Contraceptive Implant Counselling

 

Hello, I’m Dr Brun, if you don’t know me, I’m a GP at Elmham Surgery. I’m also one of the doctors who fits contraceptive implants and that’s what I’d like to talk to you briefly about today. 

You may be watching this simply because you’d like to know a little more about the contraceptive implant. Or perhaps you’ve been asked to watch this short video prior to your implant insertion so you understand the procedure fully. 

So what is the implant?

The implant is a form of long-acting reversible contraception. It’s sometimes called a ‘fit and forget’ model. By this we mean we fit itand you can forget about it while it does it’s job for 3 years. You can continue to have implants fitted every 3 years until you want to stop using them, or you go through the menopause. As soon as it’s removed, fertility can return. This may take up to 3 months in some people.

Because it only contains 1 hormone, it’s safe for a large proportion of people to use. There is no evidence of any increased risk of blood clots, heart disease or strokes which we occasionally see with other types of contraception. 

It’s a small bendy plastic device about the size of a matchstick. It sits under the skin of your upper arm about here (show location on arm). It slowly releases a form of progesterone, a sex hormone we naturally have. This hormone works to prevent an egg being released each month. It also thickens the mucous at the entrance at the entrance to the womb and thins the lining of the womb. This all means that it’s harder for the sperm to get into the womb and be more difficult for a pregnancy to implant and grow there. 

It is the most effective contraceptive we have, meaning it’s over 99% effective at preventing pregnancy. In the first year after fitting, less than 1 in 1000 implants will fail. Because it stops ovulation for most users, it may also help to reduce premenstrual symptoms (PMS) symptoms as well. 

While any hormonal contraceptive including the implant can potentially cause some headaches, breast tenderness, spots and mild mood changes initially, the implant has a few other things to bear in mind; 
Firstly your bleeding pattern may be affected by the implant. After fitting it may take up to 6 months for your bleeding pattern to settle down. After that some ladies find they have no bleeding at all, some find they still have a regular monthly bleed and some find they continue to have irregular bleeding. If your bleeding continues to be problematic, do speak to us as there are options of things we can try to help settle the bleeding a little. 

Secondly, the implant will not protect you from sexually transmitted infections. Only barrier methods, such as condoms, can do that. 

Thirdly, there are a small number of medications that can interfere with the implant, so do tell us if you’ve started on new medication, including things you buy over the counter, at the time of your fitting. 

There is a possible association between hormonal contraception (including the implant) and breast cancer. The overall risk is thought to be very small indeed and disappears once the contraception is removed. However, because of this, we don’t fit an implant if you have breast cancer and really try and avoid it if you’ve ever had breast cancer in the past. 

Because the implant sits under the skin in the upper arm, it requires a small procedure to fit it. This is done at the surgery and takes approximately 10-15 minutes in total. It involves using some local anaesthetic to numb the skin, before inserting the implant. With any procedure there can be risks. There is a small risk of infection, bleeding and bruising at the insertion site. We try to choose the site carefully, making sure we avoid important structures such as blood vessels and nerves, but there is always a tiny chance of hitting one of these, or the implant sitting too deep under the skin which can make removal rather tricky. There will be a small scar at the site of the insertion. Removing an implant also involves a small local anaesthetic injection and a tiny incision (or cut) to find and remove the implant. 

After each procedure, you will have some steristrips and a small dressing applied to your arm. A bandage will be put on to wear for the first 24 hours to reduce the bruising and bleeding risk. The area will be a little sore afterwards and you should avoid heavy lifting for a couple of days to let it settle.  If the implant is fitted on days 1-5 of your period, then it will work straight away for contraceptive purposes. If it’s fitted at any other time in your cycle, it will take 7 days to be effective, so you’ll need to use another form of contraception until it can be relied upon.  

Most people get on really well with the implant and enjoy not having to remember to take a pill each day. If you’d like any more information about the implant, or any other form of contraception, do have a look at the websites listed after this short talk.

Thank you for listening and goodbye.