The video will provide you with an overview of how the contraceptive implant provides contraceptive protection.
How does the contraceptive implant work? The video will provide you with an overview of how the contraceptive implant provides contraceptive protection. Read video transcript
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How does the contraceptive implant work?

  • The contraceptive implant is a tiny rod
  • The implant is placed just under the skin
  • A hormone is released into the blood
  • The hormone circulates at low levels around the body
  • The hormone stops egg development and release, and thickens the cervical mucus, making it harder for sperm to pass into the womb
  • The hormone also thins the lining of the womb, and inhibits implantation of an egg if it does manage to get fertilized
  • The implant provides contraceptive protection for up to 3 years

Contraceptive implant

A long-acting reversible contraceptive (LARC) implant is a small (4 cm long and 2 mm diameter), flexible, white plastic rod that contains 68 mg of etonogestrel, a synthetic progestogen hormone1 placed under the skin of the arm. The hormone is released slowly into the tissue under the skin, from where it is transferred via the bloodstream to the rest of the body over a 3 year period1.

How the contraceptive implant works

The contraceptive implant contains etonogestrel, a synthetic progestogen hormone which is released into the bloodstream1. Etonogestrel stops eggs developing in your ovaries and their subsequent release, thereby preventing fertilization and hence pregnancy1. It also thickens the mucus (the secreted fluid) at the cervix, which is the entry to your womb, thus making it harder for sperm to reach an egg for potential fertilization1. Furthermore, the hormone also thins the lining of your womb, reducing the ability of an egg to implant there2.

The implant starts to work as soon as it is placed, provided this is done between the first and fifth day of your menstrual cycle1. If fitted on any other day of your cycle, you should use an extra method of contraception, such as a condom, for seven days1. The implant can also be placed immediately after an abortion, or at the earliest from four weeks after having given birth if you are breastfeeding1.

Before placement of the contraceptive implant

Before the contraceptive implant is inserted, your healthcare professional will ask you some questions about your personal health history and that of your close relatives. The healthcare professional will also measure your blood pressure, and depending on your personal situation, may also carry out some other tests1.

Placement of the contraceptive implant

The contraceptive implant will be fitted by a healthcare professional trained in the procedure. It is placed just under the skin of your upper non-dominant arm (i.e. the one that you don’t write with) using a specially designed disposable applicator1.

Placement of a contraceptive implant.You will be given a local anesthetic and asked to lie on your back, with your non-dominant arm (the one you don’t write with) slightly bent at the elbow and turned outwards.

Placement of a contraceptive implant.The skin is stretched and a needle containing the implant is inserted directly under, and parallel to, the skin on the inside of your upper arm. The implant will then remain under the skin when the needle is withdrawn

A local anesthetic is provided just before the insertion1. During the insertion of the implant, there may be some bruising, pain or itching and in rare cases an infection1. There may also be a scarring or a numbness (or lack of feeling) at the insertion site1. Incorrect insertion too deep under the skin may lead to difficulty of removal, or damage to nerves or blood vessels1. The implant may migrate from the original insertion site if it hasn’t been correctly placed or has been manipulated into another position, for example, through physical contact such as participation in contact sports1.

Check-ups after placement of the contraceptive implant

Your healthcare professional may ask you to return for a routine medical check-up 3 months after placement of the implant1. The frequency and nature of further check-ups will depend on your personal situation.

Contact your healthcare professional as soon as possible if1:
  • you have severe pain or swelling in either of your legs
  • unexplained pains in the chest
  • breathlessness
  • an unusual cough, especially when if you cough up blood
  • you have a sudden, severe stomach ache or look jaundiced
  • you feel a lump in your breast
  • you have a sudden or severe pain in the lower part of your belly or stomach
  • you have unusual, heavy vaginal bleeding
  • you are to be immobilized (for example being confined to bed) or are to have surgery (consult your doctor at least four weeks in advance)
  • you suspect that you are pregnant1


Removal of the contraceptive implant

Your contraceptive implant should be removed by a trained healthcare professional1. He/she will feel for the ends of the implant using the fingertips, but if it cannot be felt, an imaging method, such as ultrasound or X-ray, will provide the exact location1. After applying a local anesthetic, a small incision is made in the skin and the tip of the implant can then be gently pushed out of your arm and removed using forceps1. Sometimes a tissue capsule has formed around the implant, which needs to be opened first before the implant can be removed. The incision is then covered with a sterile dressing along with a pressure bandage1. The bandage can be removed after 24 hours, and the dressing after 3 to 5 days1.

Effectiveness of the contraceptive implant (in preventing pregnancy)

The implant will provide you with effective contraception for up to 3 years although if you are overweight the doctor may advise you to replace the implant earlier1. Pregnancy rates with this type of contraceptive are very low. Less than one per thousand women will get pregnant during the first year of using the implant3. By using the implant, which is permanently in place, no pregnancies occur due to problems remembering to use a contraceptive.

Women who rely on their partner using condoms can typically experience a pregnancy rate of as high as 180 per thousand women per year (only 20 per thousand if used perfectly)3.

As with other long-acting reversible contraceptives (LARC), the implant system offers the advantage of a contraceptive that you don’t have to think about and which doesn’t stop the spontaneity of sex.

The contraceptive efficacy of the contraceptive implant may be reduced if you use other medications. These include medicines used for the treatment of epilepsy (e.g. primidone, phenytoin, barbiturates, carbamazepine, oxcarbazepine, topiramate, felbamate), tuberculosis (e.g. rifampicin), HIV infections (e.g. ritonavir, nelfinavir, nevirapine), other infectious diseases (e.g. griseofulvin), depressive moods (the herbal remedy St. John’s wort)1. The contraceptive implant may also interfere with the working of other medicines; e.g. increase the activity of ciclosporin and decrease the effect of lamotrigine1.

You should always tell your healthcare professional which medicines or herbal products you are already using1. They can tell you if you need to take additional non-hormonal contraceptive precautions and if so, for how long, since the interaction may last up to four weeks after you stop using the contraceptive implant1. They may also advise that the contraceptive implant is removed1. If you want to use herbal products containing St. John’s wort while you are already using a contraceptive implant, you should consult your healthcare professional first1.

Return to fertility after using the contraceptive implant


There is no effect on fertility, and after your contraceptive implant is removed, your fertility returns to ‘normal’ as before placement2.

Using the contraceptive implant while breastfeeding


Although a small amount of the etonogestrel passes into breast milk, studies have not shown any negative effects on the production or the quality of breast milk, nor on the growth and development of the child1. If you are breastfeeding and want to use the implant, ask your healthcare professional for further advice.

The implant should be placed at the earliest from four weeks after giving birth if you are breastfeeding, or 21 to 28 days after childbirth if you are not breastfeeding1.

Side-effects & the contraceptive implant

Changes to your periods


A common side-effect of using a contraceptive implant is a change to your periods. You may experience a change in frequency (absent, less, more frequent or continuous), intensity (reduced or increased) or in duration1. Around 1 in 5 women experience an absence of bleeding while another 1 in 5 women have frequent and/or prolonged bleeding1. Occasionally, heavy bleeding has been observed1. In clinical trials, bleeding changes were the most common reason for stopping treatment (about 11 %)1. The bleeding pattern that you experience during the first 3 months generally indicates your future bleeding pattern1.

However, such changes do not indicate that the implant is not working or is not suitable for you, but you should consult your healthcare professional if bleeding is heavy or prolonged1.

Other side-effects1


Very common and common side-effects

Very common side-effects in more than 1/10 womenCommon side-effects in more than 1/100 women
  • acne
  • headache
  • increase in body weight
  • breast tenderness
  • pain and infection of the vagina


  • hair loss
  • dizziness
  • depressive moods
  • emotional lability
  • nervousness
  • decreased sexual drive
  • increased appetite
  • abdominal pain
  • nausea
  • gas in stomach and intestines
  • painful menstruation
  • decrease in body weight
  • influenza-like symptoms
  • pain
  • fatigue
  • hot flushes
  • implant site pain
  • implant site reaction
  • ovarian cysts (small fluid-filled sacs that develop in the ovaries that usually disappear on their own but sometimes cause mild abdominal pain. On rare occasions they may lead to more serious problems).


For a comprehensive list of side-effects, including those that are uncommon, as well as information on specific areas of concern, go to the side-effects: contraceptive implant page.

When should you not use the contraceptive implant?

There are a number of medical conditions which may make it unsuitable for you to have a contraceptive implant. These include1:

  • if you are allergic to etonogestrel or any of the other ingredients of the implant
  • if you have a thrombosis (formation of a blood clot in a blood vessel such as the legs or lungs)
  • if you have or have had jaundice (yellowing of the skin) or severe liver disease (when the liver does not function correctly)
  • if you have or have had or may have cancer of the breast or of the genital organs
  • if you have any unexplained vaginal bleeding


If any of the above conditions appear for the first time while using a contraceptive implant, consult your healthcare professional immediately.

Use with caution

If the implant is used in the presence of any of the conditions listed below, you may need to be kept under close observation1. You should tell your healthcare professional before the implant is inserted. Also if the condition develops or gets worse while you are using the implant, you must tell your doctor if:

  • you have had cancer of the breast
  • you have or have had a liver disease
  • you have ever had a thrombosis
  • you have diabetes
  • you are overweight
  • you suffer from epilepsy
  • you suffer from tuberculosis
  • you have high blood pressure
  • you have or have had chloasma (yellowish-brown pigmentation patches on the skin, particularly of the face); if so avoid too much exposure to the sun or ultraviolet radiation


Your contraceptive choices

FAILURE RATE

FAILURE RATE

FAILURE RATE

FAILURE RATE

2| 1,000WOMEN(number of pregnancies after one year of use)
6-8| 1,000WOMEN(number of pregnancies after one year of use)
2-60| 1,000WOMEN(number of pregnancies after one year of use)
< 1| 1,000WOMEN(number of pregnancies after one year of use)

ADMINISTRATION

ADMINISTRATION

ADMINISTRATION

ADMINISTRATION

Placement in womb
Placement in womb
Injection in arm or buttock
Placement under the skin of arm

LENGTH OF PROTECTION

LENGTH OF PROTECTION

LENGTH OF PROTECTION

LENGTH OF PROTECTION

Up to 5 years
Up to 5 to 10 years, depending on model
12 weeks
Up to 3 years

RETURN TO FERTILITY

RETURN TO FERTILITY

RETURN TO FERTILITY

RETURN TO FERTILITY

No delay
No delay
Possible delay of up to 1 year following treatment cessation
No delay

MENSTRUAL BLEEDING

MENSTRUAL BLEEDING

MENSTRUAL BLEEDING

MENSTRUAL BLEEDING

  • Initially periods may be lighter or heavier, longer or shorter or absent.
  • Infrequent or absent periods likely after several months.
  • Bleeding and spotting days may increase in first few months.
  • Bleeding may be heavier.
  • Irregular and possibly lengthy bleeding or spotting or no bleeding at all.
  • Periods may become more or less frequent, continuous or absent.
  • May reduce or increase in intensity or duration.

BODY WEIGHT

BODY WEIGHT

BODY WEIGHT

BODY WEIGHT

No effect
No effect
May cause weight gain of 2.3 – 3.6 kg in the first year
No effect

USE DURING BREASTFEEDING

USE DURING BREASTFEEDING

USE DURING BREASTFEEDING

USE DURING BREASTFEEDING

  • Yes
  • 6 weeks after birth
  • Yes
  • 6 weeks after birth
  • Yes
  • 6 weeks after birth
  • Yes
  • 4 weeks after birth

HEAVY PERIOD TREATMENT

HEAVY PERIOD TREATMENT

HEAVY PERIOD TREATMENT

HEAVY PERIOD TREATMENT

Yes
No
No
No

USE IN ESTROGEN THERAPY

USE IN ESTROGEN THERAPY

USE IN ESTROGEN THERAPY

USE IN ESTROGEN THERAPY

Yes – Recommended for use in conjunction with estrogen replacement therapy
No – Not recommended for use in conjunction with estrogen replacement therapy
No – Not recommended for use in conjunction with estrogen replacement therapy
No – Not recommended for use in conjunction with estrogen replacement therapy