Sindh Government

Implanon is a single-rod contraceptive implant (40 mm by 2 mm), which contains 68 mg of etonogestrel (ENG) dispersed in a membrane of ethylene vinyl acetate. Implanon delivers ENG at a dose sufficient to suppress ovulation in every cycle throughout the 3 years of use.

Benefits

Very effective, even in overweight women.
Long-term pregnancy protection, but reversible. A single decision can lead to
very effective contraception for up to 3–7 years.
No need to do anything at the time of sexual intercourse.
Increased sexual enjoyment because no need to worry about pregnancy.
One-time activity.
Effective within 24 hours after insertion.
Fertility returns almost immediately after implants are removed.
They do not affect the quantity and quality of breast milk.
No estrogen side effects.
Help prevent iron deficiency anemia.
Help prevent ectopic pregnancies.
May help prevent endometrial cancer.
May make sickle cell crises less frequent and less painful.
May reduce the risk of PID.

Limitations

The client cannot start or stop use on her own. Capsules must be inserted and
removed by a specially trained health care provider.
Minor surgical procedures are required to insert and remove capsules. Some
women may not want anything inserted in their arms or may be bothered
that implants may be seen or felt under the skin.
Discomfort for several hours to 1 day after insertion for some women.
Removal is sometimes painful and often more difficult than insertion.
In very rare instances when pregnancy occurs, as many as one in every six
pregnancies is ectopic.
Do not protect against sexually transmitted infection (STIs), including HIV/
AIDS.

Sides effects & management

Most women using implants have some changes in their menstrual pattern such as spotting or irregular bleeding in between periods. Some may have scanty menses or amenorrhoea after about a year of use. Assure the client that these menstrual changes will not harm her and will settle in a few months.

Sides effects	Management
Pain in the arm for 1–2 days	• Reassure client. • Give her tab paracetamol.
Pain continues after 2–3 days with swelling of the insertion site	Give her appropriate antibiotic and analgesic and follow her.
Menstrual changes: spotting/slight bleeding between period	• Reassure the client that it will be resolved on its own. • advise ibuprofen up to 800 mg (max) or ponstan 500 mg three times daily after meal for 5 days. • Give iron tab 1x3 for 1 month, or • Give COC pills 1 daily for 21 days. • If this does not help, provide: − 50 mcg of ethinyl estradiol daily for 21 days. • If bleeding continues to be heavy and the client is worried, remove the implants.
Amenorrhoea after scanty menses	Reassure the client that it will not harm her (as it does not harm her when she is pregnant).
Amenorrhoea after regular cycles	• Do a pregnancy test. • If not pregnant, reassure the client. • If pregnant, remove the implants.
Rare side effects
Weight gain less than 2 kg in 3 months	• Reassure the client. • ask her to reduce food intake, especially fats and sweets.
Weight gain more than 2 kg in 3 months	Watch her weight for another 2–3 months on a reduced diet.
If client continues to gain weight	Remove the implants.
Depression or other mood changes	Refer client to a doctor.
Infection at the insertion site (pain, heat, and redness) but no abscess	• Do not remove the implants. • Clean the infected area with soap and water or antiseptic. • Give an oral antibiotic for 7 days and ask the client to return in 1 week. If still not better, remove the implants or refer for removal.
Infection with abscess	• If significant skin infection is involved, give oral antibiotic for 7 days. • prepare the infected area with antiseptic, make an incision, and drain the pus. • Remove the implants or refer for removal. • treat the wound.