Birth control implant – is it right for you?

What is a contraceptive implant?

The contraceptive implant (known as Nexplanon) is a flexible plastic rod that's about the size of a matchstick. It’s placed under the skin in your upper arm, releasing the hormone progestogen steadily into your bloodstream to stop you getting pregnant. Think of it as birth control that goes in your arm.

You’ll usually have it replaced every 3 to 5 years.

US figures from 2015 to 2017 (the latest national figures available) show that about 4% of women aged 15-44 who currently use contraception use the implant.

How high is birth control implant effectiveness?

The implant is over 99% effective at preventing pregnancy. “The effectiveness is partly because women who use it don’t have to remember to take a pill every day so it is always working,” says Dr Ann Nainan, family doctor and Healthily expert. “It’s also sometimes known as ‘get-it-and-forget-it’ contraception or long-acting reversible contraception (LARC).”

• if you have your implant put in during the first 5 days of your period, you’re protected from pregnancy immediately
• if you have it put in at other times in your cycle, you need to use another type of contraception (such as condoms) during the 1st week. After that time you’re protected

What should I do if I think I’m pregnant?

It’s rare to get pregnant while you have a birth control implant but around 1 in every 100 women could. If you think you might be pregnant, do a pregnancy test or speak to your doctor or nurse as soon as possible. The implant will not affect a pregnancy test.

If you do get pregnant while you’re using the implant there’s no evidence that it will harm the baby. You should arrange for the implant to be removed if you want to continue with the pregnancy.

How does a contraceptive implant work?

There are 3 main ways that a birth control implant stops you getting pregnant:

• it stops your ovaries releasing an egg every month (ovulation)
• it thins lining of your uterus so that a fertilized egg is less likely to implant there
• it thickens the mucus in your cervix (that’s the entrance of your uterus), making it more difficult for sperm to travel past it

How is a contraceptive implant put in?

The implant is inserted under your skin, in the same way that you’d have an injection. Here’s the lowdown:

• a specially trained doctor or nurse will use a local anesthetic to numb the area on the inside of your upper arm
• the implant is fitted under your skin
• your doctor or nurse will ask you to feel the implant under your skin so you know how it should feel – you should be able to feel both ends between your thumb and finger
• you don’t need any stitches after your implant has been fitted. Your arm may feel slightly bruised or tender for a day or 2 afterwards

How do you get a birth control implant taken out?

If you want your implant removed – or a new one needs to be put in – here’s what happens:

• you’ll be given a local anesthetic
• the doctor or nurse makes a tiny cut in your skin before gently pulling out the implant
• if you don’t have another implant fitted, as soon as an implant has been removed you're no longer protected against pregnancy
• sometimes, an implant can be difficult to feel under your skin or remove. If this happens, you might be referred to a specialist center to have it removed with the help of a scan such as an ultrasound

Where can I get a contraceptive implant?

• in the US most insurance plans cover US Food & Drug Administration (FDA)-approved birth control but check your insurance cover to see what’s included
• If you don’t have health insurance, check with your state’s Medicaid programme to see what’s covered
• in the UK you can get the contraceptive implant for free (including if you're under 16) from sexual health clinics, your doctor’s surgery and some young people's services

What are the advantages of a contraceptive implant?

• once it’s inserted and protecting you against pregnancy, you don’t need to remember to use a contraceptive every time you have sex
• it doesn’t interrupt sex – you can concentrate on having fun!
• it works for 3 to 5 years before you need to change it
• if you can’t take estrogen-based contraception (such as the combined pill, contraceptive ring or patch) it’s safe to use
• your fertility returns to normal once it’s taken out
• it’s safe to use if you’re breastfeeding
• it can reduce heavy periods or period pain

What are the disadvantages of a contraceptive implant?

It doesn’t protect you against sexually transmitted infections, so you may need to use extra protection such as condoms

• rarely, having an implant put in or removed from your arm can cause an infection it may also sometimes be difficult to remove the implant from your arm but this is uncommon

Birth control implant side effects

In the early months after you’ve had an implant fitted you may have temporary symptoms such as:

• irregular periods– this may happen in just over a third of people which means that it doesn’t happen for almost 2 thirds of people
• headaches – a quarter of people may experience them, which means that 3 quarters won’t
• your periods may stop altogether – this can happen in 22% of people, which means that it won’t happen for 78% of people
• acne – this can happen in 13.5% of people using the contraceptive implant
• breast tenderness – this can happen in 13% of people using the contraceptive implant
• mood swings – this can happen in 7% of people using the contraceptive implant
• nausea – this can happen in 6% of people using the contraceptive implant

How should the birth control arm implant feel?

Even though it’s small, you should be able to feel the implant just under your skin. It shouldn’t be painful and you shouldn’t be aware it’s even there. “It’s important to check your implant from time to time to make sure you can still feel it,” says Dr Ann. “Why not set a monthly reminder on your phone?”

When to see your doctor

Speak with your doctor as soon as possible if:

• you can’t feel your implant
• you think you’re pregnant
• you’re going to be immobile or you’re going to have surgery

Contact your doctor urgently or go to the emergency department if:

• you develop severe abdominal pain
• you feel a lump in your breast
• you have unusual, heavy bleeding from your vagina
• you have chest pains, breathlessness, pain and swelling in either leg, or you cough up blood. These can all be signs of a thrombosis or blood clot in the lungs or legs

Your health questions answered

Do any medicines affect the birth control that goes in your arm?

“Yes, some medicines may make the implant less effective at protecting you against becoming pregnant. These include some medicines used to treat HIV and epilepsy, as well as some antibiotics such as rifampicin which is used to treat tuberculosis (TB). Complementary medicines such as St John’s Wort may also affect it,” says Dr Roger Henderson, doctor and Healthily expert.

“If you’re taking any of these, use additional methods of contraception, such as condoms, or speak with your doctor about other types of contraception that aren’t affected by medicines you’re taking.”