2. OBJECTIVES
By the end of the session students will be able to:
Describe hormonal Implants
Identify the appropriate users and medical
eligibility criteria for use of implants.
Demonstrate the standard insertion and removal
procedures for implants
Identify and manage side effects and complications
3. INTRODUCTION
DEFINITION:
Implants are progesterone only containing hormonal
contraceptives that are:
o Most effective
o Safest
o Easy to use
o Quickly reversible up on removal and
o Long acting methods
4. INTRODUCTION…
Implants are :
Small plastic rods or capsules, each about the size of
a matchstick.
A specifically trained provider places the implants
under the skin on the inside of a woman’s upper arm.
Do not contain estrogen, so can be used throughout
breastfeeding and by women who cannot use
methods with estrogen.
5. INTRO…
Implants interrupt fertility by:
Thickening cervical mucus (mechanically preventing
the sperm from accessing the ovum) and
Through hormonal effects that prevent ovulation in
about half of menstrual cycles.
6. INTRODUCTION TO IMPLANTS…
Nearly all women can use hormonal implants including:
Women of any age
Women who have or have not children
Married or not married
Women who wish to space or limit births
Women who had abortion or miscarriage
Women who are breast feeding (6 weeks post partum)
Women who have HIV/AIDS and are on ART
Implants DON’T protect against HIV/STI
7. EFFECTIVENESS
Implants are:
Less than 1 pregnancy per 100 women using implants
over the first year
NOTE:
Implants start to lose effectiveness sooner for
heavier women (80 kg or more)
Implants in such women should be replaced after 4
years.
8. TYPES OF IMPLANTS
Norplant
Six LNG containing capsules
Each capsule contain 36mg LNG
Each capsule size is 2.4mm by 34mm
Jadelle
Two LNG containing capsules
Each capsule contain 75mg LNG
Each capsule size is 2.4mm by 44mm
10. FEATURES OF CONTRACEPTIVE IMPLANTS
• Are safe and Highly effective
• Not client motivation dependent
• Can be used during lactation
• Discreet, virtually invisible
• Rapidly reversible fertility
• Fewer hormonal ups and downs
• Irregular bleeding is the most
common side effect
11. FEATURES (Cont…)
• Stable hormone levels
• Extended protection (3 – 5 Years)
• Contain no estrogen
• Does not protect against STIs and HIV
• Requires a minor surgical procedure for insertion
and removal of the rods
• Cannot discontinue the method on one’s own.
12. NON CONTRACEPTIVE HEALTH BENEFITS
Help prevent ectopic pregnancy
Help protect against Symptomatic PID
Help prevent iron deficiency anaemia
May prevent endometrial cancer
Implants have no effect on sexual function.
13. MECHANISM OF ACTION
Mechanisms are:
Increased thickness of the cervical mucus (within 48-
72 hours after insertion).
Inhibition of ovulation - in about 50% of menstrual
cycles.
Suppression of endometrial growth so that it is less
receptive to implantation.
14. RETURN TO FERTILITY
There is no delay in return to fertility upon
removal of implants
implants have no impact upon long-term fertility.
15. SIDE EFFECTS
Changes in bleeding patterns (many bleeding
disturbances diminish with continued use)
Typical changes include:
o Lighter bleeding
o Fewer days of bleeding
o Irregular bleeding that lasts more than eight days
o Infrequent bleeding and
o No monthly bleeding.
16. DRUG INTERACTION EFFECT ON IMPLANTS
EFFECTIVENESS
Use of some drugs can induce hepatic enzymes that break
down hormonal contraceptives.
Implants are likely to be less effective in such clients that may
lead to unintended pregnancy or breakthrough bleeding.
These drugs include:
Rifampicin
Griseofulvin
Phenobarbital, phenytoin, Dilantine....
Some ARV drugs
17. APPROPRIATE USERS FOR IMPLANTS
Implants can be used by most women of the reproductive
age who:
Prefers a long-term method
Can not remember to take a pill every day.
Are breastfeeding and after 6 weeks post-partum.
Is postpartum and not breastfeeding.
Cannot take estrogen-containing contraceptives
Is considering sterilization but not ready to make a final
decision.
Is post-abortal (immediately after) or post partum
(After 6 weeks)
Has moderate to severe menstrual cramping,
Smoke
18. MEDICAL ELIGIBILITY
Nearly all women can use implants safely and effectively,
including women who:
Have or have not had children
Are not married
Are of any age, including adolescents and women
over 40 years old
Have just had an abortion, miscarriage, or ectopic
pregnancy
Have anemia now or in the past
Have varicose veins
Are infected with HIV, whether or not on
antiretroviral therapy
19. MEDICAL ELIGIBILITY...
Implants may not be appropriate for some women.
Therefore, service providers must assess clients
regarding the appropriateness of using implants.
20. CLIENT ASSESSMENT
Take history that identifies the clients reproductive
goals, screens for precautions to the use of implant,
and screens for any medical problems.
Pelvic examination is not recommended unless under
certain circumstances.
Pregnancy test is not necessary unless indicated
Rule out pregnancy reasonably using the checklist
before initiation of implants
21.
22. TIMING OF INSERTION
During menstruation:
Days 1-7 of the menstrual cycle
Post partum:
After 6 weeks if breastfeeding but not using
Lactational amenorrhea (LAM);
immediately or within 6 week, if using LAM
Post abortion:
Immediately or within the first 7 days)
23. IF SWITCHING FROM ANOTHER CONTRACEPTIVE
METHOD
Natural family planning or Barrier:
First 7 days of the menstrual cycle
COC:
During the 7 days after the 21st pill has been taken
POP
On the day the last pill in the pack is taken
Injectable Hormone(s)
Any time up to the time of the next scheduled injection.
IUCD:
anytime, but need to use a backup method of contraception
for 7 days.
Implant:
at the same time the implant rods are being removed.
24. TIMING OF IMPLANT REMOVAL
At anytime during the menstrual cycle.
At 5 years of use for Jadelle,
4 years for sino-plant and
3 years for Implanon.
(Implant’s effectiveness drops after the specified years,
increasing the risk of intrauterine and ectopic pregnancy)
Anytime client requests for removal, (after adequate
counseling)
25. LIMITATIONS OF CONTRACEPTIVE IMPLANTS
Can cause irregular bleeding
Requires clinician visits for insertion and removal
Does not protect from STDs
High cost ???
Misperceptions surrounding implant history
26. Limitation Cont…
If removed before 3 yrs of use not economical
No protection of STI & HIV
Decrease in effectiveness with the use of some drugs
Some users may experience side effects
27. IN CONCLUSION
Implants are:
Advancement in contraceptive options
Safe, highly effective, and rapidly reversible
Offers women additional choice
Can be used by most reproductive-age women
Clients are satisfied with them because they are
• Convenient to use,
• Long-lasting and
• Highly effective
• Continuation rates are high
28. IN CONCLUSION cont…
Implants provide highly effective, long-acting pregnancy
protection (3 to 5 years)
Although insertion and removal require a trained
provider, both procedures are done quickly
Contraceptive protection is immediately reversible upon
implant removal
Implants have no impact on long term fertility
