Contraception Implants

Overview

A contraceptive implant is a small, thin, flexible rod — about the size of a matchstick — that a trained health professional places just under the skin of your upper arm. It slowly releases a hormone called a progestogen (a man-made version of the natural hormone progesterone) into your body. This hormone prevents pregnancy, mainly by thickening the mucus at the entrance of the womb so sperm cannot get through, and by thinning the lining of the womb. Most implants protect against pregnancy for three years, and some for up to five, depending on the type used. You do not have to remember to take anything daily, and it can be removed at any time by a trained professional.

Yes. Contraceptive implants are used by millions of people around the world and are one of the most popular long-acting methods. Many clinics offer them free or at low cost as part of routine contraceptive care.

Implants are for anyone who could become pregnant and wants reliable, long-acting contraception — including teenagers, adults, and people who cannot use methods containing oestrogen (such as the combined pill). They are not used before puberty. Most people can keep using one until around the menopause, but your clinician will check whether it suits you.

Symptoms

Common symptoms

• A change in your bleeding pattern — periods may become lighter, less frequent, irregular, or stop altogether. This is the most common change and is not harmful.
• Headache or migraine in the first few months.
• Tender breasts, mild nausea, or spotty skin (acne).
• Mood changes or feeling more emotional than usual.
• Bruising, tenderness, or a small scar where the implant was put in.
• Small, usually harmless fluid-filled sacs on the ovaries (ovarian cysts), which most people never notice.
• Some people notice a change in weight or sex drive, though the evidence for a direct link is mixed.

Symptoms in children

• Implants are not used before puberty, so they are not relevant for young children.
• For teenagers who are sexually active, an implant can be a safe and very effective option, and clinicians are used to discussing it confidentially and without judgement.

Symptoms in older adults

• Implants can be used through your 40s and up to the menopause.
• As you get closer to menopause, your clinician may suggest a different method or discuss when it is safe to stop, because pregnancy risk falls over time.

Causes

Main causes

• This is not an illness, so it has no 'cause'. It is a contraceptive method that works by releasing a small, steady dose of a progestogen hormone.
• The hormone thickens the mucus at the neck of the womb, which stops sperm reaching an egg.
• It also thins the lining of the womb, making it harder for a fertilised egg to settle, and in some cycles it stops the ovary releasing an egg (ovulation).
• The effect is fully reversible: once the implant is removed, the hormone clears from your body and your normal cycle returns.

Risk factors

• You should not use an implant if you have, or have had, breast cancer, because the hormone may affect it.
• Unexplained vaginal bleeding that has not been investigated needs checking first.
• Serious liver disease or a liver tumour means an implant is usually not recommended.
• Some medicines — for example certain epilepsy medicines, HIV medicines, or herbal remedies such as St John's wort — can make the implant less effective, so always tell your prescriber about it.
• A very high body weight may slightly reduce how well it works; your clinician can discuss this with you.
• A history of blood clots, heart attack, or stroke should be discussed with your clinician, though the risk with a progestogen-only method is generally low.

When to see a doctor

See a doctor urgently if:

• Signs of infection at the insertion site: increasing pain, heat, redness, pus, or fever.
• You cannot feel the implant, or it feels wrong in any way.
• Sudden severe belly pain, fainting, or a positive pregnancy test.
• Severe headache with visual changes, or pain and swelling in one leg.
• Any bleeding that is very heavy and makes you feel dizzy or unwell.

Book a routine appointment if:

• You want the implant removed or replaced, or it is nearing its expiry date.
• The bleeding changes are bothering you and you would like advice.
• You are starting a new medicine and want to check it does not interfere with the implant.
• You have new side effects such as troublesome acne, low mood, or headaches.
• You want to talk about switching to a different method of contraception.

Diagnosis

There is no test to 'diagnose' an implant — it is a choice, not a condition. Instead, you will have a conversation with a trained doctor or nurse about your health, your medicines, and what you want from contraception. They will check your blood pressure and ask about your medical and family history to make sure the implant is safe for you. If there is any chance you could already be pregnant, they may offer a pregnancy test first.

Tests that may be done

• Blood pressure measurement.
• A review of your medical history, medicines, and family history.
• A pregnancy test if there is any possibility you are pregnant.
• A sexual health (STI) check, if you want one — this is usually offered, not required.
• A quick check that you can feel the implant in your arm after it is placed.

What to expect at your appointment

The appointment usually takes 15 to 30 minutes. The clinician will numb a small patch of skin on your inner upper arm with a local anaesthetic injection, then place the implant using a small applicator. It takes a few seconds. You may feel a brief stinging from the anaesthetic and some bruising or tenderness afterwards. You can go back to normal activities straight away, but avoid heavy lifting with that arm for a day or two. The implant works straight away if it is put in during the first five days of your period; otherwise your clinician may advise using condoms for a week.

Treatment

An implant is itself a form of contraception, so 'treatment' here means having it fitted, living with it comfortably, and having it removed or swapped when you choose. It is fitted by a trained doctor or nurse in a clinic or GP surgery, and removal is done the same way, usually through a tiny cut under local anaesthetic.

Self-care at home

• Check you can feel the implant in your arm now and then — it should feel like a small thin rod.
• Note the date it was fitted and when it needs replacing, and keep that somewhere you will see it.
• Use condoms until your clinician says the implant is fully working (usually seven days if it was fitted outside the first days of your period).
• Use condoms to protect against sexually transmitted infections, as the implant does not cover these.
• Keep the insertion site clean and dry, and cover it with a plaster for a day or two if advised.
• If you have the implant removed and do not want to become pregnant, have another method ready to start straight away.

Medical treatments

The main 'treatment' is the fitting itself, which a trained professional does in a short appointment. If side effects such as unpredictable bleeding bother you, your clinician can talk through options — for example, a short course of another hormone medicine or an anti-inflammatory to settle the bleeding, or switching to a different contraceptive. They can also remove the implant at any point if you would prefer. Never buy medicines to manage side effects without checking with a pharmacist or doctor that they are safe alongside your implant.

When is surgery considered?

Insertion and removal are minor procedures done in a clinic room, not an operating theatre. Occasionally, if the implant cannot be felt or has moved deeper, you may be referred for a scan and a slightly bigger procedure to remove it — this is uncommon.

Living with this condition

Most of the time you simply forget it is there. Your main jobs are remembering roughly when it needs replacing and telling any doctor, nurse, dentist, or pharmacist that you have one, so they can check for medicine interactions. If your periods change, give it a few months — the pattern often settles, and many people end up with lighter or no periods, which many find a bonus.

Lifestyle tips

• There is no need to change your daily routine, exercise, or travel plans because of an implant.
• Alcohol and smoking are not directly affected, but smoking raises your risk of blood clots in general, so it is always worth discussing with your clinician.
• Tell your clinician about any new medicine, including herbal products, before you start it.
• If you play contact sports, mention it to your clinician — usually no change is needed, but a pad or support may help in the first week.

Diet and exercise

No special diet is needed. Eating a balanced diet and staying active are good for your general health and mood, and can help with symptoms like headaches or low mood. There is no evidence that any particular food affects how well the implant works.

Mental health and emotional wellbeing

Some people notice mood changes, especially in the first few months, and hormonal contraception affects everyone differently. If you feel persistently low, anxious, or not like yourself, you do not have to put up with it — talk to your doctor or nurse. They can help you weigh up whether to keep the implant, and you can have it removed whenever you choose. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line straight away.

Prevention

This topic is about preventing pregnancy, so there is no condition to prevent. The implant is itself a highly effective way to avoid an unplanned pregnancy. The main things you can do are to keep track of when it needs replacing, check it now and then, and tell your clinician about any new medicines that could reduce how well it works.

Screening programmes

The implant does not replace routine health checks. You should still go for cervical screening (smear tests) when invited, and consider regular sexual health checks if you have new or multiple partners. Your clinician can tell you when you are next due.

Complications

If left untreated

• If the implant is left in past its expiry date, it may stop protecting you and pregnancy becomes possible.
• Rarely, the implant can fail — for example if it is affected by certain medicines or if it is not where it should be.
• If pregnancy happens with an implant in place, there is a small chance it could be an ectopic pregnancy (pregnancy outside the womb), which is a medical emergency.
• Insertion or removal can occasionally cause infection, minor scarring, or, very rarely, nerve irritation in the arm.
• Very rarely, progestogen-only methods are linked to blood clots — the risk is much lower than in pregnancy.

Long-term outlook

For most people, the implant is a convenient, very reliable method with few problems. Side effects often settle within the first few months, and you can have it removed at any time if it does not suit you. Your fertility usually returns quickly afterwards, so it does not affect your long-term plans for a family. If you are unsure whether it is right for you, a friendly chat with your doctor or nurse is a good place to start.

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