Contraception: Progestogen only implant

The implant works in a number of ways.

The main action is to stop your ovaries releasing an egg (ovulation). It also works by:

• thickening the mucus from your cervix (neck of the womb). This makes it difficult for sperm to move through it and reach an egg
• thinning the lining of your uterus (womb) so it’s less likely for a fertilised egg to be able to implant into the womb and create a pregnancy.

It’s common for your bleeding pattern to change while you’re using the contraceptive implant. It may change at any time over the three years the implant lasts.

Bleeding may be irregular, lighter, shorter, more frequent, less frequent, last longer or stop altogether.

These changes to your bleeding may be a nuisance but they're not harmful.

If you have bleeding that's a problem for you at any time, talk to your healthcare professional. They may be able to give you some additional hormone or medicine that can help control the bleeding. They may also check that the bleeding isn't due to other causes, such as an infection.

The implant is the most effective method of contraception. It's well over 99% effective. Less than one in 1000 implant users will get pregnant in the first year of use.

The implant is a method of long-acting reversible contraception (LARC). LARC is very effective because it doesn’t depend on you remembering to take or use it.

Most women can use the Progestogen only implant. A doctor or nurse will ask you about your own and your family’s medical history.

Some of the conditions which may mean you shouldn’t use the implant are:

• you think you might already be pregnant
• you take certain medicines.

You have now or had in the past:

• heart disease or a stroke
• disease of the liver
• breast cancer.

If you’re healthy and there are no medical reasons for you not to use the implant, you can use it until your menopause or until you’re 55 years old.

It works for three years.

You can probably use it if you can’t take oestrogens, like those found in the Combined oral contraceptive pill, combined contraceptive patch or ring.

It can be prescribed independently of Body Mass Index (BMI).

You can use it at any age until the age of 55, but it’s especially useful if you smoke and are 35 years or over.

It may help with premenstrual symptoms and painful periods.

You can use it if you’re breastfeeding.

Your fertility will return to normal as soon as the implant is taken out.

Your bleeding pattern may change in a way that’s not acceptable to you; this is particularly true when you first start the progestogen only implant (or any method of hormonal contraception). Some women may stop bleeding completely with the implant and this is nothing to worry about.

The implant doesn’t protect you against sexually transmitted infections, so you may want to use condoms as well.

It requires a small procedure to insert and remove it.

You may get some temporary side effects when you first start using the implant, such as skin changes, breast tenderness and headaches. These often settle within a few months.

Rarely, you may get an infection in your arm where the implant's been inserted. This can usually be easily treated with antibiotics

Very rarely, the implant may be inserted too deeply into your arm. It can be removed by an experienced healthcare professional.

Very rarely the implant may cause damage to a nerve or blood vessel within the arm.

If you can't feel the implant in your arm, or if you have pain, numbness or pins and needles in your arm, ask a healthcare professional to check it for you.

Research about the risk of breast cancer and hormonal contraception is complex and contradictory. Research suggests women who use hormonal contraception may have a small increase in the risk of being diagnosed with breast cancer compared to women who don’t use hormonal contraception.

You can normally start using the contraceptive implant at any point in your menstrual cycle.

There is special guidance if you have just had a baby, abortion or miscarriage.

You can have the contraceptive implant inserted at any time in your menstrual cycle if you’re sure you’re not pregnant.

If you have the contraceptive implant inserted:

• On the first day of your period, you’ll be protected from pregnancy immediately
• Up to, and including, the fifth day of your period, you’ll be protected from pregnancy immediately
• At any other time in your menstrual cycle, you’ll need to avoid sex or use additional contraception, such as condoms, for the first seven days after your implant has been inserted.

If you have a short menstrual cycle with your period coming every 23 days or less, starting the contraceptive implant as late as the fifth day of your period may not give you immediate contraceptive protection. This is because you may ovulate (release an egg) early in your menstrual cycle. You may wish to talk to your doctor or nurse about this and whether you need additional contraception for the first seven days.

If you have the progestogen only implant inserted after having had unprotected sex or after taking emergency contraception please do a pregnancy test three weeks after the last time you had unprotected sex.

Some medicines may make the contraceptive implant less effective. These include some of the medicines used to treat HIV, epilepsy and tuberculosis (TB), and the complementary medicine St John’s Wort. These are called enzyme-inducing drugs. If you take these medicines, it’ll be recommended that you change to a different method of contraception or that you use additional contraception, such as condoms.

Always tell your healthcare professional that you’re using the contraceptive implant if you’re prescribed any medicines.

The implant isn't affected by common antibiotics, diarrhoea or vomiting.

The implant is the size of a matchstick. It’s placed just under your skin in the side of your upper arm.

A trained healthcare professional will give you a local anaesthetic to numb the part of your arm where the implant will go, so it won’t hurt.

It only takes a few minutes to insert and feels like having an injection. You won’t need stitches.

After it’s been inserted, the healthcare professional will check your arm to make sure the implant's in place. You’ll be shown how to feel the implant with your fingers, so you can check it’s in place.

The area may be tender for a day or two and may be bruised and slightly swollen. The healthcare professional will put a dressing on it to keep it clean and dry and to help reduce 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 shouldn’t break or move around your arm. You’ll be able to do normal activities and you won’t be able to see it.

You don’t need a vaginal examination or cervical screening (smear) test to have an implant inserted.

An implant can be left in place for three years. It can be removed sooner if you want to stop using it.

A specially trained healthcare professional must take it out. They'll feel your arm to locate the implant. They’ll give you a local anaesthetic injection in the area where the implant is. They’ll make a small cut in your skin and gently pull the implant out.

They’ll put a dressing on the arm to keep it clean and dry and to help reduce any bruising. Keep this dressing on for a few days.

It usually only takes a few minutes to remove an implant. If the implant's been inserted correctly, it shouldn’t 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, you may be referred to a specialist centre to have it removed with the help of an ultrasound scan.

If you want to carry on using an implant, you can get a new one inserted at the same time. You’ll then continue to be protected from pregnancy.