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  Contraceptive Implant

An implant is a small flexible rod that is placed just under your skin in your upper arm. It releases a progestogen hormone similar to the natural progesterone that women produce in their ovaries. It is a very effective, long-term hormonal method of contraception which protects you from pregnancy for up to 3 years. The implant that is available in the UK is called Implanon.

How effective is an implant?
How does an implant work?
Where can I get an implant?
Can anyone use an implant?
How long is an implant effective for?
What are the advantages of an implant?
What are the disadvantages of an implant?
Are there any risks?
When can I start using an implant?
How soon can I have an implant after having a baby, miscarriage or abortion?
Can I use an implant if I am breastfeeding?
How is an implant put in?
How is an implant taken out?
Can anything make an implant less effective?
How will an implant affect my periods?
What should I do if I want to stop using the implant or try to get pregnant?
If I have to go into hospital for an operation should I stop using the implant?
How long can I use the implant for?
What should I do if I think that I am pregnant?
Are there any other types of implants?
How often do I need to see a doctor or nurse?


How effective is an implant?
How effective any contraceptive is depends on how old you are, how often you have sex and whether you follow the instructions.

If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year.

If you follow the instructions, implants are over 99% effective. This means that less than 1 woman in 100 who use an implant will get pregnant in a year.

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How does an implant work?
The main way it works is to stop your ovaries releasing an egg each month (ovulation). It also:

Thickens the mucus from your cervix. This makes it difficult for sperm to move through your cervix and reach an egg
Makes the lining of your womb thinner so it is less likely to accept a fertilised egg.

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Where can I get an implant?
Only a doctor or nurse who has been trained to fit implants can insert the implant. You can go to a family planning clinic or to the doctor or nurse at your general practice. If you prefer not to go to your own general practice, or they don’t provide contraceptive services, they can give you information about another practice or clinic. All treatment is free and confidential.

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Can anyone use an implant?
Most women who want to use an implant can have one fitted. The doctor or nurse will need to ask you about your own and your family’s medical history to make sure that the implant is suitable. You should tell them about any illnesses or operations you have had. An implant may not be suitable for you if:

you think you might already be pregnant
you do not want your periods to change
you take certain medicines.
you have now, or have had in the past:

- breast cancer
- unexplained vaginal bleeding (for example, bleeding between periods or after sex)
- thrombosis (blood clots) in any vein
- a heart attack or stroke (serious arterial disease)
- active liver disease

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How long is an implant effective for?
An implant is designed to be used for 3 years and is a long-term method of contraception. If you are not sure you want contraceptive protection for this long, other methods may be more suitable for you.

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What are the advantages of an implant?
You don’t have to think about contraception for as long as the implant lasts.
It does not interrupt sex.
You can use it if you are breastfeeding.
It is a good method if you cannot use estrogens (hormones), like those in the combined pill.
Your normal level of fertility will return as soon as the implant is taken out.
It offers some protection against pelvic inflammatory disease.
It may give you some protection against cancer of the womb.
It may reduce heavy, painful periods.

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What are the disadvantages of an implant?
Your periods may change in a way that is not acceptable to you (see How will an implant affect my periods?).
Other possible side-effects include headaches, spotty skin, putting on weight, tender breasts, bloating, and changes in mood and sex drive.
It requires a small procedure to insert and remove it (see How is an implant put in? and How is an implant taken out?)
An implant does not protect you against sexually transmitted infections, so you may need to use condoms as well.

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Are there any risks?
Very rarely, soon after the implant is put in it can cause an infection in your arm, where it has been inserted.
Research about the risk of breast cancer and hormonal contraception is complex and contradictory. Current research suggests that women who use hormonal contraception appear to have a small increase in risk of being diagnosed with breast cancer compared to women who don’t use hormonal contraception. Further research is ongoing.

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When can I start using an implant?
An implant will usually be put in during the first 5 days of your period. You will be immediately protected against becoming pregnant.

If the implant is put in on any other day you will not be protected against pregnancy for the first 7 days after it has been fitted. So you will need to use another method of contraception, such as condoms, during this time.

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How soon can I have an implant after having a baby, miscarriage or abortion?
You can have an implant put in 3 weeks (21 days) after you have given birth. If the implant is put in before day 28 you will be protected from pregnancy immediately. If the implant is put in later than day 28 you will need to use an extra method of contraception for 7 days.

The implant can be put in immediately after an abortion or miscarriage if you were pregnant for less than 24 weeks. You will be protected against pregnancy immediately.

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Can I use an implant if I am breastfeeding?
Yes. The implant is safe to use when you are breastfeeding. It will not affect your milk supply or harm the baby.

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How is an implant put in?
The implant, which is the size of a hair grip, is placed just under your skin in the inner area of your upper arm. It must be put in by a doctor or nurse who has been trained to insert implants. They will give you a local anaesthetic to numb the part of your arm where the implant will go, so it won’t hurt as it is put in. It only takes only a few minutes to put in and feels similar to having an injection. You won’t need any stitches. After it has been fitted the doctor or nurse will check your arm to make sure that the implant is in position.

The area may be tender for a day or two and may be bruised and slightly swollen. The doctor or nurse will put a dressing on it to keep it clean and dry and to help stop the bruising. Keep this dressing on for a few days and try not to knock the area.

Don’t worry about knocking the implant once the area has healed. It should not break or move around your arm. Most women can feel the implant with their fingers, but usually you can’t see it. It won’t affect you moving your arm and you will be able to do normal activities.

You do not need to have a vaginal examination or cervical smear to have an implant inserted.

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How is an implant taken out?

An implant can be left in place for 3 years or it can be taken out sooner if you decide you want to stop using it. A specially trained doctor or nurse must take it out. The doctor or nurse will feel your arm to locate the implant and then give you a local anaesthetic injection in the area where the implant is. They will then make a tiny cut in your skin and gently pull the implant out through the opening. They will put a dressing on the arm to keep it clean and dry and to help stop the bruising. Keep this dressing on for a few days.

It usually only takes a few minutes to remove an implant. If the implant has been put in correctly, it should not be difficult to remove. Occasionally, an implant is difficult to feel under the skin and it may not be so easy to remove. If this happens, your doctor or nurse may refer you to a specialist centre to have it removed with the help of an ultrasound scan.

If you want to carry on using an implant, the doctor or nurse can put a new one in at the same time. You will continue to be protected against pregnancy.

If another implant is not put in you will stop being protected against pregnancy immediately.

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Can anything make an implant less effective?

Some medicines may make an implant less effective. These include some of the medicines used to treat HIV, epilepsy and tuberculosis, and the complementary medicine St John’s Wort. These are called enzyme inducers. If you are using these medicines it will be recommended that you use additional contraception, such as condoms, or that you change your method of contraception. Always tell your doctor, nurse or dentist that you are using an implant if you are prescribed any medicines.

The Implant is not affected by common antibiotics, diarrhoea or vomiting.

It is important to have your implant changed at the right time. If it is not changed at the right time you will not be protected against pregnancy. If you have sex without using another method of contraception and don’t wish to become pregnant you may want to consider using emergency contraception (see Emergency contraception).

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How will an implant affect my periods?

Your periods will probably change.

In some women periods will stop completely.
Some women will have irregular periods or spotting (bleeding between periods).
Some women will have periods that last longer and are heavier.
These changes may be a nuisance but they are not harmful.

If you do have prolonged bleeding it may be possible for the doctor or nurse to give you some additional hormone or medicine that can help control the bleeding. They may also check that the bleeding is not due to other causes, such as an infection.

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What should I do if I want to stop using the implant or try to get pregnant?

If you want to stop using the implant you need to go back to the doctor or nurse and ask them to take it out. Your periods and natural fertility are likely to return quickly and it is possible to get pregnant before you have your first period. If you don’t wish to become pregnant then you should use another method of contraception from the day that your implant is removed.

If you want to try for a baby it helps to wait for one natural period before trying to get pregnant. This means that the pregnancy can be dated more accurately and you can start pre-pregnancy care such as taking folic acid and stopping smoking. You can ask your doctor or nurse for further advice. Don’t worry if you do get pregnant sooner, it will not harm the baby.

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If I have to go into hospital for an operation should I stop using the implant?

No. It is not necessary to stop using the implant if you are having an operation. However, it is always recommended that you tell the doctor that you are using the implant.

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How long can I use the implant for?

If you have no medical problems you can continue to use the implant until you reach the menopause. Each implant will last for 3 years and will then need to be changed.

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What should I do if I think that I am pregnant?

The implant is a highly effective method of contraception. If you have not taken any medicine that might make the implant less effective and have had the implant changed on time it is very unlikely that you will become pregnant. If you think that you might be pregnant then you can do a pregnancy test or speak to your doctor or nurse as soon as possible. If you do get pregnant while you are using the implant it will not harm the baby.

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Are there any other types of implants?

At one time in the UK a contraceptive implant called Norplant was available. This consisted of 6 rods that were placed under the skin of the arm and provided protection from pregnancy for 5 years. Although this is no longer available in the UK some women may still be using this type of implant.

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How often do I need to see a doctor or nurse?

You only need to go to the clinic or your general practice if you have any problems with your implant or when it needs to be replaced. If you have any problems you should contact your doctor or nurse.

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