Questions and Answers About Implants

1.    Do users of implants require follow-up visits?

No. Routine periodic visits are not necessary for implant users. Annual visits may be helpful for other preventive care, but they are not required. Of course, women are welcome to return at any time with questions.

2.    Can implants be left permanently 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.

3.    Do implants cause cancer?

No. Studies have not shown increased risk of any cancer with use of implants.

4.    How long does is 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. Some women may have to wait a few months before their usual bleeding pattern returns.

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 move around within a woman’s body or come out of her arm?

Implants do not move around in a woman’s body. The implants remain where they are inserted until they are removed. Rarely, a rod may start to come out, most often in the first 4 months 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 implants 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 to 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, so a provider should be aware that ectopic pregnancy is possible if implants fail.

8.    How soon can a breastfeeding woman start a progestin-only method implants, progestin-only pills or injectables, or LNG-IUD?

WHO guidance calls for waiting until at least 6 weeks after childbirth to start a progestin-only contraceptive (4 weeks for the LNG-IUD). In special cases a provider could make the clinical judgment that a woman can start a progestin-only method sooner (see p. 115).

A WHO expert consultation in 2008 endorsed WHO‘s current guidance, based on theoretical concerns about the effect on infant development of hormones in breast milk. These experts noted, however, that, where pregnancy risks are high and access to services is limited, progestin-only methods may be among the few available. Also, starting implants and IUDs requires providers with special training. These providers may be available only when a woman gives birth. The experts concluded,“Any decisions regarding choice of a contraceptive method should also consider these facts.”

Also note: Guidance in some countries, based on their own expert panel reviews, allows breastfeeding women to start progestin-only methods at any time. ‡ This includes starting immediately postpartum, a long-standing practice in these countries.

9.    Should heavy women avoid implants?

No. These women should know, however, that they need to have Jadelle or Norplant implants replaced sooner to maintain a high level of protection from pregnancy. In studies of Norplant implants pregnancy rates among women who weighed 70–79 kg were 2 per 100 women in the sixth year of use. Such women should have their implants replaced, if they wish, after 5 years. Among women who used Norplant or Jadelle implants and who weighed 80 kg or more, the pregnancy rate was 6 per 100 in the fifth year of use. These women should have their implants replaced after 4 years. Studies of Implanon have not found that weight decreases effectiveness 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 only require treatment if they grow abnormally large, twist, or burst. These follicles usually go away without treatment (see Severe pain in lower abdomen).

11.  When will Norplant implants no longer be available?

The manufacturer intends to produce Norplant implants until 2011 and expects to replace Norplant with a newer product, Jadelle. Jadelle implants are similar to Norplant (see Comparing Implants). Jadelle is easier and faster to insert and remove because it has only 2 rods, compared with Norplant’s 6 capsules. One study found that providers can easily switch from providing Norplant to providing Jadelle. They preferred the greater ease of inserting and removing Jadelle.

12.  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.

13.  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.

‡ See, for example, Faculty of Sexual and Reproductive Healthcare (FRSH). UK Medical Eligibility Criteria. London, FSRH, 2006. and Centers for Disease Control. U.S. medical eligibility criteria for contraceptive use, 2010. Morbidity and Mortality Weekly Report 59. May 28, 2010.

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