What is the contraceptive implant?

The contraceptive implant is a small plastic rod that is inserted under the skin of your upper arm by a doctor or nurse. It is approximately 4cm long and releases progesterone to prevent pregnancy.

The contraceptive implant is classed as a medical device because it is implanted into your skin. Its effects can last for 3 years before it needs to be replaced, but you can choose to have it removed sooner. The contraceptive implant can be a good alternative for women who find it difficult to remember to take the pill or are sensitive to the effects of oestrogen. However, it may not be suitable for everyone.

The implant works by steadily releasing a synthetic version of the hormone progesterone into the bloodstream, which stops you getting pregnant by:

• stopping your ovaries from releasing an egg (ovulation)
• thickening the cervical mucus, making it difficult for sperm to reach an egg
• thinning the womb lining so that an egg cannot implant itself

The implant works similarly to the mini pill, which is a contraceptive pill taken every day to prevent pregnancy that also contains progesterone as its only active ingredient.

How long does the contraceptive implant last?

The contraceptive implant lasts for 3 years before it needs to be replaced. However, you can choose to have it removed before then if you want to try for a baby or no longer want to use the implant as a birth control method.

How long does the contraceptive implant take to work?

If the implant is fitted during the first 5 days of your period, you will be protected against pregnancy straight away.

If the implant is fitted after day 5, you will need to use another method of contraception, like condoms, for 7 days because you will not have immediate protection.

How effective is the contraceptive implant?

The contraceptive implant is over 99% effective at preventing pregnancy. That means that fewer than 1 in 100 women using the implant will get pregnant in a year. However, if the implant is not replaced after 3 years, its effectiveness drops.

A doctor or nurse must fit the contraceptive implant, which will be inserted under the skin of your arm. The whole procedure usually takes a few minutes. To fit the implant, a healthcare professional will:

1. Use a local anaesthetic injection or spray to numb the area so you do not feel any pain.
2. Make a small cut in the skin of your upper arm.
3. Insert the implant into your skin.
4. Seal the cut with a dressing which can be removed once the cut has healed.

Once the implant is inserted and the wound has healed, it will not be visible. You will be given a Patient Alert Card, which will tell you where the implant is located, the date it was inserted, and the latest date it can be removed. You should keep this card in a safe place, as you will need this when you get the implant removed.

The only contraceptive implant available in the UK is Nexplanon. It’s a small, soft, flexible plastic rod that is around 4cm long and 2mm wide.

It contains 68mg of etonogestrel, a synthetic version of progesterone. Once inserted, Nexplanon continuously releases a small amount of etonogestrel into your bloodstream to stop you getting pregnant.

Nexplanon has replaced a previously available implant called Implanon. Both Implanon and Nexplanon contain the same active ingredient, in the same strength and work in the same way, but Nexplanon:

• contains barium sulphate, a chemical which stops it from being visible on an X-ray
• comes preloaded in an applicator, making it easier to insert into your arm, lowering the risk of implantation error

You can find out more about Nexplanon in the patient information leaflet.

The contraceptive implant is available for free on the NHS, or you can choose to have it fitted privately at a clinic, but you will need to pay for this service. You can get an implant fitted at:

• a sexual health clinic
• some GP surgeries
• some young people’s services
• private GPs and clinics (charges will apply)

To get the contraceptive implant removed, you’ll need to make an appointment with a doctor or nurse because it can only be taken out by a trained healthcare professional. It can be removed whenever you choose or no later than 3 years after it has been inserted. You will need the Patient Alert Card you were given when the implant was inserted, so the healthcare professional can easily locate it.

The removal of the contraceptive implant is usually straightforward and involves:

1. Lying on your back, with your arm bent at the elbow and your hand underneath your head.
2. Your upper arm will be disinfected and anaesthetised (numbed), so you should not feel pain during the procedure.
3. A small incision will be made along the arm just below the tip of the implant.
4. The implant is gently pushed towards the incision and removed with forceps.
5. A sterile adhesive wound closure will be applied and can be removed after 3 to 5 days, and a pressure bandage will be placed over the wound to minimise bruising – this can be removed after 24 hours.

The contraceptive implant, like all medications, can cause side effects, but not everyone will get them. You may notice that your periods become irregular, lighter, heavier, or absent. These changes are considered normal, but if you experience heavy or prolonged bleeding, you should contact your doctor for advice.

Very common side effects, affecting more than 1 in 10 people, include:

• acne
• headaches
• weight gain
• breast tenderness or pain
• irregular bleeding
• vaginal infections

Common side effects, may affect up to 1 in 10 people, include:

• hair loss
• depression
• dizziness
• nervousness
• low sex drive
• increased appetite
• abdominal pain
• feeling sick (nausea)
• increased gas
• weight loss
• flu-like symptoms
• pain
• fatigue
• hot flushes
• implant site reaction or pain
• ovarian cysts

Uncommon side effects, may affect 1 in 100 people, include:

• itching
• itching in the genital area
• rash
• excessive hair growth
• migraine
• anxiety
• sleeplessness
• being sick (vomiting)
• constipation
• urinary tract infections (UTIs)
• vaginal discomfort
• enlarged breasts
• breast secretions
• back pain
• fever
• fluid retention
• painful urination
• allergic reactions
• inflamed or painful throat
• joint pain
• muscle pain
• skeletal pain

After the implant has been fitted or removed, you may experience some pain, swelling, or itching at the insertion site.

How long do contraceptive implant side effects last?

Many of the implant side effects are mild and temporary and get better within a few weeks.

However, if they last for a few months, become severe, or you are concerned, it’s important to let your doctor or nurse know. They will advise you if any further action is required, such as considering switching to a different contraceptive method.

What to do if you get the contraceptive implant side effects

Most mild contraceptive implant side effects can be managed at home in the following ways:

Headaches

Get plenty of rest, drink clear fluids, and speak to a pharmacist about over-the-counter painkillers to manage pain.

Acne

Wash the area with a mild soap or cleanser and lukewarm water. If you are worried, consider specific acne treatments.

Weight gain or loss

Follow a healthy, balanced diet and get regular exercise to help keep your weight within a healthy range.

Feeling or being sick

Get some rest, avoid rich or spicy foods, and sip clear fluids. It may also help to eat and drink slowly and choose smaller, more frequent meals.

Thrush

There are several effective thrush treatments available to help relieve symptoms.

Bacterial vaginosis

Speak to a pharmacist about over-the-counter treatments or a doctor for prescribed bacterial vaginosis treatments.

If you experience any side effects that you feel are lasting for too long or are difficult to manage, speak to your doctor for advice.

The contraceptive implant may not be suitable for everyone. Do not use the contraceptive implant if you have:

• an allergy to etonogestrel or any of its other ingredients
• a blood clot in a blood vessel
• or have had jaundice, severe liver disease, or a liver tumour
• or have ever had breast or cervical cancer
• unexplained vaginal bleeding

Before you have the contraceptive implant inserted, you should tell the doctor or nurse if you have or have ever had any of the following:

• breast cancer
• liver disease
• a blood clot
• diabetes
• obesity
• epilepsy
• tuberculosis
• high blood pressure
• chloasma (yellowish-brown pigmentation patches on the skin, particularly of the face) – if so, avoid too much exposure to the sun or ultraviolet radiation

The contraceptive implant and other medications

Before choosing the contraceptive implant as your preferred birth control method, you should tell your doctor or nurse about any prescribed, over-the-counter, or herbal medications you are currently taking or considering taking.

Some medications can:

• influence the blood levels of the implant’s active ingredient
• make it less effective at preventing pregnancy
• cause unexpected bleeding

These include medications that are given to manage or treat:

• epilepsy
• tuberculosis
• HIV infections
• Hepatitis C virus
• other infectious diseases
• high blood pressure in the blood vessels in the lungs
• depressive moods

The contraceptive implant is not the only birth control method available. There is a wide range of different types of contraception to choose from, including hormonal and non-hormonal alternatives. Contraception also comes in a variety of forms, and there are options available to suit your personal preferences and individual needs.

Hormonal contraception

Hormonal contraception is over 99% effective if used perfectly. Effectiveness can decrease if you do not take it as you’re supposed to, such as missing a contraceptive pill or not getting the contraceptive injection on the day it's due.

The different types are discussed more in this table:

The IUS, also called the contraceptive coil, is the most similar to the implant in that it’s a long-lasting contraceptive method. It can stay in for anywhere between 3 to 8 years, depending on the type used.

Non-hormonal contraception

Non-hormonal contraception uses different methods to prevent pregnancy, so the effectiveness can differ depending on the type. Just like hormonal contraception, effectiveness can be reduced if not used perfectly, such as a condom or diaphragm tearing, or if the copper coil moves out of place.