Implanon is a hormone-releasing implant containing progestin (etonogestrel) which is used for birth control. It is one of the most reliable contraceptive methods with a failure rate of less than 1% per year.
Contents:
Indications for use
Implanon is used for long-term birth control.
This method is most suitable in the following cases:
- no pregnancy is planned for the next few years;
- estrogens are contraindicated;
- breastfeeding period;
- an unfortunate experience with combined oral contraceptives;
- a woman is not ready for a radical birth control method – sterilization.
Mechanism of action
Implanon implant prevents pregnancy, due to the action of the active ingredient, etonogestrel which inhibits ovulation, suppressing the release of luteinizing hormone in the middle of the period. Etonogestrel also increases the viscosity of cervical mucus, preventing sperm from moving to the egg (fertilization).
In addition, etonogestrel can suppress proliferation of the endometrium, making it difficult to implant a fertilized egg into the uterine mucosa.
- Suppression of ovulation;
- Endometrial atrophy;
- Impact on spermatozoa migration – thickening of cervical mucus.
Device description
Implanon contraceptive is a rod that consists of two parts:
- The core with the hormone in a state of dispersion – the smallest grinding. The core is fixed on a matrix of a copolymer of ethylene vinyl acetate;
- The outer shell, which has a membrane structure with tiny pores. The thickness of the shell is 0.06 mm. It regulates the gradual release of the active substance etonogestrel into the blood.
The pack also includes a disposable needle-applicator, which is needed to insert the implant.
How to use a birth control implant?
The implant is installed and removed only in a medical facility and only by specialists who know how to install it.
Implanon is a long-acting contraceptive. The device is placed subcutaneously and can serve for up to 3 years. If necessary, it can be removed earlier.
The insertion of an implant is carried out within the strictly prescribed time frame. It depends on the condition of the woman. Pregnancy should be excluded.
Women who did not take hormonal contraceptives get the drug inserted on menstruation days. The optimal time – 1 to 5 days. If the period is prolonged, the insertion is carried out until the 5th day of menstruation.
Women who used combined oral contraceptives get Implanon inserted the day after the last pill. Those who used a bandage or a vaginal ring as a contraceptive get the system inserted on the day of removal of the previous contraceptive. The same instructions are applied to those who used gestagen-containing contraceptives (mini-pills, another implant, an intrauterine system).
After an abortion (up to 12 weeks of pregnancy), the implant is inserted immediately.
After an abortion in the 2nd trimester, the device is inserted 21-28 days after interruption of pregnancy or after delivery. If the deadline is missed and the insertion occurs later, it is necessary to use barrier methods of contraception within the first week after it. If you had sexual intercourse before the implant insertion, you need to exclude pregnancy, wait for the first menstruation and get the birth control device installed on 1-5 day of menstrual bleeding. The approach is similar for those who gave birth on time and breastfeeding women.
When installing the hormone rod in a time that does not meet the recommendations, it is necessary to use additional non-hormonal birth control methods. The concentration of the hormone in the blood will reach a level that can block ovulation in a week. Cases of pregnancy on the background of using Implanon contraceptive were not registered. The Perl index is 0.05.
Menstruation after use of the drug should begin on time. If you have no menstruation after the implant removal, you need to visit a doctor. Probably, you will need an additional medical examination.
How to insert Implanon?
The system insertion should be carried out only by a doctor who owns these skills. The kit contains a special disposable applicator, which facilitates the installation.
Aseptic conditions must be observed to reduce the possibility of infection of the wound.
The rod is installed on the non-dominant hand. A woman is offered to lie down, take the hand aside and bend the elbow. A doctor determines the place for implantation and disinfects the skin area.
To eliminate pain, local anesthesia is used (a solution of lidocaine).
Then the applicator is removed from the package. Be sure to check if it contains an implant. It looks like a white stripe inside the needle. Only after this, you can remove the cap from the tip of the needle. It is very important to keep the applicator in an upright position – when tilted, the hormonal system can fall out of the needle. Also, care should be taken to maintain sterility of the needle. If there is a disruption, the drug should be replaced with a new one.
A doctor stretches the skin with the thumb and forefinger on the inside of the hand. At an angle of 20 degrees, the tip of the needle is inserted. The skin is released. The applicator is placed in a horizontal position. Gradually, the needle is completely inserted for the entire length under the skin. The applicator maintains a position parallel to the arm.
Observance of the insertion depth is very important. If Implanon contraceptive is established deeper, a sense of paresthesia may appear. If the implant enters the fascia or muscle, it can migrate with contractions.
When the needle is inserted correctly, break the jumper of the applicator. A doctor twists the obturator 90 degrees and gradually removes the needle from the skin. The obturator is never pressed.
After the extraction of the needle, a doctor checks the absence of a contraceptive system in it. A groove from the obturator should be visible at its end. Palpate the injection site to determine the position of the hormonal system.
If the implant is not palpable, you need to choose another way to establish its position. The most accessible and easy way is ultrasound. If he did not determine the position, then a woman will have to undergo an MRI. If there is no possibility to resort to these methods, hormonal research is conducted, which allows determining the concentration of etonogestrel in the blood. If its concentration is increased, this means that the drug was inserted successfully.
It is recommended to use barrier methods of contraception until the presence of the hormonal system is confirmed.
At the injection site, a sterile bandage is applied, which will slightly compress the skin. This will not allow bruising.
After the manipulation, the doctor fills in the woman’s card that comes with the drug. He marks the series and number of the hormonal system, the date when the injection was made, the exact location on the arm, the name of the medical institution and the name of the doctor. These data will be needed in the future when the system is removed.
How to remove Implanon?
The duration of hormonal contraception makes up to 3 years. After this time, you need to remove the system or replace it with a new one.
Implanon should be removed at a medical institution by a doctor who inserted the device. You need to have a user card with you. Removal of the implant is carried out in compliance with the rules of asepsis and antiseptics.
First, a doctor needs to feel the location of the remedy. Then he determines its closest end to the elbow. If the device cannot be felt, a woman undergoes an ultrasound, MRI and a test which allows determining the content of etonogestrel in the blood. Surgical intervention without information about the implant localization is strictly prohibited.
A solution of lidocaine is used for anesthesia.
The doctor presses the proximal end of the stem with the hormone and fixes it. The distal end may become noticeable in the form of a convexity under the skin. A doctor makes a small incision along the arm, gradually pushes the implant to the place of the incision, until it appears from the wound. Then he uses a forceps to grasp the notable end and remove it.
After the procedure, a clamp and an aseptic pressure bandage are applied to the place of the incision to prevent hematomas.
If a woman wants to continue using this method of contraception, she can get a new implant inserted immediately after the removal of the previous drug. The procedure remains the same.
Contraindications
Contraindications for using Implanon are similar to those for gestagen contraceptives. Do not try to insert the system if there are any of the conditions listed below. Also, the hormonal system is removed if any of the below-listed diseases develop:
- Individual intolerance of the components of the drug or hypersensitivity to them;
- Pregnancy. Large doses of etonogestrel can contribute to the development of signs of masculinization in a female fetus;
- Antiphospholipid syndrome – the presence of antibodies to phospholipids, a condition in which the risk of developing thrombosis increases. Often this disease is diagnosed with habitual miscarriage;
- Venous or arterial thromboses (in the anamnesis). It can also be deep vein thrombophlebitis, pulmonary embolism, myocardial infarction, transient ischemic attacks, a stroke of the brain;
- Mammary cancer. It can be a diagnosed disease or condition after treatment. Tumor cells respond to the ratio of hormones, so the implant insertion can accelerate the tumor growth or relapse;
- Malignant or benign hormone-dependent tumors that can also respond to the gestagens and accelerate their growth or cause a relapse;
- Bleeding from the genital tract of unclear etiology. This condition needs to be diagnosed – it can be the first symptom of a tumor of the genital organs;
- Benign or cancerous liver tumors (including in an anamnesis). The liver is the main organ of sex hormone metabolism. Any changes in this organ disrupt the process of neutralization;
- Migraines with focal neurological symptoms also increase the risk of micro thrombosis;
- Arterial hypertension, which cannot be corrected and controlled;
- Age under 18.
In each case, one should approach individually the question of the insertion or premature removal of Implanon. Particular attention should be paid to women with diabetes who have diabetic angiopathy.
Vascular damage in diabetes also increases the risk of thrombosis.
After the surgical intervention, which requires a prolonged immobilization, the question of removing the hormonal system should be raised. Long stay in the supine position leads to the release of clotting factors, which increases the risk of thrombosis of vessels.
It is necessary to decide the issue in favor of removing a birth control implant in the following cases:
- treatment with anticoagulants;
- conditions that precede the development of thrombosis (angina pectoris, damage to the heart valves, fibrillation);
- extensive injuries.
Side effects
The drug is safe when used correctly. Side effects of Implanon implant are rare but they cannot be excluded completely.
Progestogen affects menstrual periods. Menstruation ceases in 20% of women. The same number of women have frequent or abundant menstrual bleeding.
Some patients complain of pain at the injection site. It can persist for several days, as a normal reaction of the body to trauma to the skin.
In rare cases, etonogestrel contraceptives may cause the following local reactions:
- redness (erythema);
- swelling of tissues;
- hematoma and bruise;
- hyperthermia (a sensation of fever over the wound).
The specific action of progestogens can lead to the following adverse reactions:
- acne, seborrhea, increased skin fat, increased hair growth (hypertrichosis);
- skin itching and rash;
- irregular menstruation;
- pain in the mammary glands,
- excretion of breast milk;
- discomfort in the labia, itching of the vulva and vagina;
- increased body weight and increased appetite;
- headaches, dizziness, migraine-like condition, drowsiness;
- pain and bloating, dyspepsia: constipation, flatulence, diarrhea, belching.
Progestogens can affect the mental state, for example, cause anxiety, insomnia, reduce feelings of sexual desire, lead to a depressed state, frequent changes in mood, nervousness.
Hormonal effects on the ovaries can lead to the formation of a cyst. This condition is first accompanied by a pulling pain in the lower abdomen, which can be amplified by movement. Sometimes it is accompanied by symptoms of an acute abdomen and requires emergency care.
In statistical studies, the following adverse reactions were reported:
- urticaria and anaphylactic reactions;
- fibrosis, scar or abscess at the injection site;
- paresthesia;
- implant migration.
In rare cases, women reported the development of ectopic pregnancy. This state can occur when the implant is inserted incorrectly.
Unique side effects of Implanon:
- cholestasis, which leads to jaundice and skin itching;
- thromboembolism of arteries, veins;
- gallstones; gallstones;
- systemic lupus erythematosus;
- hemolytic-uremic syndrome;
- tumors of the liver and breast;
- relapse of herpes;
- otosclerosis, which led to hearing loss.
These negative reactions are extremely rare. If a doctor correctly assesses the condition of the patient at the time of the hormonal system insertion, most side effects can be avoided.
Interactions
Misuse of medicines can lead to serious consequences. Implanon interaction with certain drugs can intensify bleeding during menstruation and reduce the contraceptive effect. No special studies on the interaction of drugs and etonogestrel implants were carried out.
Presumably, hepatic metabolism can reduce or accelerate the excretion of the drug. Neutralization of toxic substances and drugs can be caused by microsomal enzyme P450. Some drugs can enhance the metabolism of sex hormones: Rifampicin, Phenytoin, Carbamazepine, Ritonavir, Griseofulvin, St. John’s wort.
Those women who had to use the listed medicines are advised to use the barrier birth control method during the treatment and 28 days after it.
Preparations that inhibit hepatic enzymes indirectly lead to an increase in the concentration of hormones in the blood. This property is possessed by the antifungal drug Ketoconazole.
A reverse situation may develop when a hormonal implant reduces the effects of some drugs. Therefore, before using any medication, you need to read the instructions and consult a doctor.
Implanon and breastfeeding
It’s allowed to use a hormonal implant during breastfeeding but only after consulting a doctor. Progestogens do not affect the quantity and quality of milk and do not change the concentration of fat, protein and carbohydrates in it. A small amount of the active substance etonogestrel penetrates into breast milk.
Gradually, the dose of the hormone released during lactation decreases. But it is necessary to consult a doctor before using hormonal contraception during breastfeeding.
Special instructions
Pregnancy can be planned in the first period after the drug removal. But you’d better give the ovaries some time to recover completely.
This birth control implant is highly effective. The hypodermic implant contains only one hormone (an analog of the female hormone progesterone) and does not contain estrogens, which makes it possible to use this contraceptive for breastfeeding women and those who cannot use estrogen, including smoking women over the age of 35, or women suffering from a migraine or arterial hypertension.
The efficiency of this contraceptive method reaches 99.9%. Its effect is reversible, fertility is restored in a short time after the implant removal.
In some cases, the system can change its location. There were few such reports, but if the rod is properly installed, this risk is minimal. The system displacement occurs when it is inserted into the muscle or fascia, if the skin has been stretched incorrectly, and the needle is inserted too deeply. This condition is not dangerous, the rod is easily determined by ultrasound or MRI.
Women with obesity can use this birth control method, but they have a higher need for hormones. Therefore, the contraceptive effect may decrease in the third year of use.
Etonogestrel can cause dizziness. Therefore, a woman should be careful when driving vehicles or working with complicated equipment.
Implanon is well tolerated by most women. The most frequent reason for premature drug removal is menstrual disorders.
The risk of developing breast cancer increases with age.
Since it is impossible to exclude the negative effect of progestogens on the development of liver cancer, an individual assessment of the benefit-risk ratio in women with liver cancer should be carried out.
Use of the contraceptive should be discontinued if thrombosis develops. You should also consider the need for the drug removal in case of surgical intervention or long-term immobilization. Women with thromboembolic disorders in an anamnesis should be warned about the possibility of their recurrence.
Women with diabetes should be carefully monitored throughout the period of use of the hormonal contraceptive system.
Despite the fact that the drug constantly depresses ovulation, the risk of ectopic pregnancy cannot be excluded (symptoms include amenorrhea or abdominal pain).
Safety and efficacy of Implanon implant have been evaluated for women of reproductive age. It is expected that the effectiveness and safety will be similar in adolescents in the post-pubertal period. Nevertheless, clinical trials in women under the age of 18 years have not been conducted. The use of this medication is not indicated until the onset of menarche.