Implanon, now known as Nexplanon, is a type of long-acting reversible contraceptive implant. It is highly effective, with a failure rate of less than 1% and provides continuous contraception for up to three years.

Nexplanon is designed to release a low, steady dose of etonogestrel over a period of up to three years. Once released from the implant, etonogestrel is absorbed into the bloodstream and circulates throughout the body, which prevent pregnancy by the following mechanisms:

1. Inhibition of Ovulation:
   • Primary Mechanism: Etonogestrel prevents the ovaries from releasing an egg (ovulation). Without ovulation, there is no egg available for fertilization, which prevents pregnancy.
2. Thickening of Cervical Mucus:
   • Secondary Mechanism: The hormone thickens the mucus in the cervix, making it difficult for sperm to enter the uterus and reach any egg that might be released.
3. Thinning of the Endometrial Lining:
   • Tertiary Mechanism: Etonogestrel also causes the lining of the uterus (endometrium) to become thinner, which makes it less likely that a fertilized egg could implant and develop.

The process of insertion of implant is as follows:

1. Consultation: The doctor will review the your medical history and discuss the suitability of the implant.
2. Preparation: The procedure is carried out in the clinic. The insertion site (usually the inner side of the upper arm) is numbed with a local anesthetic.
3. Insertion: The doctor uses a pre-loaded applicator to insert the rod-shaped implant just under the skin. The process takes only a few minutes.
4. Post-Insertion: A small bandage is applied to the insertion site. Patients may be advised to avoid heavy lifting or strenuous activity with the arm for a short period.

Side Effects

• Common Side Effects:
  • Irregular Bleeding: Changes in menstrual bleeding patterns are common, including irregular bleeding, spotting, or sometimes the absence of periods (amenorrhea).
  • Headaches: Some women may experience headaches.
  • Breast Tenderness: Tenderness or pain in the breasts can occur.
  • Mood Changes: Some users report mood swings or changes in mood.
• Less Common Side Effects:
  • Weight Gain: Some women may experience weight gain while using the implant.
  • Acne: Changes in skin condition, such as acne, may occur.
  • Ovarian Cysts: Benign ovarian cysts can develop but usually resolve on their own.
  • Pain or Discomfort at the Insertion Site: Temporary pain, bruising, or swelling at the insertion site is possible.
• Other Considerations:
  • Infection: There is a small risk of infection at the insertion site.
  • Migration: Rarely, the implant can move from the original insertion site.
  • Remval Complications: Difficulty in removing the implant can occur if it has migrated or if scar tissue has formed around it.

Advantages

• Highly Effective: Provides continuous and reliable contraception for up to three years.
• Convenience: Once inserted, it requires no daily action from the user.
• Quick Return to Fertility: Fertility typically returns quickly after the implant is removed.

Disadvantages

• Irregular Bleeding: The potential for irregular bleeding patterns can be a drawback for some women.
• Hormonal Side Effects: Some women may experience side effects related to the hormone etonogestrel.
• Discomfort During Insertion and Removal: The insertion and removal processes can be uncomfortable.

Removal of implant:

The removal of the contraceptive implant is a straightforward procedure.

The patient lies on their back with their arm positioned to allow easy access to the implant site. A local anaesthetic is injected into the skin around the implant site to numb the area, minimizing discomfort during the procedure. A small incision (about 2-3 mm) is made near the tip of the implant and the implant is gently pushed towards the incision site, grasped and removed. After removal, the small incision is closed with stitches, Steri-Strips or a small bandage.

Most patients can resume normal activities shortly after the procedure. Some bruising or soreness at the removal site is common but typically resolves within a few days.

Fertility generally returns quickly after the implant is removed, often within a few days to a week.