Contraceptive Implants

Session I, Slide #1
1
What Are Implants?
Progestin-filled rods (each about the size of
a match stick) that are inserted under the ski
n
– Jadelle: 2-rod system, effective for 5 years
– Levoplant (Sino-implant (II)): 2-rod syste
m, effective for 3 years (possibly 5)
– Implanon NXT (Nexplanon): 1-rod system,
effective for 3 years (possibly 5 years)
– Norplant: 6-capsule system, effective for
5-7; no longer manufactured but some wo
men are still using it

Session I, Slide #2
2
Key Points for Providers and Clients
What it is:
– Small, flexible plastic rods placed under the skin of inner, upper arm.
– Hormones released from the rods block sperm from reaching egg and
prevents release of egg.
How to use:
– Specially trained provider inserts and removes implants.
– Nothing to remember to do after insertion.
What to expect:
– Changes in monthly bleeding including irregular bleeding, spotting, h
eavier bleeding or no monthly bleeding, are common and safe.
Important to remember:
– Use another method if waiting for appointment.
– Use condoms if you need protection from STIs or HIV/AIDS.
Session I, Slide #3
3
Implants: Mechanism of Action
Implants work in two ways

Suppresses hormones
responsible for
ovulation

Thickens
cervical mucus
to block sperm

Implants have no effect on an existing pregnancy.

Session I, Slide #4
4
Implants: Characteristics
• Very safe and 99.95%
effective
• Easy to use
• Fertility returns without
delay when removed
• Can be used by breastf
eeding women
• Offer health benefits
• Have side effects
• Requires a minor proc
edure to insert and re
move
• Cannot be initiated an
d discontinued without
provider’s help
• Provide no protection
from STIs/HIV

Source: WHO, 2016; CCP and WHO, 2018. Session I, Slide #5

5
 Implants: Health Benefits
• Reduced risk of symptomatic pelvic inflammat
ory disease (PID)

• May help protect against iron-deficiency anem

ia

• Reduced risk of ectopic pregnancy

– 6 per 100,000 in implant users
– 650 per 100,000 in women using no contraception

Source: CCP and WHO, 2018

Session I, Slide #6
6
Who Can and Cannot Use Implants
(part 1)

Most women can safely

use implants
But usually cannot use impla
nts if:

May be pregnant Some other serious

health conditions

Session I, Slide #7
7
 Who Can and Cannot Use Implants
(part 2)
Most women can safely use implants. But usually cannot use implan
ts if:
May be pregnant • If in doubt, use pregnancy checklist or perform pregnancy test.

Some other serious • Has blood clot in lungs or deep in legs now and is not on anticoa
health conditions gulant therapy. Women with superficial clots (including varicose
veins) CAN use implants.
• Ever had breast cancer.
• Unexplained vaginal bleeding. If the bleeding suggests a serious
condition, help her choose a method without hormones to use u
ntil unusual bleeding is assessed.
• Serious liver disease or jaundice (yellow skin or eyes).

Session I, Slide #8
8
Possible Side Effects of Implants (part 1)
Some users report changes in bleeding
patterns:
First several months: After about one year:
• Lighter bleeding and fewe • Lighter bleeding and fewe
r days of bleeding r days of bleeding
• Prolonged bleeding • Irregular bleeding
• Irregular bleeding • Infrequent bleeding
• Infrequent bleeding • No monthly bleeding
• No monthly bleeding
How would you fe
*Implanon NXT users are more likely to h el about these
ave no or prolonged monthly bleeding or side-effects?
infrequent bleeding than irregular bleedin
g. Session IVA, Slide 9
Possible Side Effects of Implants (pa
rt 2)
• Headaches
• Lower abdominal pain
• Acne (can improve or worsen)
• Weight change
• Breast tenderness
• Dizziness
• Mood changes
• Nausea, nervousness
Session I, Slide #10
10
When to Start Implants
(A Review)

• What if this client, who has no medical

conditions that would preclude implants
use, wants to initiate implants?
• Client situation:
– In day 4 of menstrual cycle
– Condom user in day 8 of menstrual cycle
– 2½ weeks postpartum, not breastfeeding
– 2½ weeks postpartum, breastfeeding
– Injectable user, amenorrheic, within reinjection window
– IUD user, mid-cycle, had sex since last menses
– After taking emergency contraceptive pills (ECPs)

Session I, Slide #11

11
 What to Remember
• Keep the insertion area dry for See a nurse or doctor if:
4 days.
• A bright spot
• Expect a bit of soreness and br in your visio
n before bad
uising. headaches
• Yellow skin
• Come back when it is time to ha or eyes

ve the implants removed. • Infection or continued

pain in the insertion si
• Side effects are common but ra te or sees rod coming
out
rely harmful Come back if they
bother you.
• Unusually • May be pregna
• Come back any time if you hav heavy or lo
ng bleeding
t, especially if p
ain or soreness
in belly
e problems or want implants re
moved.
Session I, Slide #12
12