Many of us want a long-term method of birth control, but know we’re not able to reliably take a daily pill or interrupt a sexual experience to use a barrier contraceptive. There are several other options available that offer protection on a weekly, monthly, or yearly basis. A very effective but often underused method is the contraceptive implant, which provides pregnancy prevention for three years. The Guttmacher Institute reports that only 0.3 to 0.5 percent of women who use birth control choose an implant, but it is one of the most effective contraceptives.
The implant protects you from pregnancy for three years and, with a failure rate of 0.05 percent, is the most effective reversible contraceptive.
There are two hormonal implants available in the United States: Implanon and Nexplanon. Both contain only a progesterone hormone, etonorgesterol. This hormone prevents pregnancy by suppressing ovulation, thickening cervical mucus, and thinning the lining of the uterus. Nexplanon is quickly replacing Implanon because it is designed to be seen on an X-ray. This feature helps medical providers be sure the implant is placed correctly and reduces problems due to incorrect insertion. If the implant is placed incorrectly, you can have numbness and it may be difficult to remove.
Nexplanon is a very small flexible plastic rod, about the size of a matchstick. It is inserted by your provider under the skin in your upper arm, where it slowly releases the progesterone hormone into your bloodstream and prevents pregnancy for three years. After three years, it must be replaced with a new one to provide continuous effective birth control. However, it can be removed at any time before three years if desired.
After taking your medical history and having a physical examination, if you and your provider agree that the implant is the right contraceptive choice for you, the insertion procedure is quick and can be done in the provider’s office. Your provider will recommend the best time for insertion according to your menstrual cycle and after testing to make sure you are not already pregnant. You may not need a back-up contraceptive method right after the procedure if your implant is inserted at an appropriate time, such as:
- between day one and day five of your period, if you used no hormonal contraceptive the previous month
- the day after the last active tablet from your combination pill or mini-pill
- the day of removal of the vaginal ring or transdermal patch
- when your next Depo-Provera shot is due
- the same day as the removal of your IUD or previous implant
First, your provider will numb the area on your upper arm where the implant will be inserted. Then the implant is placed through a needle in your arm under the skin in just a few minutes. Once inserted, your health care provider will show you how to feel the implant under your skin and may do an ultrasound to make sure it is placed properly. You should be able to feel, but cannot see, the implant once it is placed.
Afterward, there could be some discomfort, redness, bruising, or swelling that should go away. Sometimes you may have a tiny scar. Any procedure can include the risk of infection, so your provider will discuss the symptoms of infection or other problems you need to watch for so that you can get treatment if needed. You will be given a user card from your provider that notes where and when your implant was inserted and the date you need to have it removed. Yearly visits with your provider are important and should include checking your blood pressure.
With the implant in place, you are now protected from getting pregnant for three years without having to worry about remembering daily pills. You also may have less painful periods. And, once you remove the implant, your regular periods and fertility return to normal very quickly, usually within 90 days.
Side effects from the implant most commonly include changes in bleeding such as irregular periods or spotting, acne, headache, weight gain, and depression. Most of these are similar to side effects of other progesterone-type birth control products, such as the mini-pill and Depo-Provera shots. If you have a history of breast cancer, blood clots, heart disease, liver disease, depression, seizure, or undiagnosed abnormal bleeding, you may not be a candidate for the implant. And it may not work as well in obese users. If you become pregnant with the implant, there is a higher chance of an ectopic pregnancy and it must be removed immediately.
Some medications such as those used for seizures, HIV, and acne may interact with the hormone in the implant, so discuss other medications you take with your provider. You can also have the implant placed while breastfeeding if you are four weeks or later from delivery, but should discuss this with your provider.
Even though the initial cost of an implant seems expensive and you need to have a provider insert and remove it, over time the cost is not much more than other contraceptive choices, and you are very effectively protected without having to do much yourself. With the new provisions under the Affordable Care Act, you may be able to have it covered under your insurance. But do remember, the implant alone does not protect you from contracting a sexually transmitted disease. Only condoms can do that.
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