Implants are small, progesterone-only contraceptive rods placed under the skin by a trained provider that provide highly effective birth control for 3-5 years. They work by thickening cervical mucus and often preventing ovulation. Nearly all women can use implants, which have few limitations but do not protect against STIs. While irregular bleeding is common, implants are very effective, long-acting, reversible, and convenient to use once inserted. Proper client assessment and timing of insertion are important to ensure safe and effective use of this long-acting reversible contraceptive method.

1. IMPLANTABLES
(IMPLANT CONTRACEPTIVES)
By: Andualem Gezahegn
Lecturer, SLU
June, 2023
E-mail: andbicha@gmail.com

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

9. TYPES OF IMPLANTS
Implanon: 1 rod
-Effective for 3 years
Sinoplant: 2 rods
-Effective for 4 years

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

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