The Birth Control Implant

The birth control implant, available in over 100 countries, is a highly-effective form of hormonal birth control that many people find to be a convenient method of preventing pregnancy. The implant is inserted into the arm and can be kept for up to five years.1 Using a synthetic version of the hormone progestin rather than estrogen, the implant stops ovulation and thickens the walls of the uterus so that sperm cannot reach an egg. Since the implant only inhibits pregnancy, it is not capable of preventing the spread of sexually transmitted infections (STIs), so barrier methods of contraception are recommended for use in conjunction with the implant. There are both benefits and risks to using the birth control implant, and one should consult with a healthcare professional about using the implant.  

two birth control implants

What Is the Birth Control Implant?

The birth control implant, which is sold currently in the United States as Nexplanon®, is a form of hormonal birth control that is inserted subdermally (under the skin) into a female’s upper arm. Sometimes, the birth control implant may be referred to as Implanon®, which is a slightly older version of Nexplanon®.2 The device is made up of a flexible piece of plastic about the size of a matchstick.

The implant is a unique and viable method for many individuals due to its ease of use and high success rate. Nexplanon users do not have to remember to take a pill or replace their birth control frequently. The implant is over 99% effective, making it one of the most effective forms of birth control.3 Once the implant is inserted, no further steps are needed to prevent pregnancy.2 The insertion of the birth control implant can be performed in a few minutes during a routine visit to a healthcare provider without needing any major surgery. The birth control implant contains a synthetic version of the hormone progestin, known as etonogestrel, which makes it a viable choice for people who cannot tolerate or do not want birth control that uses estrogen.3  

How Is It Inserted?

Before having the birth control implant inserted, it is important to inform your doctor of any previous hormonal contraceptive use and of any abortions or miscarriages you might have had.  Furthermore, your doctor might perform a physical examination and/or give you a pregnancy test.  This information will help your doctor time the insertion of the birth control to your menstrual cycle. Depending on when implanted during a person’s menstrual cycle, it may be necessary to use a barrier method  of contraception for the week following insertion.4 

The birth control implant is surgically implanted by a medical professional just under the skin on the inside of the upper arm. During the procedure, the individual receiving the implant will lie on their back with their non-dominant arm flexed at the elbow. The insertion site is disinfected and the medical professional gives the arm a shot to numb the area where the implant will be inserted. The implant is then inserted with a tool to slide it under your skin. Most people only feel a pinch when receiving the shot, and do not feel the implant being inserted. The implant is inserted just under the skin in the inner part of the upper non-dominant arm, an area distant from blood vessels and nerve structures so that it is unlikely to cause damage to the arm.4 It is extremely important to have the implant inserted by a trained medical professional in order to avoid any problems and to ensure that the device works properly.

For up to two weeks after insertion, it is possible to have bruising or soreness around the birth control implant.2 This is completely normal and is not a cause for concern. If pain persists for a longer period of time or is very severe, the user should contact their medical care provider.  

seven pomegranates

How Does It Work?

The birth control implant releases low levels of progestin, the hormone that prevents ovulation from occuring.4 Without ovulation, no eggs are released, so one cannot become pregnant.5 The implant also makes a woman’s cervical mucus thicker, thereby blocking sperm from traveling into the uterus.3 The birth control implant is highly effective at preventing pregnancy. However, like other types of hormonal contraception, it does not protect against sexually transmitted infections (STIs), so it is recommended to use a barrier method such as a male or female condom along with the implant and get tested for STIs regularly. 

How Effective Is It?

The birth control implant has been shown to be over 99% effective in preventing pregnancy with less than 1 out of 100 people becoming pregnant while using the implant.3 When used for longer than the currently recommended time frame of three years, the implant has been found to continue to be effective for up to five years.1 One study found that there were no pregnancies out of 200 women using the Nexplanon implant for five years rather than the typically recommended three years.6 

Part of what makes the birth control implant such an effective method of birth control is that there is less room for user error, as users do not have to remember to take a pill. As long as the implant was inserted correctly and does not move, it will continue to release hormones at a steady, constant rate for at least three years and potentially up to five years.4 

How Is the Birth Control Implant Removed?

The birth control implant can be removed at any time after insertion if one no longer wants to use this method of birth control. It is typically recommended by health professionals that the implant is removed after three years, however the implant can be effective for up to five. It is up to the individual and the guidance of their health professional to decide when to remove the implant, whether that be three years, five years, or any time in between. 

The removal procedure must be performed by a healthcare professional and is relatively pain free. This procedure only takes a few minutes longer than the insertion. During removal, the health care provider will first feel the arm to locate the implant. Although movement of the implant is rare and usually only consists of several millimeters, it is possible that the healthcare provider may not be able to feel the implant. In this case, an ultrasound or X-ray will be performed to locate the implant prior to removal.4 Once the implant is located, the health care provider numbs the area by administering a shot and makes a small incision to remove the implant with sterile surgical forceps.4 During the procedure, individuals have the option of inserting a new implant to continue protection against pregnancy for another three to five years.3 If a person decides not to reinsert a new implant, then pregnancy can occur any time after the implant is removed.3

pennies spilling out of jar

How Much Does It Cost?

Depending on an individual’s insurance, the insertion of the birth control implant can cost anywhere from $0 to $1,300.2 The removal can cost between $0 and $300.2  Although it can be a high cost upfront, the implant is very cost effective since it prevents pregnancy for up to five years.1 Many insurance plans cover the implant partially or completely.3  Health centers such as Planned Parenthood can connect individuals interested in the implant with resources to access birth control at a low or no cost; if you live in the United States, you can find your local Planned Parenthood by clicking here. Some individuals in the United States may also be able to get Nexplanon for free through the birth control coverage offered by the Affordable Care Act.3

What are the Benefits of the Birth Control Implant?

The implant has several prominent advantages over other forms of contraception:

  • It can be removed at any time and is reversible, meaning that users can get pregnant soon after its removal. Etonogestrel, the synthetic hormone used in the implant, was shown to be undetectable in the blood one week after removal.4 
  • It can be used while breastfeeding without altering an individual’s ability to lactate. 7
  • It can be inserted directly following a birth, abortion, or miscarriage to avoid unintended pregnancy.8
  • It is convenient and does not require daily or weekly action by the user to ensure effectiveness.3
  • It is one of most effective forms of birth control.3
  • It provides long-lasting birth control that does not involve sterilization.3
  • It does not contain estrogen.3
  • It can be cost effective, depending on an individual’s insurance situation. In the United States, the Affordable Care Act may provide a way for some individuals to get Nexplanon for free.3

The implant can be very appealing to people who cannot take estrogen and who want a long lasting and low maintenance form of contraception. The implant’s reversibility is also very appealing to people who would like to become pregnant soon after removal of the implant.

What Are The Risks and Side Effects?

Some side effects of the etonogestrel birth control implants include irregular periods, the absence of monthly periods (amenorrhea), or periods that are either heavier or lighter than usual.9  Users may also experience spotting between periods.9 There are also possible side effects not related to the menstrual cycle, such as weight gain, headaches, acne, changes in breast tenderness, and depression.10

If an implant user is experiencing more severe or pronounced side effects then they should contact a medical professional. These side effects include changes in vaginal discharge, a moving implant, ejection of the implant, redness, pus, or pain at the insertion side, or severe headaches.10  If one is having prolonged menstrual bleeding or yellowing of the skin or eyes, a medical professional should be alerted.5

stethoscope with keyboard

When to Avoid the Birth Control Implant 

Usage of the implant can lead to health complications in some specific circumstances. Individuals experiencing these circumstances should not use the birth control implant:

  • Are pregnant or think they may be pregnant.3
  • Have a history of blood clots.3
  • Have liver disease or liver tumors.3
  • Have unexplained vaginal bleeding.3
  • Currently have or have had certain types of cancer such as breast cancer and other progestin-sensitive cancers. 3
  • Are allergic to any substance in the implant.3

Individuals considering using the Nexplanon implant should always speak to a doctor about their health history and any health conditions they may have. If they are unsure about whether they have a health condition or not, it is advised to speak to a doctor, as well as ask if the birth control implant is appropriate for their situation. 

health spelled out with pills

Concluding Remarks 

The birth control implant offers many benefits and is extremely effective at preventing pregnancy. However, it does not provide any protection against sexually transmitted infections (STIs), so it is recommended that the implant be used in conjunction with barrier methods such as male or female condoms. Insertion of the implant is a simple procedure that takes only a few minutes and provides at least three years and up to five years of contraception.1 The implant is one of the most effective forms of contraception and offers easy and convenient use.  

References

  1. Mcnicholas, Colleen, Erin Swor, Leping Wan, and Jeffrey F Peipert. “Prolonged Use of the Etonogestrel Implant and Levonorgestrel Intrauterine Device: 2 Years beyond Food and Drug Administration–approved Duration.” American Journal of Obstetrics and Gynecology. Vol. 216, no. 6. June 2017.
  2. “Birth Control Implant.” Planned Parenthood. (n.d).
  3. “NEXPLANON (Etonogestrel Implant) 68 Mg Radiopaque.” Nexplanon. (n.d.).
  4. Palomba, Stefano, Angela Falbo, Annalisa Di Cello, Caterina Materazzo, and Fulvio Zullo. “Nexplanon: The New Implant for Long-term Contraception. A Comprehensive Descriptive Review.” Gynecological Endocrinology. Vol. 28, no. 9. 01 Sep. 2012.
  5. Hirsch, Larissa. (2018, June). “Implantable Contraception.” TeensHealth from Nemours. June 2018.
  6. Ali, Moazzam, Ayse Akin, Luis Bahamondes, Vivian Brache, Ndema Habib, Sihem Landoulsi, and David Hubacher. “Extended Use up to 5 Years of the Etonogestrel-releasing Subdermal Contraceptive Implant: Comparison to Levonorgestrel-releasing Subdermal Implant.” Human Reproduction.  Vol. 31, no. 11. Oxford University Press:  Nov. 2016.
  7. Turok, David K, Lawrence Leeman, Jessica N Sanders, Lauren Thaxton, Jennifer L Eggebroten, Nicole Yonke, Holly Bullock, Rameet Singh, Lori M Gawron, and Eve Espey. “Immediate Postpartum Levonorgestrel Intrauterine Device Insertion and Breast-feeding Outcomes: A Noninferiority Randomized Controlled Trial.” American Journal of Obstetrics and Gynecology. Vol. 217, no. 6. Dec. 2017.
  8. Curtis, Kathryn M, Tara C Jatlaoui, Naomi K Tepper, Lauren B Zapata, Leah G Horton, Denise J Jamieson, and Maura K Whiteman. “U.S. Selected Practice Recommendations for Contraceptive Use, 2016.” MMWR. Recommendations and Reports: Morbidity and Mortality Weekly Report. Recommendations and Reports. Vol. 65, no. 4. July 2016. 
  9. Mansour, Diana, Tjeerd Korver, Maya Marintcheva-Petrova, and Ian S Fraser. “The Effects of Implanon® on Menstrual Bleeding Patterns.” The European Journal of Contraception & Reproductive Health Care. Vol. 13, no. S1. 2008.
  10. Blumenthal, Paul, Kristina Gemzell-Danielsson, and Maya Marintcheva-Petrova. “Tolerability and Clinical Safety of Implanon®.” European Journal of Contraception & Reproductive Health Care. Vol. 13. 2008.

Last Updated: 11 May 2021.