These problems also may or may not be due to the use of implants.

Migraine headaches (see the job aid on Identifying Migraine Headaches and Auras)

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

Unexplained vaginal bleeding (that suggests a medical condition not related to the method)

• Refer or evaluate by history and pelvic examination. Diagnose and treat as appropriate.
• If no cause of bleeding can be found, consider stopping implants to make diagnosis easier. Provide another method of her choice (but not progestin-only injectables, or a copper-bearing or hormonal IUD) to use until the condition is evaluated and treated.
• If bleeding is caused by sexually transmitted infection or pelvic inflammatory disease, she can continue using implants during treatment.

Certain serious health conditions (suspected blood clots in deep veins of legs or lungs, serious liver disease, or breast cancer). See Appendix B – Signs and Symptoms of Serious Health Conditions.

• Remove the implants or refer for removal.
• Give the client a backup method to use until the condition is evaluated.
• Refer the client for diagnosis and care if she is not already under care.

Heart disease due to blocked or narrowed arteries (ischemic heart disease) or stroke

• A woman who has one of these conditions can safely start implants. If, however, the condition develops while she is using implants:
  • Remove the implants or refer for removal.
  • Help her choose a method without hormones.
  • Refer the client for diagnosis and care if she is not already under care.

Suspected pregnancy

• Assess the client for pregnancy, including ectopic pregnancy (see “Severe pain in lower abdomen”).
• Remove the implants or refer for removal if she will carry the pregnancy to term.
• There are no known risks to a fetus conceived while a woman has implants in place (see Question 5).