Bleeding for 3 weeks on implanon: Contraceptive Implant (Implanon) – SHINE SA

Contraceptive Implant (Implanon) – SHINE SA

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What is the contraceptive implant?

The contraceptive implant is a plastic rod that is inserted under the skin of the inner, upper arm to stop pregnancy by slowly releasing progestogen (this is similar to a natural hormone produced by the body). It is often referred to as Implanon.

How does it work?

Progestogen works by:

• stopping the release of an egg by the ovary (ovulation)
• making the mucus (sticky fluid) at the opening of the uterus thicker so sperm can’t get through.

How effective is it?

It is an extremely effective method of contraception (99.95%).

How do I get the contraceptive implant?

The contraceptive implant has to be inserted by a health professional trained in this procedure. Make an appointment with your doctor or at SHINE SA to discuss this method and get a prescription. You will then need to have the implant inserted. This may be done on the same day or it may require a second appointment.

How is it inserted?

An area on the inner arm above the elbow is cleaned and then numbed with local anaesthetic. Then the doctor or nurse puts the implant under the skin. After the implant is inserted, a dressing is put on which should stay on for 3-5 days. The arm is bandaged to reduce bruising, this bandage should be left on for up to 24 hours.

When does it start working?

It’s immediately effective if:

• inserted during the first 5 days of your menstrual cycle, which starts with the first day of bleeding.
• inserted within 21 days of having a baby
• inserted within 5 days of having an abortion or miscarriage
• replacing an existing contraceptive implant that has not been in for more than 3 years
• inserted while using another form of contraception that continues for 7 more days after the implant is inserted.

The implant is effective after 7 days if it is inserted at any other time. Other contraceptive measures such as condoms should be used for these 7 days. If changing from the Pill or another method of contraception discuss the best time for insertion with your doctor.

How long does it last?

It is effective as a contraceptive for 3 years. The implant should be taken out and replaced with a new implant every 3 years. It can be removed earlier than 3 years if it is no longer wanted.

How do I stop using it?

To stop using the implant it needs to be removed by a trained health professional in this procedure. Before removal, the area of skin will be cleaned and numbed with local anaesthetic. A small cut to the skin over the top of the implant is made to find the tip and then it is removed.

When will I be fertile again?

There is a rapid return to fertility after removal. Most people return to their normal menstrual cycle and fertility within a month of removing the implant. If you do not want to be pregnant you need to use other contraception as soon as it is removed.

What are the benefits of the implant?

• It is highly effective (99.95% effective).
• It lasts a long time (up to three years).
• It is reversible and the return to fertility is rapid.
• It does not need you to remember to take a pill every day.
• It is a cost-effective method of contraception.
• It may reduce painful periods, premenstrual syndrome (PMS) and acne in some people.

What are the side effects?

You may not get regular bleeding.
Bleeding patterns are likely to change:

• bleeding may become lighter and less painful
• bleeding may stop altogether
• bleeding may continue and not stop.

Many people have no other side effects. Some may experience the following problems:

• Acne may develop, improve or get worse.
• Weight gain can occur over time and is often thought to be caused by the implant, but has not been directly proven.
• Headaches, breast pain, hair thinning and mood changes can occur but usually go away within a few weeks/months.
• Bruising and mild soreness at the site of insertion or removal can last up to 2 weeks. A small scar remains.

Occasionally the implant can be difficult to feel or remove and you may need to have an ultrasound to check its position in your arm.

What should I do if I get changes in bleeding?

Irregular bleeding is a common side effect and will usually settle down within 3 months. Whatever your bleeding pattern, the implant is still effective.
If the bleeding does not settle or you are unhappy with the bleeding you can see a doctor for medications that can help with this. You don’t have to wait until 3 months to do this.

Who can use the implant?

This method suits most people no matter what age up to menopause, who don’t mind having an implant under their skin. It’s safe for heavy smokers and people with diabetes, high blood pressure and high cholesterol.

Who should not use the implant?

People who are pregnant, people with breast cancer, people with unexplained vaginal bleeding, people with severe liver disease or using medication that affects the liver, should not use the implant.

Where can I get the implant?

The implant is prescribed by a doctor and can be inserted at SHINE SA clinics as well as by doctors, nurses and gynaecologists who have been trained in this procedure.

What You Should Know About Breakthrough Bleeding With Birth Control

Breakthrough bleeding is a common concern among women using hormonal birth control. It’s usually a small amount of spotting at a time when you’re not expecting your period, though some women have heavier bleeding. Most often, my patients come in saying they feel fine, but are noticing a little spotting when they use the bathroom. Should they be worried?

I reassure them that breakthrough bleeding rarely signals a health problem. And it doesn’t mean your birth control isn’t effective at preventing pregnancy. But there are ways we can try to fix it.

Here’s what I tell my patients about birth control and breakthrough bleeding.

It can happen with any type of hormonal birth control.

All these methods work by delivering hormones that prevent pregnancy. These methods include

• birth control pills

• the birth control implant, a small plastic rod that’s placed under the skin of the upper arm

• hormonal IUDs (intrauterine devices)

• the birth control shot given by a health care professional

• the vaginal ring that women can place and remove on their own

• the skin patch that contains hormones

But it’s more common with certain types of birth control.

Breakthrough bleeding happens more often with low-dose and ultra-low-dose birth control pills, the implant, and hormonal IUDs.

With IUDs, women often have spotting and irregular bleeding in the first months after placement. This usually gets better in 2 to 6 months. With the implant, though, the bleeding pattern women have in the first 3 months is usually their pattern going forward.

Some women are more likely to experience it.

Breakthrough bleeding happens more often in women who smoke cigarettes and in women who don’t take their birth control pills consistently. Some medications, like emergency contraception pills, also can cause irregular bleeding. Having certain infections, such as chlamydia or gonorrhea, also can increase risk.

It’s also more common when women who use birth control pills or the ring take a continuous dose of hormones to skip their periods altogether. One more factor: Benign (not cancerous) growths such as uterine fibroids can cause irregular bleeding that’s unrelated to birth control.

Some women can improve breakthrough bleeding on their own.

Quitting smoking can help. So can taking birth control pills at the same time each day.

If you’re getting continuous hormones with birth control pills or the ring, try scheduling a period every few months. This gives the uterus a chance to shed any built-up lining. It can help reduce irregular spotting and bleeding.

Your ob-gyn can help.

Although breakthrough bleeding with birth control isn’t physically harmful, it can be really annoying. When a patient says they’re having spotting or irregular bleeding, we first chat about the factors that might be causing the bleeding. Then we may do a physical exam as well.

After we confirm the bleeding is related to birth control, there are usually a number of options. For example, we can switch from an ultra-low-dose birth control pill to a low-dose pill. We also can change the number of placebo (or pill-free) days. Or we can explore other methods of birth control. With IUDs, implants, or the birth control shot, taking ibuprofen can be helpful, or we can add short-term treatment with estrogen pills.

No matter the situation, talk with your ob-gyn if you’re unhappy with your bleeding. We don’t want women to struggle with breakthrough bleeding, and we definitely have options to improve it.

Published: January 2021

Last reviewed: February 2023

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Implant insertion Implanon

Implanon – hormonal subcutaneous implant refers to methods of long-term reversible contraception. Effective for 3 years and does not require daily, weekly or monthly intake. Thus, there is no need to remember to take pills every day.

Benefits of IUD contraception

Advantages of the IUD over other contraceptives:

• Contraceptive with an efficiency greater than 99.9%
• Can be installed for up to 3 years
• Contraceptive protection is provided by etonogestrel (ENG). ENG is an active metabolite of the third generation progestogen, desogestrel. This hormone is also found in MSD’s estrogen-free oral contraceptive Charosetta®
• After the coil is removed, the woman’s fertility is immediately restored. The body does not need time to “recover”.

How Implanon works against pregnancy

Implanon® prevents pregnancy due to the action of the active ingredient, ENG, which inhibits ovulation by suppressing the release of luteinizing hormone (LH) in the middle of the cycle. ENG also increases the viscosity of cervical mucus, preventing sperm from reaching the egg (fertilization).

In addition, ENG can inhibit endometrial proliferation, making it difficult for a fertilized egg to implant in the uterine lining.

* Ovulation suppression
* Endometrial atrophy
* Impact on sperm migration – thickening of cervical mucus

Who is it for?

Ideal for women who:

• Busy with their career or studies and not planning a pregnancy in the next few years
• Are at high risk of unwanted pregnancy
• Cannot take estrogen (if contraindicated)
• Are in the postpartum period (including breastfeeding)
• Had a negative experience with COCs (tablets)
• Looking for a reversible alternative to sterilization

Contraindications

• individual intolerance to the material
• acute inflammatory diseases of the subcutaneous fat
• cervical dysplasia
• uterine bleeding;
• malignant neoplasms.

How is Implanon administered?

• Implanon® should be administered under aseptic conditions, and only by a doctor who is proficient in this technique.
• Implanon® is injected with a special applicator. .
• The patient is asked to lie on her back with her non-dominant arm (a hand that a woman does not use for writing) turned outward and bent at the elbow.
• Implanon® is injected from the medial side of the upper arm (non-dominant arm) approximately 8-10 cm above the medial epicondyle of the humerus.
• Mark the site of administration.
• Wipe the injection site with a disinfectant.
• Anesthetize with a spray or 2 ml of lidocaine (1%) is injected subcutaneously along the “input channel”.
• A sterile disposable applicator containing Implanon® is removed from the blister.
• Leaving the protective cap on the needle, visually check for the presence of an implant, which is visible as a white object inside the needle.
• Carefully, without effort, while lifting the skin, insert the needle to its full length, providing superficial insertion.
• The applicator is held parallel to the skin surface.
• Rotate the obturator 90°.
• Hold the obturator parallel to the shoulder with one hand and slowly withdraw the cannula (needle) from the arm with the other hand.
• The presence of an implant should always be verified by palpation and the woman herself should also palpate the implant.
• Apply a sterile gauze and pressure bandage to prevent bruising.
• Fill out the User Card and give it to the patient to facilitate the timely removal of the implant later

Frequently Asked Questions

When is it possible to administer Implanon after childbirth or induced abortion?

Implanon® can be administered directly on the day of the abortion.
After childbirth, the introduction of Implanon® is possible after 6-8 weeks.

Can the implant be seen or felt after insertion?

After implantation of Implanon®, the patient should not notice the presence of the implant. She may feel the implant slightly under the skin with gentle palpation (by touching the area where the implant will be placed with her fingers).
In addition, due to the fact that Implanon NXT® is radiopaque, it can be seen using x-rays, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) – x-rays and CT are the latest methods used to clarify implant localization.

Can Implanon® m play on the body?
Rarely. If Implanon® is installed correctly (correctly), it cannot easily migrate in a woman’s body from its original place of installation under the skin. However, there are isolated reports of implant migration. This is usually a slight movement (up to 2 cm) in relation to the original location, if the implant was not placed too deep (i.e. correctly).

Can Implanon® be given to overweight patients?
A study conducted in 2005 (Flores) showed that the use of Implanon® in overweight women did not increase the pregnancy rate. Among 417 women weighing more than 70 kg (maximum weight 117.5 kg), no pregnancy was observed in the Flores study.8 Clinical experience with Implanon® in overweight women in the third year of use is limited. Therefore, the possibility that the contraceptive effect in these women during the 3rd year of use may be lower than in women with normal weight cannot be ruled out. Therefore, the clinician may consider earlier implant replacement in overweight women (i.e. after 2 years of use).

Does the menstrual cycle interfere with the use of Implanon®?
With a high degree of probability, the nature of menstrual bleeding in women changes, while the nature of the changes is unpredictable. Perhaps the appearance of acyclic bleeding (no discharge, or become more frequent, rarer or permanent) and a change in the intensity of bleeding (scanty or heavy) or their duration. However, in many women, according to the pattern of bleeding observed during the first 3 months, it is possible to judge in general terms the nature of the menstrual cycle in the future.

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Para Medical Center LLC. Implant (Implanon)

Mode: every three years
Efficacy: 99%
Application: alone / subcutaneous
Hormone content: contains a synthetic analogue of the female hormone a progestogen

The hormonal implant provides women with reliable protection against unwanted pregnancy for three years. It does not require any daily worries on the part of a woman, and most importantly, it is highly effective. The effectiveness of contraception does not depend on the correct use and always remains high. The implant contains only one hormone – an analogue of the female hormone progesterone and does not contain estrogens, which makes it possible to use them for women who are breastfeeding, as well as for women who are contraindicated or undesirable for estrogens. Such women include, for example, smoking women over the age of 35, or women suffering from migraines, hypertension, etc.

The hormone implant is a flexible implant consisting of a complex system of membranes and the hormone progestogen, 4 cm long and only 2 mm in diameter, which is inserted under the skin of the middle third of the upper arm from the inside. Outwardly, it is not noticeable, but it can be felt by slightly pressing on the injection site.

The insertion of the implant is carried out by a specially trained physician in a procedure resembling a subcutaneous injection under local anesthesia, in which the implant is placed under the skin of the upper third of the upper arm. This mode of use is convenient, since it is not required to monitor the intake of a contraceptive daily. Such contraception can also be used by women who have not yet given birth. You can remove it at any time if you wish, if the woman’s plans have changed. The implant is removed under local anesthesia through a small incision of 2 mm.

After installation, the implant is almost invisible, only with pressure you can feel a slight seal at the insertion site. Only you and your doctor will know that you are using this method. Once inserted, the implant can be left in place for up to three years, although it can be removed earlier if you wish, and fertility will return after 3 weeks.

The main mechanism of action is the suppression of ovulation, so fertilization of pregnancy is not possible. In addition, the viscosity of the mucus of the cervical canal increases, which makes it difficult for spermatozoa to pass into the uterine cavity. The inner lining of the uterus (endometrium) becomes thin, making it unsuitable for egg implantation (attachment).

Benefits	Drawbacks
— Long-term contraception up to three years — High efficiency — Low dose of hormones — Suitable for women who have contraindications to taking estrogen — Privacy — Rapid restoration of fertility	– Insertion and removal of the implant must be performed by a doctor (invasive procedure). – Possible changes in the menstrual cycle – periods may become irregular

How reliable is the implant?

The implant reliably inhibits ovulation (release of the egg from the ovary). In addition, since it does not require any action on the part of the woman after the correct insertion, the implant is regarded as one of the most reliable methods of contraception.

Is implant insertion painful?

During implant insertion, some women may experience an injection-like burning sensation. A local anesthetic may be used to reduce discomfort. There may also be some sensitivity within one day at the site of the implant.

What if I change my mind?

If you wish, the implant can be removed at any time. The ability to conceive returns immediately after the removal of the implant, usually after 3 weeks. Some women become pregnant within a few days after the implant is removed.