A guide to the contraceptive implant

Reviewed by Dr Bhavini Shah

The implant is a long-acting reversible contraception (LARC) that prevents pregnancy. Many women find the contraceptive implant a convenient and highly effective form of contraception.

• A small, flexible rod
• Inserted under the skin in the upper arm
• It releases hormones
• Can protect against pregnancy for up to three years
• It's over 99% effective

In this article, we’ll look at how the implant works, where you can get it and how long it lasts.

What is the contraceptive implant and how does it work?

The implant is a form of contraception that stops you getting pregnant.  The implant steadily releases the hormone progestogen into your body, which prevents your ovaries from releasing an egg every month. This hormone also thickens the mucus within your womb (cervix) making it difficult for sperm to reach an egg. The womb lining is also thinned so that an egg cannot easily implant itself onto the wall of your womb.

• A small is a small flexible rod, about the size of a matchstick
• It’s placed under the skin or your upper arm
• Once the implant is in place it can stay in your body for three years
• If you decide to have it taken out it can be removed at any time
• Can be used by women who can’t use contraception containing oestrogen
• It is also useful for women who find remembering to take the pill difficult 

How effective is the contraceptive implant?

The implant protects against pregnancy for three years. It’s more than 99% effective as a form of contraception. This means less than 1 in 1000 women who have the implant for three years will get pregnant.

While the implant stops you from getting pregnant it will not stop you from catching an STI (sexually transmitted infection). If you’re not sure on the STI status of your partner(s) you should use condoms.

Who can use the contraceptive implant?

The implant can be used by most women. Unlike some hormonal contraceptives, the implant can be used while you’re breastfeeding. You can have it fitted any time after having a baby.

“If you have endometriosis hormonal contraception may be a suitable option to help manage your symptoms.  Hormone treatments can reduce bleeding and inflammation from your endometriosis and reduce pain. If you are prescribed hormone treatment, it is recommended that you give it at least 3–6 months to work. Your doctor will work with you to find the best treatment method for your circumstances.” - Dr Bhavini Shah

However, you may not be able to have the implant if you:

• Have unexplained bleeding in between periods or after sex
• Take medication that may affect the implant
• Have a liver condition
• Have or have ever had breast cancer
• Have a condition affecting your heart or blood vessels   

If you have a health condition which may impact the contraception you can use, talk to your doctor or nurse.

Can I use medication?

There are some medicines that can make the implant less effective, these include:

• HIV medication
• Epilepsy medication
• St John’s Wort and other complementary remedies
• Riabutin (an antibiotic)   

You should use extra contraception, like condoms, if you’re taking any of these. Tell your doctor that you are using the implant if you’re prescribed any of these medicines.

Pros and cons of the implant

The implant is suitable for lots of different women but as with every contraceptive option there are advantages and disadvantages.

The potential advantages and disadvantages of the implant:

How is the contraceptive implant fitted?

The implant can be inserted at your local sexual health clinic or GP surgery by a doctor or nurse. You won’t need to stay in hospital and the procedure usually takes about half an hour.

The implant is inserted just below the skin on your upper arm. You’ll be lying on your back with your arm either out straight or bent at the elbow with your hand near your head. The healthcare professional will find a spot on your upper arm and you’ll have an anaesthetic injection to numb the area. They’ll check to make sure you can’t feel anything before the implant is inserted using an applicator. This makes a small wound in your arm which is closed with a dressing. There’s no need for stitches and you shouldn’t feel any pain while it’s being inserted into your arm.

Will it hurt?

The doctor or nurse who inserts the implant will numb a small area of your upper arm with a local anaesthetic (an injection) before they will put the implant in. The implant is around the size of a hair grip, and takes just a few minutes to put in. You'll be shown how to check that the implant is in place by feeling with your fingers.

The area may be a little tender for a day or two, with slight bruising and swelling. Your doctor or nurse will put on a dressing to protect it, and you should keep this on for a few days. 

How do I get the implant?

The implant has to be inserted by a trained doctor or nurse. You can get it fitted in most GP surgeries, GUM clinics and contraception clinics.

You’ll be immediately protected against pregnancy if the implant is fitted in the first 5 days of your menstrual cycle. If it’s fitted on any other day during your cycle, you won’t be protected for up to 7 days. You’ll need to use another form of contraception, like condoms, during this time.

If you have recently given birth you can have the implant fitted at any time, to be immediately protected this needs to be on or before day 21 after you have given birth. If you have the implant fitted after day 21 you’ll need to use additional contraception for the next 7 days. Also it’s safe to use the implant while you’re breastfeeding.

If you’ve had a miscarriage or abortion, you can have the implant fitted immediately. It’ll stop you getting pregnant as soon as it’s fitted.

Will the implant be visible in my arm?

Once the area has healed, you shouldn’t be able to see the implant at all, although you will be able to feel a slight bump if you press in the right place.

You won’t need to worry about knocking the implant, as it won’t break or move around your arm, and you should be able to continue with all your normal activities.

Tips for your appointment

• Have a list of medications you take and bring this to your appointment
• Keep using your current method of contraception
• Eat a meal before your appointment
• Stay hydrated and take a drink with you
• Let the healthcare professional know if you have a needle phobia or are prone to fainting
• Wear clothing so the top of your inner arm is easy to access   

Side effects of the contraceptive implant

As with any medicine, some people experience other side effects while using the implant. However, many of these effects are temporary and should only last for a few months. If you feel that the disadvantages of the implant outweigh the benefits you can have it removed at any time. Your fertility will very quickly return to how it was before you had the implant fitted, and your regular period cycle should resume.

Side effects include:

• Breast tenderness
• Acne (if you already have acne it could get worse)
• Nausea
• Headaches
• Changes in mood
• Loss of sex drive

Similarly to other hormonal methods of contraception the implant can affect your menstrual cycle.

Many women find that their periods:

• Become irregular
• Stop completely
• Last longer than usual

Risks associated with the implant

The contraceptive implant is a safe option for many women, however there are some risks:

• You can get an infection at the site of the implant, this is very rare
• The implant can move out of place
• Blood clots 

If you’re concerned about any of the risks speak to your doctor or nurse.

Contraceptive implant replacement and removal

When you have your implant removed:

• Your healthcare practitioner will numb the area with a local anaesthetic. This means you will not feel any pain when the implant is removed but may feel slight tugging.
• The doctor or nurse to make a tiny cut in the skin and gently pull out the implant.
• The small wound will be closed, and you’ll be given a bandage or plaster to wear.
• If you’re having a new implant inserted this can be done at the same appointment.

The implant lasts for three years but you can have it removed at any time. It only takes a few minutes for the implant to be removed. You can get pregnant after the implant is removed. If you don’t want to get pregnant you should use condoms or another method of contraception.

What are the alternatives to the birth control implant?

If the implant isn’t for you, there are plenty of other contraceptives which are also effective at preventing pregnancy. These include:

• The contraceptive pill – daily hormonal pills
• The injection – hormonal injection administered every 8-13 weeks
• The IUS – small plastic hormonal device inserted into the womb for up to five years
• The IUD (the coil) – small copper device inserted into the womb for up to 10 years
• The patch – hormonal patch worn on the skin, changed weekly
• The vaginal ring – small plastic hormonal ring, inserted in the vagina, changed every three weeks
• Diaphragms – small device inserted into the vagina, acts as a barrier against sperm
• Male condoms – worn over the penis to prevent sperm from entering the vagina
• Female condoms – inserted into the vagina to prevent sperm from reaching an egg  

The most popular method of long-term contraception in the UK is the contraceptive pill. There are many brands and strengths of the contraceptives pill; the two main types are the combined pill (containing a combination of two hormones) and the mini pill, also known as the progesterone-only-pill.

Conclusion

The contraceptive implant is a long-term method of contraception that’s more than 99% effective at preventing pregnancy. Once it’s in place you don’t need to think about it for three years. If you have side effects or decide you want a baby, it can easily be taken out. If you’re still not sure, we can help you find the right contraception for you.

References

https://www.nhs.uk/conditions/contraception/contraceptive-implant/
https://www.nhsinform.scot/healthy-living/contraception/contraceptive-implant/
https://www.nhs.uk/contraception/methods-of-contraception/contraceptive-implant/who-can-use-it/