The Contraceptive Implant
Increasingly popular contraception, especially amongst women under 35, mainly due to the convenience it brings to their daily lives.
Summary points
- Once inserted, the implant lasts three years and is more than 99% effective.
- It is long-acting reversible contraception (LARC), which means if you decide to plan a pregnancy, your fertility will return with the removal of the implant.
- The implant does not protect against any sexually transmitted infections (STIs).
The contraceptive implant is currently the fourth most popular option for women seeking long term contraception. The first implant, Norplant, became available in the UK in the early 1990s, consisting of six hormone-releasing rods. In the late 1990s, Implanon was introduced, a single rod implant, releasing progestogen hormone called etonogestrel, similar to the progesterone the ovaries produce. In 2010, Implanon was slowly phased out and eventually discontinued in 2014, replaced by a newer version, Nexplanon. Nexplanon is flexible and about the size of a matchstick, precisely 4cm long, 2mm in diameter. They contain the same progestogen, but Nexplanon comes with an applicator which makes insertion easier and safer, also it contains barium, making it X-ray opaque. This is a useful feature should the implant move from its original site, as an X-ray will be able to pinpoint its location in the body.
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The popularity of a contraceptive implant is greatly boosted by its low compliance requirement, described as a get-it-and-forget-it method. It works by releasing the hormone, etonogestrel at a steady rate over three years when implanted correctly. The hormone plays three roles in contraception, mainly by preventing ovulation (release of the egg from the ovaries). It also helps by thickening the mucus layer in the cervix hence creating a hostile environment for sperms that enter. Last but not least, it thins the lining of the womb so that a fertilised egg is less likely to attach to the wall.
When can I have the implant?
The implant can be fitted at any point by a trained professional, provided you are not pregnant. However, the timing of insertion plays a vital role in determining how quickly the implant starts to provide a contraceptive effect. Prior to insertion, the trained doctor or nurse will check where you are at your menstrual cycle. If it is fitted in the first five days of your menstrual cycle, the contraceptive effect commences immediately. Outside of the first five days, additional contraception is needed for the next seven days.
If the implant is fitted on or before the first 21 days after childbirth, the contraceptive effect also starts immediately. After that, addition contraception is required for the next seven days. For women who had a miscarriage or abortion, an immediate insertion of the implant will provide protection from pregnancy immediately.
Like all contraception, the implant also comes with its own set of pros and cons. It is always advisable to look into whether this is the most suitable option for you.
Pros:
- Only need one every three years to receive continuous contraception.
- Safe to use while breastfeeding.
- Depending on the day it was inserted, you may be protected from pregnancy immediately.
- May improve period pains or heavy periods.
- It is reversible, your fertility returns very quickly once the implant is removed.
- Does not interrupt sex life.
- Suitable for those who could not tolerate oestrogen.
Cons:
- Mild bruising or soreness at the site of administration.
- Short term side effects that should resolve on their own in the first few months, these include mood change, breast tenderness and headaches.
- Change to periods, this could be in terms of frequency, volume, or duration. In some cases, periods may stop altogether.
- Could cause an acne problem, or worsen an existing acne condition.
- A small procedure is required to fit and remove the implant, in an appointment with trained medical personnel.
- The implant does not protect users against sexually transmitted infections (STIs), an additional form of contraception is still required for that purpose.
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Is it suitable for everyone?
The short answer is, no. While most women can have the contraceptive implant fitted, but it may not be as suitable for those who,
- Could already be pregnant.
- Don’t want their periods to be affected.
- Are taking certain medicines that could affect the implant.
- Have a history of an allergic reaction to the implant and/or its components.
- Have liver disease.
- Have or had breast cancer.
- Have unexplained vaginal bleeding (e.g. between periods or after sex).
- Have or had blood clots, arterial disease, serious heart disease or stroke.
- Have a medical condition that may affect your contraception options.
If you fit any of the above, it is best to speak to a medical professional such as your doctor, nurse, or pharmacist, to explore contraceptive options available.
How is the implant fitted?
The implant has to be inserted and removed by a trained medical professional, while most doctors and nurses are trained, it is advisable to contact your GP surgery beforehand to check if they provide this service. Alternatively, visit a sexual health clinic, a contraception clinic, and occasionally young people’s services. This is a free service under the NHS.
The procedure usually takes only a few minutes. However, doctors or nurses who will be administering the implant will have to assess your eligibility and understanding before your first implant. Subsequent implants should be more straightforward if your circumstances had not changed. It is usually inserted just under the skin on the inner side of the upper arm. The healthcare professional (HCP) will position your arm before insertion, and locate the groove between the biceps and triceps as this should be avoided. Then, a local anaesthetic is usually applied at the site of insertion to minimise pain. Once the implant is successfully inserted, the HCP will feel your arm again and you will also be requested to feel the implant yourself. This is to confirm it had been inserted successfully and properly, ensure you know how it should feel, also to make sure it was not inserted too deeply as that requires immediate removal.
After that, two bandages will be applied by your HCP. The smaller bandage to keep the site clean and dry, it should be left on for the next three to five days. Whereas the top bandage is a pressure bandage, to keep the implant in place, it can be removed after the first 24 hours.
The HCP should also give you a User Card, which contains information such as which arm has the implant, the date of insertion and the date by which it should be removed.
How often should I see the doctor?
If everything goes well, your next appointment should be made for the removal of the current implant at the end of the three-year mark. If you wish to have another implant inserted, this can be done at the same appointment. However, the implant can be removed at any point for various reasons, for example, if you are planning a pregnancy.
In some cases, an immediate appointment with the HCP is strongly recommended, for example if you become pregnant, could not feel the implant under your arm, the implant feels different in shape, feel a lump in your breast, have a sudden shortness of breath, or have a pain in your lower leg that is not going away. The list is not exhaustive, so if you suspect something is not right, seek immediate medical attention.
Is this available to those under 16 years old?
As a general rule, contraception service is free and confidential to people of all ages. There are strict guidelines and protocols in place when HCPs deal with anyone under the age of 16. The HCP you speak to will encourage you to discuss this with your parents or carer, but they can not make you. They will not disclose any information with your parents or carer as long as they are satisfied you understand the information given, and the decision you make.
