(Published September 2011)

Implant

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Description

Implanon^® is a progestin-only long-acting reversible contraceptive method. It consists of a single, matchstick-sized rod that contains the progestin etonogestrel (the same progestin contained in the vaginal ring). The implant is effective for 3 years and is a good contraceptive choice for women who cannot use estrogen.

Use

The contraceptive implant is inserted in the subdermal tissue of the

inside aspect of the upper non-dominant arm. Once placed, it is not visible but is usually palpable. The rod must be inserted and removed by a trained provider. Because the insertion of the rod involves no incision, it is quick (less than 1 minute) and relatively painless.³⁶ The implant must be removed within 3 years of insertion—a procedure that takes about 3 minutes.

Effectiveness

This method is extremely effective, with a failure rate of 0.05 percent.¹⁸

Risks

 

There is no evidence of long-term effects such as deep vein thrombosis, anemia, or decreased bone mineral density (BMD); on the contrary, studies found that lumbar spine BMD improved.³⁷

Side Effects

As with other progestin-only methods, irregular endometrial bleeding and amenorrhea are common. In clinical studies, the bleeding patterns observed in women were irregularly irregular³⁸ and included:

• Spotting (50 percent declining to 30 percent after 6 months)
• Amenorrhea (20 percent)
• Prolonged bleeding (20 percent declining to 10 percent after 3 months)
• Frequent irregular bleeding (<10 percent)
• Unpredictability of bleeding pattern over time³⁹

Contraindications and Precautions

Medical Eligibility Criteria for the Contraceptive Implant
Category 4 (unacceptable health risk if the contraceptive method is used)	Current breast cancer
Category 3 (theoretical or proven risks usually outweigh the advantages of using the method)	Ischemic heart disease or stroke (current or history of)—for continuing method (i.e., if heart disease worsens in a woman who is already using the contraceptive implant) SLE (positive for antiphospholipid antibodies or status unknown) Migraine with aura—for continuing method (i.e., if migraines worsen in a woman who is already using the contraceptive implant) Unexplained vaginal bleeding prior to evaluation Breast cancer in the past; no evidence of disease for 5 years Severe cirrhosis Malignant liver tumor
Source: Reference 5

Advantages

• Long-term method
• Discreet
• Very effective
• After up-front cost, cost-effective for term of use
• Rapidly reversible: after implant is removed, most women (94 percent) ovulate by 3 months; the majority ovulate within 3 weeks⁴⁰
• Quick and easy insertion and removal procedures
• Can be inserted anytime during menstrual cycle when pregnancy can be excluded
• Non-contraceptive benefits, such as improved dysmenorrhea
• Lack of estrogen in the implant makes it appropriate for smokers older than age 35, postpartum breastfeeding women, and others with contraindications to estrogen

Disadvantages

• Requires visit to trained clinician for insertion and removal
• Irregular bleeding patterns
• No protection against STIs

Counseling Messages

• The implant provides 3 years of continuous pregnancy prevention and must be removed within 3 years; a new rod can be inserted at the time of removal.
• Once placed, the implant is not visible but is usually palpable. (Providers may want to show women the implant and briefly describe the insertion and removal process.)
• The contraceptive implant can cause bleeding irregularities, including amenorrhea.
• Non-hormonal back-up contraception is needed for the first 7 days after insertion.
• This method does not protect against STIs.