Transdermal implant contraceptive removal

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In February 2014, the Health Minister announced that South Africa will make transdermal implant contraceptives (like Implanon) freely available in the country's public clinics. It is implanted below the skin of the arm and is effective for up to three years. It is also one of the safest forms of hormonal contraception available.

Like any contraceptive option, it suits some women and not others; but for those who are keen to conceive, who are experiencing unwanted side effects or who just want to “have a break” from using contraception, removal of their Implanon device becomes necessary. 

Some women experience side effects from having Implanon and aren’t convinced it’s the right contraceptive choice for them. But according to the evidence, most side effects settle down within three months of having the device inserted. 

What exactly is Implanon?

Implanon is a small rod of flexible plastic. It looks just like a matchstick from one of those matchbooks people collect from restaurants. It is 40 mm long and 2 mm wide and small enough to be very discrete when it is in place, inserted just under the woman’s skin. The plastic rod is infused with Etonogestrel - a synthetic female hormone, very similar to Progesterone. And it is this hormone that prevents conception from occurring. Etonogestrel is slowly released into the bloodstream from the rod for about three years, after which time it either needs to be removed or a new one inserted. 

Implanon cannot dissolve and won’t go anywhere until it is removed. It also contains a small amount of an X-ray detectable compound, which makes it clearly visible on X-ray. Very occasionally, it is necessary for women to have an X-ray or ultrasound so that the exact location can be found. 

It is important that the Implanon is easily palpable (felt) under the skin. This means it can be easily located and seen as a slightly raised rectangular rod just under the surface of the skin. Implanon is most commonly inserted just above the elbow joint, on the inside aspect of the upper arm. 

How does Implanon work?

Like many contraceptive devices, Implanon works by a combination of factors. It prevents ovulation so that there is no egg to be fertilised in the first place. It makes the lining of the womb thin and not suitable for a fertilised egg to nestle in, as well as thickening the cervical mucous, which acts as an effective barrier for the sperm to work their way through to the womb. 

Where do I go to get my Implanon inserted or removed?

It is important for women who have Implanon inserted to keep a mental and physical record of when it was inserted in the first place. As the three-year cut-off point approaches, plans can be made for its removal or replacement. 

Your General Practitioner or local clinic sister will be able to remove the device. 

Healthcare practitioners need to be trained in the insertion and removal of Implanon and although it is not a complex procedure, this still requires a degree of skill. According to our Minister of Health, a number of nurses have already undergone training in inserting the implant, and 4 000 more are to be trained.

If the Implanon is not clearly visible under the skin, it is important to seek the assistance of a healthcare practitioner who has skills in more complicated removal. If you are planning to have another one inserted immediately, then it is possible to use the same cut in the skin. It only takes 10-15 minutes to carry out the removal procedure. 

Will it hurt to have the Implanon removed?

You will need to have a local anaesthetic injection into the skin above the Implanon so that the area surrounding it is numb. Local anaesthetic injections can certainly sting and it takes a few minutes for them to be effective. You may want to ask your GP or nurse if you can have some local anaesthetic patches to apply before the injections are done. 

A small cut of around 2-3 mm is made and the Implanon is removed with a pair of surgical tweezers (known as a forceps). If the area has been properly anesthetised you will not feel anything other than a little pulling and tension. You may need to have a stitch (suture) inserted if the cut was big enough, but generally this is not necessary. In most women the skin edges sit closely together and they heal very neatly. Occasionally, a minute scar is visible but with time this will fade to white and barely be noticeable. 

Occasionally, the Implanon has been inserted too deeply when it was first put in. This means that, when it comes to removing it, the procedure is not as straightforward as it should be. If the Implanon cannot be felt then it is sometimes necessary to have an ultrasound or, occasionally, an X-ray to locate exactly where it is under the skin. Once this is clear, then it is easier to target its exact location and remove it. 

How long will it take for me to be fertile again?

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Most women start to ovulate again within a few weeks of having their Implanon device removed. The time frame for conceiving after using Implanon is generally thought to be the same as for ceasing other forms of hormonal contraception. In terms of long-term infertility risk, Implanon does not seem to be a problem. 

Some women become fertile again immediately once the Implanon is removed. This is why alternative forms of contraception are often recommended to women before they make the appointment to have the Implanon removed. Unless, of course, they are keen to fall pregnant.

Although the Implanon device is still effective for three years, as this “use-by-date” gets closer the amount of hormone it releases is not as high as when first inserted. If it is left in for longer than three years, then there is an increased risk of pregnancy and ectopic (tubal) pregnancy. 

For more information: Implanon - consumer information

 
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