Some pictures relating to Nexplanon® insertion technique:
What is the subdermal contraceptive implant?
Subdermal means ‘under the skin’.
Subdermal contraceptive implants consist of small rods, about the length of a hair grip, which contains the hormone, progestogen.
They’re inserted under the skin (sub-dermally) of the upper arm and slowly release the hormone into the woman’s body for various lengths of time, depending upon the implant used.
Internationally, there are several different types available.
At the time of writing, the implant of choice in the UK is Nexplanon®.
How does the implant work?
Its action is similar to that of the contraceptive injection.
The implant suppresses (suspends) ovulation for the duration of use; forms a barrier of thick, infertile mucus at your cervix (neck of the womb), so that sperm can’t swim through to meet an egg;
and affects the lining of your womb – preventing pregnancy.
What is the progestogen called, that’s used in the implant?
Two types of progestogen are used to make contraceptive implants.
The first is levonorgestrel (lee-vo-nor-jes-trel) (LNG).
The second is etonorgestrel (e-toe-no-jes-trel).
They are both used in other methods of hormonal contraception.
For how long do implants work?
Implants work for different durations.
1) Nexplanon® / Implanon® works for up to three years, consists of one rod and contain the progestogen called etonogestrel. (Duration advice may change.)
2a) Jadelle®, Jadelle Sine Inserter® Sinoplant®, Sinoplant II/Sino-implant II® or Zarin® works for up to five years and consist of two rods (formerly called Norplant II®) which contain the progestogen called levonorgestrel.
2b) Norplant®, the original implant, consists of six rods and now works for up to seven years. In China, it is called Sinoplant I® and also contain the progestogen called levonorgestrel.
This relates to the etonorgestrel based implants, Nexplanon® and Implanon®
What’s the difference between Nexplanon® and Implanon®?
They contain the same progestogen and act in exactly the same way.
Implanon® preceded Nexplanon®.
Nexplanon®, which has a different introducer, is designed to make insertion easier and safer.
And, Nexplanon® is visible on x-ray, which Implanon® is not.
How is the implant put in (inserted)?
A local anaesthetic is used to numb the area, then the implant is injected under the skin of the upper arm using a special type of syringe, or introducer.
The woman, and the practitioner feel the area to check that it has been implanted properly before the small wound is covered with a plaster, which is worn for 3-5 days.
To minimise bruising, discomfort and swelling, the manufacturer recommends that a compression bandage should be provided, and worn for 24 hours. Some places offer this, while others no longer do.
The area should not be knocked or allowed to get wet for 3-5 days.
Although not always necessary, a follow-up visit may be advised a few weeks later, to check that the user is happy with their implant.
Breaking the skin... Image of Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant being inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Breaking the skin - Image of Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant being inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Photo of Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant being inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Image of Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant being inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Image of Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant being inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Image of Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant being inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Photo of Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant being inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Nexplanon® (contraceptive progestogen only implant) demonstrator showing implant inserted and dropped in situ under the skin by pulling back on the insertion device once correctly situated
Nexplanon® (contraceptive progestogen only implant) demonstrator
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Does it hurt when it’s put in?
No. Injection of the local anaesthetic may sting a little, but after that, insertion of the implant does not hurt.
What might I notice after insertion?
After insertion you may notice one or more of the following:
pain or discomfort (as local anaesthetic wears off);
bruising or swelling (temporarily);
redness (temporarily);
infection (at the site of insertion);
scarring (small);
(Colleague observation: skin pigmentation change over implant site, is more often noticed on darker skin; Asian in particular).
If concerned about anything, speak to your inserting practitioner.
How is the implant removed?
As with insertion, a local anaesthetic is used to numb the area before a small incision (cut) is made beside the lower end of the implant, and it is gently pulled out using a special instrument.
A dressing is then applied, in the same way as after insertion.
Can I have another inserted at the time of removal, through the same incision?
Yes. This is a common request and contraceptive protection continues immediately when a replacement is inserted straight after removal.
Does it hurt when it’s taken out?
No. Implant removal does not hurt because local anaesthetic is used to numb the area.
Who is suitable to use the implant?
As with other progestogen only methods, the implant is suitable for most women, even if they have different medical conditions.
How reliable is the implant?
The implant is one of the safest and most reliable methods of contraception available.
However, as with other methods, there is a small failure rate, with a small risk of ectopic (tubal) pregnancy.
Who MAY not be to use it?
The implant is NOT suitable for women who are pregnant or who undiagnosed vaginal bleeding, active liver disease, known or suspected breast cancer and some other potentially serious medical conditions.
You should discuss with your practitioner if you’ve had or have:
1. breast cancer;
2. unusual vaginal bleeding;
3. active liver disease (hepatitis);
4. circulatory or cardiac (heart) problems;
5. a history of thrombosis;
6. epilepsy;
7. TB (tuberculosis);
8. high blood pressure (if over 100 kg your implant may be changed sooner than three years);
9. are overweight;
10. a history of chloasma (a skin pigmentation that occurs in sunlight, commonly on the face);
11. an allergy to any of its constituents.
If you are in doubt about the importance of something in your own, your parents’ or brother’s/sister’s medical history, disclose it (tell them).
What are the advantages of using an implant?
Advantages of implants are that:
it is highly effective, very reliable, low dose, long acting, reversible
contraception that are low in total cost;
it can last for three or more years;
they are very safe to use;
they can be used by women who are breastfeeding;
they are helpful for women who
experience heavy, painful periods;
implants do not interfere with sexual spontaneity;
their use can’t be forgotten on a daily basis.
What are its disadvantages?
The list of possible side effects looks frightening but it does NOT mean that they will be experienced.
There may be one or more of the following:
unpredictable, irregular bleeding;
an itch around the insertion site;
nausea, vomiting and/or dizziness;
acne (may improve or worsen);
breast pain/discomfort;
abdominal pain;
and there may be other rare
effects, listed by the manufacturer.
According to the latest UK guidance from NICE (National Institute for Health and Care Excellence) and the FSRH (Faculty of Sexual and Reproductive Health), there is no association between the use of progestogen-only implant and headaches, weight change, mood change, or reduced libido (sex drive).
Can I have it removed if the side effects become too much?
Yes, of course, you can have it removed if you feel that the side effects become intolerable and given help to find an alternative method.
When does the implant start to work?
It starts to work straight away if put in on the first day of menstruation, otherwise, extra protection (or no sex) is necessary for 7 days.
As with all hormonal methods of contraception, it takes about three months for the implant to settle and any side effects to improve greatly.
Will the implant control my periods?
No progestogen methods of contraception control menstrual bleeds.
Irregular bleeding/spotting may last for up to six months, occasionally longer.
If this happens to you, return to your healthcare practitioner who will guide you about keeping it, suggest using extra hormones, or having it removed.
What will it do to my periods?
Your bleeding pattern may be a little chaotic, with either irregular bleeding, no bleeding or bleeding at the time you would expect if you were not using it.
If you are concerned about your bleeding pattern, speak to your prescriber.
Can anything stop it from working?
The herbal antidepressant called St John’s Wort reduces efficacy; and enzyme inducers.
(These are drugs used to treat a range of conditions such as TB, epilepsy, anxiety and/or depression.)
If in doubt, you can check a drug’s compatibility with your pharmacist.
When should I stop using it?
If you are comfortable using it, there is no reason to stop until you want to get pregnant or use something else.
Will it protect me against pregnancy AND infection?
No, it won’t. You will still need to use condoms for protection against sexually acquired infection.
The barrier of mucus, which forms at your cervix, may slow the progress of an infection into your womb and tubes, but it won’t prevent you from catching it.
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