Gynaecological surgery

The implant, placed just under the skin on the inside of the upper arm, is a contraceptive that works for up to three years. Only a doctor who has undergone special training may install and remove the implant. The contraceptive active ingredient etonogestrel is placed in a small, soft, flexible plastic rod with a length of 4 cm and a diameter of 2 mm, from which it is absorbed into the bloodstream in certain amounts every day.

The implant helps prevent pregnancy by making the cervical mucus impassable to sperm cells and also inhibits ovulation in some women. The implant is a very effective user-independent contraceptive that works for up to three years – fewer than one woman out of 1000 gets pregnant during one year of use.

Fertility usually returns to normal within 3-4 weeks after implant removal.

Whom is the implant suitable for?

The implant is suitable for women of all ages who seek long-term pregnancy prevention:

• Women who have given birth and who have not given birth
• Breastfeeding women who need effective contraception
• Women who have contraindications to oestrogen-containing products, such as combined contraceptive pills, vaginal ring, and patches
• Overweight women (but there is often the need for earlier implant replacement)

You must make sure you are not pregnant before placing the implant. The implant is placed on the inside of the upper arm of the non-dominant arm. The skin on the upper arm is cleaned and anaesthetised with a pain-relieving injection. Using a special applicator, the implant is placed under the skin. A patch and pressure bandage are placed at the insertion site to prevent bruising. After the placement, the doctor palpates the implant under the skin and teaches you how to do the same. A properly placed implant can be felt under the skin between the thumb and a finger.  Although the implant can be placed at any time, the best time for this is between the 1st and 5th day of menstruation.

After placement

After the procedure, a patch with a pressure bandage is placed on the implant insertion site to reduce bruising. You can remove the bandage after 24 hours. The need to wear the patch may be present for a few days after the procedure – in this case, change the patch daily.

Contradictions

A doctor must be consulted before placing the implant. Contraindications for an implant:

• allergy to the active substance (etonogestrel) or the components of the implant
• thrombosis
• jaundice, severe liver disease or a liver tumour
• breast or genital cancer or suspected cancer
• vaginal bleeding of unknown cause

Adverse effects

As with any medication, the contraceptive implant can have adverse effects.

• Changes in menstrual bleeding. The length, frequency and nature of menstruation may change. The pattern of periods in the first three months often predicts the pattern of subsequent menstruations. If the accompanying changes interfere with your daily life, it is possible to have the implant removed.
• Bruising, pain, swelling or itching at the insertion/removal area may occur during implant placement/removal. In rare cases, inflammation or an abscess may develop at the insertion site and a scar may form.
• The implant can be felt under the skin with the fingers, but sometimes the implant can move from the original insertion site. In this case, imaging may be necessary to determine the location and removal may require a larger surgical incision.
• Fluid-filled cysts may develop in the ovaries, which generally disappear on their own and in rare cases cause mild abdominal pain. In very rare cases, the cysts require medical intervention.
• Thrombosis, or the formation of a blood clot in a blood vessel. Although the risk of thrombosis with an implant is lower than during pregnancy or when using birth control pills, you should contact your doctor immediately if you experience symptoms of thrombosis. Possible indications of thrombosis are: severe pain or swelling in one leg, chest pains, shortness of breath and coughing up blood.