Contraceptive implants are increasingly being used for fertility regulation all over the world. They have the practical advantage of overcoming the risk of user failure and low continuation rates associated with other methods that require continuous motivation.
What are contraceptive implants?
Contraceptive implants are made up of two small rods the size of a matchstick. The rods are put under the skin in the inside of the arm in order to prevent pregnancy.
They slowly release a hormone called progestogen (levonogestrel/etonogestrel).
They work for up to 5 years. You can have them taken out whenever you want and your ovulation will return almost immediately.
Examples/brands of contraceptive implants
- implanon
- nexplanon (inserted with a preloaded shotgun/applicator, used in Britain)
- norplant I
- jadelle (norplant II)
- sino-implant (II), marketed as Zarin, Femplant and Trust
These are all trade names of implants. They have the same mechanism of action, similar advantages and disadvantages, and almost the same duration of action which is 3 to 5 years.
The Norplant family (Jadelle) contains levonogestrel while implanon contains etonogestrel.
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Insertion
Insertion of implants is performed under local anaesthesia. The usual location is subdermal in the inner aspect of the arm. Removal is also under local anaesthesia through a 2mm skin incision.
Incorrect insertion makes removal much more difficult, hence ensure it is done by a trained health worker.
how does it work?
Norplant, implanon, nexplanon, and jadelle works through the following mechanism:
- thickening of the cervical mucus to prevent passage of sperm
- suppression of ovulation
- impairment of oocyte maturation
- thinning of the uterine lining (endometrium) to prevent implantation.
how well does contraceptive implants work?
The implant is more than 99 percent effective in preventing pregnancy. This means for every thousand people using an implant, only a few will get pregnant each year.
An implant inserted into the inner arm. Credit: Planned Parenthood
advantages
- decreases dysmenorrhoea and ovulation pain
- decreases mentrual blood loss
- requires little user compliance
- highly effective
- can be used by women who have contraindications to estrogen
- convenience and reduction of pregnancy risk may improve sexual pleasure.
- reduces risk of endometrial cancer
- decreases risk of pelvic inflammatory disease compared to IUD
- very suitable for adolescents and breast feeding mothers.
- can be removed at any time and easily reversible.
- suitable for hypertensive patients.
disadvantages of contraceptive implants
- irregular bleeding and spotting during the first 12 months.
- spotting and bleeding may interfere with sexual activity.
- insertion and removal require trained personnel.
- risk of infection and bleeding hematoma at site of insertion.
- unacceptable to women who dislike foreign bodies or have needle phobia
- offers no protection against STIs
- weight gain.
- headache, breast pain (fullness), bloating, acne (pimples), hair growth or hair loss.
- potential allergy to anaesthetic or other agents used for insertion
- risk of ectopic pregnancy with Norplant.
- may cause depression and irritability in some women.
cost of contraceptive implants
Implanon, Jadelle and Norplant I are very affordable because there is a subsidy on them by the federal government to encourage birth control.
Contraceptive implants costs between N500 to N1,500 naira in government owned hospitals and around N2,000 to N3,000 naira in private facilities. Nexplanon is around N10,000 naira or more. It is not a popular implant in Nigeria. You may have to pay for your appointment to have it inserted.
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