Providing Implants

When to Start

IMPORTANT: A woman can start using implants any time she wants if it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist. No tests or examinations are necessary before starting implants, although blood pressure measurement is desirable.
Woman's situation When to start
Having menstrual cycles or switching from a nonhormonal method

Any time of the month

  • If it is within 7 days after the start of her monthly bleeding, she can have implants inserted immediately and there is no need for a backup method.
  • If it is more than 7 days after the start of her monthly bleeding, she can have implants inserted any time if it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after insertion.
  • If she is switching from an IUD, see Switching From an IUD to Another Method, in Chapter 10 – Copper-Bearing Intrauterine Device.
Switching from a hormonal method
  • If she has been using the hormonal method consistently and correctly or if it is otherwise reasonably certain she is not pregnant, she can have implants inserted immediately (no need to wait for her next monthly bleeding) and there is no need for a backup method.
  • If she is switching from a progestin-only or combined monthly injectable, she can have implants inserted when the repeat injection would have been given. There is no need for a backup method.
Fully or nearly fully breastfeeding

Less than 6 months after giving birth
  • If her monthly bleeding has not returned, she can have implants inserted any time between giving birth and 6 months. There is no need for a backup method.
  • If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
More than 6 months after giving birth
  • If her monthly bleeding has not returned, she can have implants inserted any time if it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after insertion. 
  • If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
Partially breastfeeding

 
  • If her monthly bleeding has not returned, she can have implants inserted any time if it is reasonably certain she is not pregnant.† She will need a backup method* for the first 7 days after insertion.
  • If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
Not breastfeeding

Less than 4 weeks after giving birth
  • She can have implants inserted at any time and there is no need for a backup method.
More than 4 weeks after giving birth
  • If her monthly bleeding has not returned, she can have implants inserted any time if it is reasonably certain she is not pregnant.† She will need a backup method* for the first 7 days after insertion.
  • If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
No monthly bleeding (not related to childbirth or breastfeeding)
  • She can have implants inserted any time if it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after insertion.
After miscarriage or abortion
  • If it is within 7 days after first- or second-trimester miscarriage or abortion, she can have implants inserted immediately and there is no need for a backup method.
  • If it is more than 7 days after first- or second- trimester miscarriage or abortion, she can have implants inserted any time if it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after insertion.
After taking emergency contraceptive pills (ECPs)

After taking progestin-only or combined ECPs:

  • Implants can be inserted on the same day as taking the ECPs. There is no need to wait for the next monthly bleeding. She will need a backup method* for the first 7 days after insertion.

  • If she does not start immediately but returns for an implant, she can start at any time if it is reasonably certain she is not pregnant.

After taking ulipristal acetate (UPA) ECPs:

  • Implants can be inserted on the 6th day after taking UPA-ECPs, so make an appointment for her to return to have the implant inserted on the 6th day after taking UPA-ECPs or as soon as possible after that. There is no need to wait for the next monthly bleeding. Implants and UPA interact. The progestin in the implant and the UPA interact with each other. If an implant is inserted sooner, and both are thus present in the body, one or both of the medicines may be less effective.
  • She will need a backup method* from the time she takes UPA-ECPs until 7 days after the implant is inserted.
  • If she does not start on the 6th day but returns later for implants, she can start at any time if it is reasonably certain she is not pregnant.

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal; the client should be informed that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.

† Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to obtain contraception are limited, some providers and programs may insert implants at the 6-week visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not yet returned.