PROGESTOGEN ONLY SUB DERMAL IMPLANT

Flexible progestogen-releasing plastic rods surgically inserted under the skin of the woman’s upper arm which
provide contraceptive protection for 3–7 years depending on the type of implant (Implanon: 3 years; Jadelle: 5 years;
Femplant: 4 years, Norplant: 5 years).

Indications

  • Women wanting long-term, highly-effective but not permanent contraception where alternative FP methods
    are inappropriate or undesirable

Contraindications

  • As for Progesteron-Only Pills

Advantages and Health Benefits

  • Highly effective (only 1-3% failure rate)
  • No delay in return to fertility after removal
  • Long-acting
  • Low user-responsibility (no need for daily action)
  • Protects against symptomatic pelvic inflammatory disease

Disadvantages and Common Side Effects

  • DOES NOT PROTECT AGAINST STI
  • Irregular bleeding, spotting, or heavy bleeding in first few months; amenorrhoea
  • Possibility of local infection at insertion site
  • Must be surgically inserted and removed by specially trained service provider
  • May not be as effective in women >70kg
  • Warning signs (require urgent return to clinic)
    • Heavy vaginal bleeding
    • Severe chest pain
    • Pus, bleeding, or pain at insertion site on arm

INSTRUCTIONS

  • Insert the implant subdermally under the skin of the upper arm following recommended
    procedures
  • Carefully explain warning signs and need to return if they occur
  • Advise client to return
    • After 2 weeks: To examine implant site
    • After 3 months: For first routine follow-up
    • Annually until implant removed: routine followup

MANAGEMENT OF SIDE EFFECTS OF IMPLANTS

No Monthly Periods

Assess for pregnancy:

  • If pregnant, reassure that the implant will not affect her pregnancy and refer her to ANC
  • If not pregnant, reassure that implants may stop women from having monthly periods, but this is not harmful. She can continue with the method

If irregular bleeding continues:

  • Give 400–800 mg ibuprofen every 8 hours when irregular bleeding starts
  • Or 500 mg mefenamic acid every 12 hours after meals for 5 days
  • Check for anaemia and treat accordingly

If bleeding persists:

  • Give 1 COC pill daily for 21 days (1 cycle)
  • Or 50 μg ethinyl estradiol daily for 21 days
  • Investigate other reasons (unrelated to implants) and treat accordingly
  • Help client choose another method of family planning

Heavy or prolonged bleeding (twice as much as usual or longer than 8 days)

  • Assess for pregnancy/abortion
  • Reassure
  • Give ibuprofen 800 mg every 8 hours when irregular bleeding starts
  • Or 500 mg mefenamic acid every 12 hours after meals for 5 days
  • Give 1 COC pill daily for 21 days (1 cycle)
  • Give ferrous salt tablets (60 mg iron) to prevent anaemia
  • Educate on nutrition

If bleeding persists:

  • Investigate other reasons (unrelated to implants) and treat accordingly
  • Help client choose another method of family planning

Weight Gain

  • Manage the same as for Injectable POC

Loss of Libido

  • Manage the same as for Injectable POC

Infection at the Insertion Site

  • Do not remove the implant
  • Clean the infected area with soap and water or antiseptic
  • Give oral antibiotics for 7–10 days
  • Ask the client to return after taking all antibiotics if the infection does not clear. If infection has not cleared,
    remove the implant or refer for removal
  • Expulsion or partial expulsion often follows infection. Ask the client to return if she notices an implant coming
    out

Migraine Headaches

  • If she has migraine headaches without aura, she can continue to use implant if she wishes
  • If she has migraine aura, remove the implant. Help her choose a method without hormones