No. Routine periodic visits are not necessary for implant users. Annual visits may be helpful for other preventive care, but they are not necessary or required. Of course, women are welcome to return at any time with questions or to have implants removed.
2. Can implants be left in a woman’s arm?
Leaving the implants in place beyond their effective lifespan is generally not recommended if the woman continues to be at risk of pregnancy. The implants themselves are not dangerous, but as the hormone levels in the implants drop, they become less and less effective. After they lose effectiveness, they may still release a small dose of hormone for several more years, which serves no purpose.
If a woman wants to continue using implants, she may have a new implant inserted in the other arm even if the first implant is not removed at that time; for example, if removal services are not immediately available.
3. Do implants cause cancer?
No. Studies have not found increased risk of any cancer with use of implants.
4. How long does it take to become pregnant after the implants are removed?
Women who stop using implants can become pregnant as quickly as women who stop nonhormonal methods. Implants do not delay the return of a woman’s fertility after they are removed. The bleeding pattern a woman had before she used implants generally returns after they are removed.
5. Do implants cause birth defects? Will the fetus be harmed if a woman accidentally becomes pregnant with implants in place?
No. Good evidence shows that implants will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while using implants or accidentally has implants inserted when she is already pregnant.
6. Can implants come out of a woman’s arm?
Rarely, a rod may start to come out, most often in the first 4 weeks after insertion. This usually happens because they were not inserted well or because of an infection where they were inserted. In these cases, the woman will see the implant(s) coming out. Some women may have a sudden change in bleeding pattern. If a woman notices a rod coming out, she should start using a backup method and return to the clinic at once.
7. Do implants increase the risk of ectopic pregnancy?
No. On the contrary, implants greatly reduce the risk of ectopic pregnancy. Ectopic pregnancies are extremely rare among implant users. The rate of ectopic pregnancy among women with implants is 6 per 100,000 women per year. The rate of ectopic pregnancy among women in the United States using no contraceptive method is 650 per 100,000 women per year.
On the very rare occasions that implants fail and pregnancy occurs, 10–17 of every 100 of these pregnancies are ectopic. Thus, the great majority of pregnancies after implants fail are not ectopic. Still, ectopic pregnancy can be life-threatening, and so a provider should be aware that ectopic pregnancy is possible if implants fail.
8. When can a breastfeeding woman start implants?
In 2015, WHO considered this question and updated its guidance to allow a woman to use progestin-only implants after childbirth regardless of how recently she gave birth. She does not need to wait until 6 weeks postpartum. This change in guidance also applies to progestin-only pills and the LNG-IUD. For details on when breastfeeding women can start implants, see the section on When to Start.
9. Should heavy women avoid implants?
No. Some but not all studies have found that Jadelle implants became slightly less effective for heavier women after 4 or more years of use. As a precaution, women weighing over 80 kg may want to have their implants replaced after 4 years for greatest effectiveness. Studies of Implanon have not found that effectiveness decreases for heavier women within the lifespan approved for this type of implant.
10. What should be done if an implant user has an ovarian cyst?
The great majority of cysts are not true cysts but actually fluid-filled structures in the ovary (follicles) that continue to grow beyond the usual size in a normal menstrual cycle. They may cause some mild abdominal pain, but they require treatment only if they grow abnormally large, twist, or burst. These follicles usually go away without treatment (see the row on “Severe pain in lower abdomen” in the section of this chapter on Managing Any Problems).
11. Can a woman work soon after having implants inserted?
Yes. A woman can do her usual work immediately after leaving the clinic as long as she does not bump the insertion site or get it wet.
12. Must a woman have a pelvic examination before she can have implants inserted?
No. Instead, asking the right questions can help the provider be reasonably certain she is not pregnant (see Pregnancy Checklist). No condition that can be detected by a pelvic examination rules out use of implants.
Yes. If a young woman wants to use implants, she can. In fact, implants and IUDs can be good methods for young women who want to be sure to avoid pregnancy for a number of years. They are highly effective and long-lasting methods. According to WHO’s Medical Eligibility Criteria for Contraceptive Use, age is not relevant to implant use. Implant use will not affect a young woman’s future fertility, whether or not she has already had children.
All young women seeking contraception, whether married or not and whether or not they have had children, can safely choose from the full range of available contraceptive methods. This includes implants, copper-bearing IUDs, and LNG-IUDs. If women want to have children in the future, however, they should not choose female sterilization, which is a permanent method.
Yes. Women taking the antiretroviral (ARV) drug efavirenz as HIV treatment should be offered implants along with the full range of contraceptive methods. However, it is important to tell women who are taking efavirenz that this drug is likely to make the implants less effective. For women taking efavirenz, implants may be about as effective as combined oral contraceptives or male condoms as typically used.
Women taking efavirenz who choose implants should be encouraged to use condoms in addition to implants to enhance protection from pregnancy. Alternatively, they can consider other effective contraceptive methods that do not interact with efavirenz or other ARV drugs. These methods include progestin-only injectables, the copper-bearing IUD, and the LNG-IUD, or—if they want no more children—female sterilization or vasectomy for their partner.
A user of implants who is starting on efavirenz or already taking it should be told about this reduced effectiveness. A provider can then help her decide whether to keep using implants or switch to another, more effective method. If she prefers another method, the provider can remove the implants and help her start the other method.