|What Is The Birth Control Implant?
A birth control implant is a small matchstick sized device which is placed under the skin and releases hormones to prevent pregnancy for up to 3 years. The implant is a flexible rod and contains progestin (etonogestrel) hormone which when released stops ovulation. It is inserted in the inner part of the upper arm by a doctor or clinician. Inserting the implant is a simple procedure that only takes a few minutes. Implanon is the name of the most common device used in the United States; although another one called Nexplanon was recently approved by the FDA. Both devices are essentially the same except that Nexplanon also contains a small amount of barium sulfate so that it can be seen by X-ray if dislodged or inserted incorrectly and it has a pre-loaded applicator which makes insertion easier. Nexplanon has replaced Implanon in the UK because of cases of incorrect insertion of Implanon by clinicians. Neither implant contains estrogen.
How Effective Are Implants In Preventing Pregnancy?
Implants are highly effective in preventing pregnancy. The number of women who will become pregnant within a year of typical use (typical means the person does not always use the contraception correctly) is:
• Implants: less than 1 woman in every 100.
• Birth control injections: 3 women.
• Vaginal ring: 8 women.
• Contraceptive patch: 8 women.
Implants provide protection for up to 3 years. If continued contraception is desired, the device is simply removed and replaced with a new one. Historically, the first implant on the market was called Norplant and it was approved in 1989. It consisted of 6 matchstick sized rods and contained a different type of progestin called levonorgestrel. The contraceptive could remain in place for 5 years. However, it was taken off the market in 2002 because of difficulties in removing it and due to suspicions about its effectiveness. Women who already had it inserted were told not to remove it. The newer devices use only one rod and better insertion and removal tools are used (even more so with Nexplanon).
How Does It Work?
Implants prevent pregnancy in several ways:
1. By suppressing ovulation: If no egg is released there is nothing for sperm to fertilize.
2. Increases the viscosity of the cervical mucus making it more difficult for sperm to reach the fallopian tubes.
3. Alters the lining of the womb making it more difficult for an embryo to implant.
How Is The Implant Inserted?
Implants must be inserted by a doctor or trained clinician. First you will be given a pregnancy test to rule out pregnancy. Next you will:
1. Lie on an examination table with your arm flexed at the elbow to expose your under arm. If you are right-handed, your left arm will receive the implant (and vice versa).
2. The doctor will make 2 dots with a sterile marker on your arm. The first will indicate where the implant is inserted and the second acts as a guiding mark during insertion.
3. The insertion site is wiped with an antiseptic solution.
4. The site is anesthetized either with an anesthetic spray or injection.
5. A needle containing the implant is inserted into the skin and the implant is injected.
6. The implant should bulge slightly under the skin so it can be felt. A small bandage is put on to protect the spot for a few days.
When Can The Implant Be Inserted?
Timing of insertion depends on your contraceptive history as follows:
You have not been using hormone contraceptives in the past month: It should be implanted between days 1 and 5 of your period (you may still be bleeding). No backup contraceptive is necessary. If it is inserted outside of this timeframe, backup should be used for the first 7 days after insertion.
You have been using hormone contraceptives in the past month: It should be inserted on the day after you take your last contraceptive pill (if you are taking the combined oral pill). If you have placebo tablets in your packet, it should be inserted the day after you take your last active tablet. If you have a vaginal ring or contraceptive patch, the implant should be inserted the day after your former contraceptive is removed.
Progestin-only contraceptives: If you are taking the mini-pill you can switch to an implant on any day of the month, within 24 hours of taking your last tablet. If you are taking birth control injections, insert the implant on the day your next injection is due. If you have an IUD device, insert the implant on the same day the implant is removed. If inserted as recommended, backup contraceptive is not required.
Postpartum: If you are not breastfeeding the implant should be inserted between days 21 and 28 after childbirth. If you are breastfeeding it should be inserted after the 4th week.
How Is It Removed?
It takes less than 5 minutes to remove an implant.
1. First the skin is cleaned and numbed, same procedure as for insertion.
2. The implant is located and a small cut is made through the skin with a scalpel.
3. The implant is pushed until it emerges through the cut. It is then grabbed with a forceps and pulled out.
4. If you would like to have another implant a fresh one can be inserted through the same incision.
5. A small bandage is put on to protect the spot for a few days.
Who Should Not Use Implants?
You should not have an implant if you:
• Are pregnant or think you may be pregnant.
• Have a history of blood clots, such as clots in your legs (deep venous thrombosis) or lungs (pulmonary embolism).
• Are totally or partially blind, have had a heart attack or stroke.
• Have liver disease or a liver tumor.
• Have unexplained vaginal bleeding. Get it investigated first.
• Have breast cancer or any other cancer that is sensitive to progestin.
Additionally, your doctor may recommend a different form of contraception if you have or have had any of the following conditions:
• Diabetes. Women with prediabetes should be monitored because it can induce mild insulin resistance.
• High cholesterol or triglycerides.
• Regular headaches.
• Gallbladder or kidney problems.
• Depression, including postpartum depression.
• High blood pressure (hypertension).
• Obesity in women: Women who weigh more than 130 percent of their ideal body weight may find implants are less effective.
Why Do Women Choose Implants?
• It is highly convenient. No need to remember to take a pill or have an injection for 3 years.
• Very effective form of contraception (99 percent).
• Discreet - most people can't see it but you may feel it by touching the skin covering the implant.
Note: It does not protect against sexually transmitted diseases. A condom (or female condom) will need to be used in conjunction if protection is required.
What Are The Side Effects?
There are no major health problems associated with birth control implants. According to the manufacturers, the most common cause for discontinuing the use of implants during clinical trials was irregular periods (11 percent cited this as the reason). You may have longer or shorter periods, spotting between periods or miss them altogether. This can take up to 2 years to settle down. There is no way to tell which type of bleeding change you may have until the implant is put in.
Additionally, the following is a list of other common adverse reactions reported in trials:
Headaches: 24.9 percent of those who reported symptoms suffered headaches.
Vaginitis: 14.5 percent of those who reported symptoms suffered vaginitis.
Weight gain: 13.7 percent of those who reported symptoms gained weight.
Acne: 13.5 percent of those who reported symptoms suffered acne.
Breast pain: 12.8 percent of those who reported symptoms suffered breast pain.
Abdominal pain: 10.9 percent of those who reported symptoms suffered abdominal pain.
Pharyngitis: 10.5 percent of those who reported symptoms suffered pharyngitis (sore throat).
Other reported problems
Ovarian cysts: most go away by themselves, but some require surgery.
Ectopic pregnancy: If you do become pregnant with an implant, there is a slightly higher risk it will be ectopic.
When To Call The Doctor
Call your doctor if you have any of the following symptoms:
• Persistent pain in the lower part of your leg.
• Severe chest pain.
• Sudden sharp chest pain, shortness of breath or coughing blood.
• Severe allergy reactions, such as swollen face, tongue or pharynx, difficulties swallowing, hives or trouble breathing.
• Severe sudden headache unlike your normal headaches.
• Numbness or weakness in the leg, arm or trouble speaking (read about signs of stroke).
• Sudden partial or complete loss of sight.
• Yellowing of your skin or whites of your eyes.
• Severe tummy pain, swelling or tenderness.
• Lump in your breast.
• Feeling very sad, problems sleeping, lack of energy or tired all the time.
• Heavy periods.
How Soon Does Fertility Return After Removal?
Within a few days of having your implant removed, the hormones released by the implant will have left the body. Your chance of fertility will return to whatever it was before you had the device inserted (taking your age into account). See, what age does fertility go down?, to learn more about the effects of aging and fertility.