What Are Implants?

• Small plastic rods or capsules, each about the size of a matchstick, that release a progestin like the natural hormone progesterone in a woman’s body.
• A specifically trained provider performs a minor surgical procedure to place the implants under the skin on the inside of a woman’s upper arm.
• Do not contain estrogen, and so can be used throughout breastfeeding and by women who cannot use methods with estrogen.
• Many types of implants:

– Jadelle: 2 rods, effective for 5 years
– Implanon: 1 rod, effective for 3 years (studies are underway to see if it lasts 4 years)
– Norplant: 6 capsules, labeled for 5 years of use (large studies have found it is effective for 7 years)

• Work primarily by:

– Thickening cervical mucus (this blocks sperm from meeting an egg)
– Disrupting the menstrual cycle, including preventing the release of eggs from the ovaries (ovulation)

One of the most effective and long-lasting methods:

• Less than 1 pregnancy per 100 women using implants over the first year (5 per 10,000 women). This means that 9,995 of every 10,000 women using implants will not become pregnant.
• A small risk of pregnancy remains beyond the first year of use and continues as long as the woman is using implants.

– Over 5 years of Jadelle use: About 1 pregnancy per 100 women
– Over 3 years of Implanon use: Less than 1 pregnancy per 100 women (1 per 1,000 women)
– Over 7 years of Norplant use: About 2 pregnancies per 100 women

• Jadelle, and Norplant implants start to lose effectiveness sooner for heavier women:

– For women weighing 80 kg or more, Jadelle,  and Norplant become less effective after 4 years of use.
– For women weighing 70–79 kg, Norplant becomes less effective after 5 years of use.
– These users may want to replace their implants sooner.

Return of fertility after implants are removed: No delay

Protection against sexually transmitted infections (STIs): None

Side Effects

Some users report the following:

• Changes in bleeding patterns including:

First several months:

– Lighter bleeding and fewer days of bleeding
– Irregular bleeding
– Infrequent bleeding
– No monthly bleeding

After about one year:

• Lighter bleeding and fewer days of bleeding
• Irregular bleeding
• Infrequent bleeding

Implanon users are more likely to have infrequent or no monthly bleeding than irregular bleeding.

• Headaches
• Abdominal pain
• Acne (can improve or worsen)
• Weight change
• Breast tenderness
• Dizziness
• Mood changes
• Nausea

Other possible physical changes: Enlarged ovarian follicles

Known Health Benefits

Help protect against:

• Risks of pregnancy
• Symptomatic pelvic inflammatory disease

May help protect against: Iron-deficiency anemia.

Known Health Risks: None.

Safe and Suitable for Nearly All Women

Nearly all women can use implants safely and effectively, including women who:

• Have or have not had children
• Are not married
• Are of any age, including adolescents and women over 40 years old
• Have just had an abortion, miscarriage, or ectopic pregnancy
• Smoke cigarettes, regardless of woman’s age or number of cigarettes smoked
• Are breastfeeding (starting as soon as 6 weeks after childbirth)
• Have anemia now or in the past
• Have varicose veins
• Are infected with HIV, whether or not on antiretroviral therapy

Women can begin using implants:

• Without a pelvic examination
• Without any blood tests or other routine laboratory tests
• Without cervical cancer screening
• Without a breast examination
• Even when a woman is not having monthly bleeding at the time, if it is reasonably certain she is not pregnant

Implants:

• Stop working once they are removed. Their hormones do not remain in a woman’s body.
• Can stop monthly bleeding, but this is not harmful. It is similar to not having monthly bleeding during pregnancy. Blood is not building up inside the woman.
• Do not make women infertile.
• Do not move to other parts of the body.
• Substantially reduce the risk of ectopic pregnancy.

• Irregular bleeding (bleeding at unexpected times that bothers the client)
• No monthly bleeding
• Heavy or prolonged bleeding (twice as much as usual or longer than 8 days)
• Ordinary headaches (nonmigrainous)
• Mild abdominal pain
• Acne
• Weight change
• Breast tenderness
• Mood changes or changes in sex drive
• Nausea or dizziness
• Pain after insertion or removal
• Infection at the insertion site (redness, heat, pain, pus)
• Abscess (pocket of pus under the skin due to infection)
• Expulsion (when one or more implants begins to come out of the arm)
• Severe pain in lower abdomen

New Problems That May Require Switching Methods

• Unexplained vaginal bleeding (that suggests a medical condition not related to the method)
• Migraine headaches
• Certain serious health conditions (suspected blood clots in deep veins of legs or lungs, serious liver disease, or breast cancer)
• Heart disease due to blocked or narrowed arteries (ischemic heart disease) or stroke
• Suspected pregnancy

Contact your doctor if you have any of the problems listed above.

1. Do users of implants require follow-up visits?
No. Routine periodic visits are not necessary for implant users. Annual visits may be helpful for other preventive care, but they are not required. Of course, women are welcome to return at any time with questions.

2. Can implants be left permanently in a woman’s arm?
Leaving the implants in place beyond their effective lifespan is generally not recommended if the woman continues to be at risk of pregnancy. The implants themselves are not dangerous, but as the hormone levels in the implants drop, they become less and less effective.

3. Do implants cause cancer?
No. Studies have not shown increased risk of any cancer with use of implants.

4. How long does is take to become pregnant after the implants are removed?
Women who stop using implants can become pregnant as quickly as women who stop nonhormonal methods. Implants do not delay the return of a woman’s fertility after they are removed. The bleeding pattern a woman had before she used implants generally returns after they are removed. Some women may have to wait a few months before their usual bleeding pattern returns.

5. Do implants cause birth defects? Will the fetus be harmed if a woman accidentally becomes pregnant with implants in place?
No. Good evidence shows that implants will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while using implants or accidentally has implants inserted when she is already pregnant.

6. Can implants move around within a woman’s body or come out of her arm?
Implants do not move around in a woman’s body. The implants remain where they are inserted until they are removed. Rarely, a rod may start to come out, most often in the first 4 months after insertion. This usually happens because they were not inserted well or because of an infection where they were inserted. In these cases, the woman will see the implants coming out. Some women may have a sudden change in bleeding pattern. If a woman notices a rod coming out, she should start using a backup method and return to the clinic at once.

7. Do implants increase the risk of ectopic pregnancy?
No. On the contrary, implants greatly reduce the risk of ectopic pregnancy. Ectopic pregnancies are extremely rare among implant users. The rate of ectopic pregnancy among women with implants is 6 per 100,000 women per year. The rate of ectopic pregnancy among women in the United States using no contraceptive method is 650 per 100,000 women per year. On the very rare occasions that implants fail and pregnancy occurs, 10 to 17 of every 100 of these pregnancies are ectopic. Thus, the great majority of pregnancies after implants fail are not ectopic. Still, ectopic pregnancy can be life-threatening, so a provider should be aware that ectopic pregnancy is possible if implants fail.

8. How soon can a breastfeeding woman start a progestin-only method—implants, progestin-only pills or injectables, or LNG-IUD?
WHO guidance calls for waiting until at least 6 weeks after childbirth to start a progestin-only contraceptive (4 weeks for the LNG-IUD). In special cases a provider could make the clinical judgment that a woman can start a progestin-only method sooner. A WHO expert consultation in 2008 endorsed WHO’s current guidance, based on theoretical concerns about the effect on infant development of hormones in breast milk. These experts noted, however, that, where pregnancy risks are high and access to services is limited, progestin-only methods may be among the few available. Also, starting implants and IUDs requires providers with special training. These providers may be available only when a woman gives birth. The experts concluded, “Any decisions regarding choice of a contraceptive method should also consider these facts.” Also note: Guidance in some countries, based on their own expert panel reviews, allows breastfeeding women to start progestin-only methods at any time. This includes starting immediately postpartum, a long-standing practice in these countries.

9. Should heavy women avoid implants?
No. These women should know, however, that they need to have Jadelle or Norplant implants replaced sooner to maintain a high level of protection from pregnancy. In studies of Norplant implants pregnancy rates among women who weighed 70–79 kg were 2 per 100 women in the sixth year of use. Such women should have their implants replaced, if they wish, after 5 years. Among women who used Norplant or Jadelle implants and who weighed 80 kg or more, the pregnancy rate was 6 per 100 in the fifth year of use. These women should have their implants replaced after 4 years. Studies of Implanon have not found that weight decreases effectiveness within the lifespan approved for this type of implant.

10. What should be done if an implant user has an ovarian cyst?
The great majority of cysts are not true cysts but actually fluid-filled structures in the ovary (follicles) that continue to grow beyond the usual size in a normal menstrual cycle. They may cause some mild abdominal pain, but they only require treatment if they grow abnormally large, twist, or burst. These follicles usually go away without treatment.

11. Can a woman work soon after having implants inserted?
Yes, a woman can do her usual work immediately after leaving the clinic as long as she does not bump the insertion site or get it wet.

12. Must a woman have a pelvic examination before she can have implants inserted?
No. Instead, asking the right questions can help the provider be reasonably certain she is not pregnant. No condition that can be detected by a pelvic examination rules out use of implants.

For a family planning consultation:

• Ask your family doctor at your health care facility in your area of residence  (see here). WARNING: if you belong to one of the socially vulnerable groups (see here) you can benefit from free contraceptives!
• Ask  Youth Friendly Health Centers
• Call the RHTC  Hotline (free and confidential call) – 0800-088-08
• Call  RHTC – 022355072 / 060903782 / 078306973
• Write to RHTC e-mail  – cidsr2012@gmail.com