic blood pressure during the 6 months follow up period. The common non menstrual adverse effects were headache, acne, alopecia. DISCUSSION: The most common menstrual patterns found in the present study were amenorrhea and irregular bleeding followed by a regular cycle. The common nonmenstrual adverse effects were headache, acne, and alopecia. There were no pregnancies in the 6-month follow-up period. Jadelle was an effective implant contraceptive method with an acceptable bleeding pattern. Over all acceptability was good. This should become another choice of contraception for Thai women.

Ethics and the comprehensive application of epistemology in medical practice.

Our simple definition of ethics is good thought, speak and action. Epistemology means the hypothesis of facts about thought, speech and action. Medical practice is all means of medicine. Medicine classifies people into normal and abnormal. The abnormal are the sick. They loose some organs or those normal looking organs are dysfunctional. They are social problems, some can be treated, and some do not get the appropriate care. The problems of society of normal people are overeating and obesity, abortion, drug abuse, promiscuity, torture, terrorism, disobeying rules and order, corruption, brain-washing and unethical advertisements, etc. On the other hand, the social problems of the abnormal are down, deafness, blindness, dumb, hypertension, hypercholesterolemia, diabetes mellitus and cancer, etc. An example of the social-doctor problem is the mal distribution of doctors in rural areas. It was reported by the ministry of public health that the ratio of doctor to population to be 1:800 in Bangkok and 1:5, 700 in some rural areas in the north eastern part of Thailand. The doctors, themselves, are at a high grade of worker and intelligent quotient. They know all the problem and, at the same time, create problems, both, faster than the general population can do. It affects good and bad in the society. In the past, present and the foreseeable future the medical students get their studies in the western style. Their medical schools are situated in big cities. These schools are old and famous. They learn their medical procedure in a big hospital of more than 400 beds in the inpatient department wards. Their instructors and professors are highly qualified, are middle class people and well accepted in the society. Their families are lovely and warm. Their children study in the first class schools in town. The medical students feel very happy and appreciate seeing their professors in television routinely at prime time. In conclusion, their professors are an example of role model for them to follow. Everyone looks for security in her/his profession. Facts need no proof and reference. People with justice in mind should believe and understand the above mentioned. This leads to the problem of mal distribution of doctors in rural areas, why do doctors live in big cities or wish to be in the private sector? In fact, not many a number of doctors serve in the rural area. About 4-5 of them, their name will be announced yearly as the best rural doctor award. After the big ceremony, lasted not longer than a month, it is hard to remember their name. They are proud to be praised, it pushes them into stress intentionally with all the best of their intelligence and the total of their body strength to work harder in rural. Unfortunately their earning, the security of their profession, the increased chance of being sued, to get caught in the medical litigation, the expenses of their family social status and the study of their children cannot be compared to of those doctors in big city and/or in the private sector. Mal distribution of doctors in remote rural areas has been a persisting unresolved problem in many parts of the world, why not apply the principles of ethics and epistemology? They have been left, untouched forever.

Risk factors of venous thromboembolism (VTE) in Thai reproductive aged female: King Chulalongkorn Memorial Hospital experience.

OBJECTIVE: To estimate the risk factors of VTE focusing on oral pill use, alcohol intake and smoking among women who attended at King Chulalongkorn Memorial Hospital between 1 January 1995 and 31 December 2004. MATERIAL AND METHOD: The study design was case-control study. A Case was defined as the female inpatient who was diagnosed with VTE and a control was defined as the healthy female patient who attended gynecological clinic for annual check up. The questionnaires were developed to interview both cases and controls. The ratio of case per control was 1:2. The data was analyzed with SPSS/PC+ version 12.0. The statistic uses were mean, standard deviation, t-test, Odds ratio and 95% confidence interval. RESULTS: Seventy of cases and one hundred and forty of controls were recruited into the study. The mean +/- SD of age of case was 37.2 +/- 9.3 years and the control was 35.6 +/- 9.9 years. There were no significant difference in term of age, parity, weight, height and BMI between cases and controls. The Odds ratio of oral contraceptive pill use, smoking and alcohol consumption were 0.94, 4.28, and 2.62, respectively. However, no statistical significance difference of Odds ratio in oral contraceptive pill use, and alcohol consumption were demonstrated. CONCLUSION: Smoking and alcohol consumption increased risk of VTE in this study. Oral contraceptive pill use did not demonstrate increasing risk. However, there was no statistical significance of odds ratio in alcohol consumption. This result may be due to the small sample of cases. The further study should be recruited with more cases in order to demonstrated the risk factors of these female patients.

Norelgestromin/ethinyl estradiol transdermal system.

The transdermal contraceptive patch is an innovative contraceptive technology. The failure rate is quite low and has high continuation rate. The side effects and complications are not different from other hormonal contraceptives. This contraceptive method should be an alternative birth control technique for women.

The effects of implanon in the symptomatic treatment of endometriosis.

OBJECTIVE: To evaluate the efficacy of Implanon on treatment of symptomatic endometriosis DESIGN: An open clinical study without control group SETTING: Family Planning Clinic and out patient department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: A total number of 50 women with symptomatic endometriosis who were diagnosed and confirmed by laparoscopy or whose symptoms recurred after surgical treatment were recruited in the study. These subjects were implanted Implanon subcutaneously at medial aspect of non-dominant forearm. The intensity of pain was assessed with Visual Analog Scale (VAS) before insertion and at 4th and 12th weeks after the insertion. The adverse effects were recorded by the patients in 4th and 12th weeks of treatment. The women evaluated their satisfaction on treatment at the end of study. RESULTS: 50 women recruited in the study and all completed follow-up. Improvements of pain severity and menstrual symptoms were observed. The mean + SD Visual Analog Scale score of dysmenorrheal were 7.08 +/- 2.09 at baseline, 3.72 +/- 2.04 at 4th week, and 0.84 +/- 1.67 at 12th week of treatment. During the study period. regular menstruation, amenorrhea, spotting, and breakthrough bleeding were reported by 21 (42%). 14(28%), 13(26%), and 2(4%). At final satisfaction evaluation, 6(12%) women were very satisfied, 34 (68%) were satisfied, and 10(20%) were uncertain. All of acceptors continued to retaining the implant after study. CONCLUSION: Implanon, a sub-dermalprogestin implant is an effective hormonal alternative for treatment of symptomatic endometriosis. However women should be carefully counseled regarding menstrual changes. has the potential for providing long-term treatment of endometriosis. Nevertheless, the further study should be conducted to compare with other of modality of treatment.