Contraceptive Implant – Nexplanon

WHAT ARE THEY?

The “Implant” (Nexplanon, previous version called Implanon) is a small, matchstick sized rod of plastic that releases hormones in the body to prevent pregnancy. The Implant is inserted into the arm just below the skin by a doctor. Once inserted, Implants provide birth control coverage for 3 years. They are fully reversible and can be removed at any time. They are extremely effective.

HOW DOES IT WORK?

Nexplanon uses a synthetic progesterone, etonogestrel, within the plastic rod. It does not contain estrogen. This rod slowly releases the hormone that prevents ovulation (prevents the egg from leaving the ovary) and acts on the cervical mucus to become thicker, which makes it harder for sperm to enter the uterus.

The Implant needs to be inserted by a doctor. To receive an Implant at HSHC, you will need two appointments. The first appointment is a pre-Implant consultation. At this appointment, you will discuss your contraceptive options, get up to date STI swab testing, go over our pre-Implant insertion instructions, and get your prescription for your Implant. This is mandatory, even if you have already discussed Implants with another doctor, already have a prescription, or if you are replacing an old Implant.

The pre-Implant instructions that we give to all of our clients are as follows:

  1. No unprotected sex for at least two weeks prior to your insertion date
  2. Come prepared to provide a urine sample for a pregnancy test
  3. Please alert your doctor or nurse if you have allergies to topical analgesics (i.e. lidocaine for freezing the skin)
  4. Pick up the Implant from the pharmacy and bring it with you to your appointment

The second appointment is the insertion. There is less flexibility and longer wait times in booking an Implant insertion than a regular appointment. If you are booked for an Implant insertion and miss your consultation, your insertion will be automatically cancelled.

You will need to purchase your Implant at a pharmacy before your insertion appointment and bring it with you. These cost approximately $350. The Implant (Nexplanon) is new to Canada (approved in 2020, although it has been used for many years in other countries), which means that private insurance may not cover it yet. Before considering Nexplanon, you may want to contact your insurance company to make sure that it is covered.

An Implant is inserted by a doctor at the office. They will give you a shot of a local anesthetic or freezing agent to numb your arm and help with discomfort. You may feel a pinch or sting while being numbed, but you shouldn’t feel the Implant being inserted.

While lying on your back with your non-dominant hand tucked behind your head, your doctor will mark the inside of your arm where it will be inserted. Nexplanon comes with a special applicator that will guide the Implant under the surface of your skin. The doctor will feel for the Implant to make sure that it is in place, and have you feel it as well. The insertion process only takes a few minutes.

You will have to wear a pressure bandage for 24 hours and a small bandage for 3 to 5 days. After the numbing medication wears off, you may experience some temporary aching from the insertion site, as well as some bruising, tenderness, or swelling for a few days. If you are sexually active, you will need to use an additional barrier method (such as a condom) for the first 7 days after insertion.

If you currently have an Implant and are getting a new one, a removal and insertion can be done in the same appointment. You will then book an appointment for a checkup after the insertion.

The Implant does not protect against STIs. Ensure that you continue to use barrier methods, such as condoms, for protection from STIs. Your schedule for Pap testing is unchanged with an Implant.

Once your Implant has expired after 3 years, you repeat this process if you desire to continue using an Implant. It is best if you do not leave your Implant inserted beyond their time limit. If you realize that you have left your Implant in too long, begin using another form of barrier birth control, such as condoms, and book an appointment with a doctor.

Implant removal only takes a few minutes, but the process is a little longer than getting it put in. Just like with the insertion, a doctor gives you a shot of a local anesthetic or freezing agent to numb your arm and help with discomfort. You may feel a pinch or sting while being numbed, but you shouldn’t feel the Implant being removed. The doctor will then make a small cut and pop the tip of the Implant up through the cut. The Implant is then removed with small forceps. The doctor will measure the Implant to make sure that the entire Implant was removed. You will have to wear a pressure bandage for 24 hours and a small bandage for 3 to 5 days. After the numbing medication wears off, you may experience some temporary aching from the insertion site, as well as some bruising, tenderness, or swelling for a few days.

HOW EFFECTIVE IS IT?

Implants are over 99% effective. Implants do not have the risks of typical vs perfect use like other birth control methods do, as there is no user error…it is always there!

WHAT ARE THE RISKS/ SIDE-EFFECTS?

Complications associated with the Implant are rare but may occur. Possible complications of inserting an Implant include irregular bleeding or spotting and problems with insertion and/or removal.

Side effects from the Implant are usually mild. Some side effects could even be considered positive! Implants can produce similar side effects as oral birth control pills, such as bloating, breast tenderness, nausea, or mood changes, but these should disappear within the first 3 months following the insertion. The most common side effect (1 in 10 users) is irregular bleeding/spotting. This can look like longer or shorter bleeding during your period, no bleeding at all during the time of your period, spotting between your periods, and varied amounts of time between your periods. For most people, the bleeding is lighter than their usual periods.

THINGS TO LOOK OUT FOR:

Excessive vaginal bleeding:  If you are changing a pad or tampon every 1-2 hrs or passing large clots, you need to be assessed as soon as possible. Please go to your local Emergency department.

Unable to feel the Implant or feel that it is broken or bent: Make an appointment to have the doctor do an exam to feel for the Implant and/or removal. In the meantime, you should use a backup form of barrier birth control, such as condoms. Nexplanon includes a small amount of a material that is detectable by an X-Ray in the instance that the implant cannot be felt by hand.

Continued pain, swelling, irritation, bruising, or infection at the insertion site: Make an appointment to have the doctor provide a treatment for the infection and assess the need for a removal.

DOES IT AFFECT MY ABILITY TO BECOME PREGNANT AFTER IT IS REMOVED?

Implants do not affect the ability to become pregnant after having it removed. Pregnancies have been reported as soon as 5 days after a removal.

ADVANTAGES AND DISADVANTAGES

ADVANTAGES:

Possible decreased to no periods at all

Less painful/crampy periods

May be appropriate for people who cannot take estrogen

Does not interfere with breast feeding

Low cost after initial purchase

3 years of consistent birth control

Does not impact fertility

Do not have to remember to take it every day

Can be inserted any time during the menstrual cycle

Inserted in your arm rather than your uterus like the IUD

Less painful insertion than IUD

Does not interrupt sexual activities

DISADVANTAGES:

Spotting and irregular bleeding

Does not protect against STIs

People currently on the Implant who get pregnant have a higher chance of it being an ectopic pregnancy than other forms of birth control.

Must be inserted and removed by a doctor

Possibility of having no periods at all, which may feel concerning to some people

High upfront cost

Uncomfortable insertion process

Bruising, swelling, and discomfort of the arm upon initial insertion

Hormonal side effects

Cannot get a tattoo over the area where the Implant is located until it is removed

HOW TO BOOK AND PREPARE FOR YOUR APPOINTMENT

BOOKING AN APPOINTMENT

Booking an appointment with us is easy! Give us a call at 902.455.9656 ext. 0. You will be speaking with either a volunteer or a medical administrator. We cannot book appointments by email or Facebook. You cannot book an appointment for someone else, even if they are your partner or child. We will need to speak with them directly. To book, we will need your full name, birth date, phone number, and a very brief reason for your visit. That’s it! The person on the phone will outline anything you need to know to prepare for your appointment. They will book both the Implant consultation and insertion if the schedule is available.

Make sure you bring your valid provincial health card with you to your appointment. Clients without health cards are subject to doctors and lab fees.

Are you a youth? You do not need parental consent for any of our appointments.

Don’t have access to or lost your health card? You are entitled to your health card information! Call MSI toll-free at 1-800-563-8880 (in Nova Scotia) or at 902-496-7008 from Monday – Friday, 8am-5pm. We require the number and the expiry date. Another tip: take a picture of your card! You will never lose it again!