What is the birth control implant?

Not to be confused with two other methods also often called “birth control implants”—the intrauterine device (IUD) and the soon-to-be discontinued permanent device, Essure—the Nexplanon implant is a tiny plastic rod that goes under the skin of your upper arm, releasing the hormone progestin into your body over time. It is the most effective form of birth control and lasts up to three years (or four years off-label). It has a 0.05% failure rate, meaning that five in 10,000 women using the implant will become pregnant in a year. The implant prevents pregnancy better than male sterilization (vasectomy), which has a 0.15% failure rate and is often irreversible.

How is it different from the IUD?

The implant and the IUD have quite a few similarities. They’re both undetectable, low maintenance LARCs that are good for at least three years once placed inside your body—unlike other LARC options (e.g. the Depo-Provera shot, the Nuvaring and the Xulane patch) which have to be re-administered or replaced much more frequently (once a week to once every three months). They both are very effective at preventing pregnancy, only take about 30 minutes at the doctor’s or health clinic to insert or remove, and allow fertility to return to normal immediately after removal.

The IUD, however, is a T-shaped device that’s placed inside your uterus, through the vagina. This means hormones from an IUD only have to travel a short distance to get to the uterine lining, whereas hormones from an implant have to make their way through the body via the bloodstream. This raises the chances for more side effects with the implant, such as prolonged irregular bleeding (compared to periods that eventually get lighter or complete stop with the IUD).

Not all IUDs deliver hormones, though. One of the five current brands of IUDs instead contains copper, which is toxic to sperm. Copper IUDs may cause periods to become longer, more frequent and 50% heavier for as long as you’re using it. Each IUD brand also has its own failure rate, ranging from 0.2% to 0.8%—still only under 10 unintended pregnancies in 1000 women who use the IUD each year. Compare the implant and the IUD head-to-head with this tool from our friends at Iodine.com.

What is the procedure like?

If I have to be honest, the insertion procedure sounds and looks worse than it actually is. Your health provider will first sterilize and apply a local anesthetic to the area of your upper arm. After checking that your arm feels numb, they will then use a special device that looks like one side of a stapler to insert the implant into your arm, right underneath the skin. The whole process takes less than 30 minutes. Since you’re under local anesthesia, the procedure will only hurt as much as the anesthetic injection. Afterwards, the area of your arm where the implant is will feel tender for a few days and bruise for up to two to three weeks. My bruise, while painless, stayed yellow for about a month.

To remove the implant, your health provider will similarly sterilize and use a local anesthetic before making a small incision on your arm near one end of the implant. They will then take out the device with forceps. If you’re getting a new implant to replace the old one at the end of its three- or four-year period, the staple-like device will also be used for insertion.

How much does it cost?

If you have health insurance, the cost of the implant and the procedure is likely to be fully covered under the Affordable Care Act. For uninsured women, the implant and insertion procedure can cost up to $1,300 and removal can cost another $300. However, you have options—try calling your local women’s health clinic or family planning centre. They may charge less (depending on your income) or offer other resources.

Though the implant has a high upfront cost, it can save you more money than other birth control methods in the long run. It’s worth weighing the pros and cons of each option to find the right contraception for you.

So why did I choose the implant?

I wanted to get off birth control pills because I was horrible at remembering to take them every day. I was deciding between the implant or the IUD since I didn’t like the idea of giving myself injections, nor did I want to stay on schedule with the ring or the patch. I just wanted a one-and-done solution, something that I wouldn’t have to think about again for a very long time.

Like many women, I’d heard about the IUD over the years—never about the implant. But after doing some research, I decided the implant was right for me. The first version of the implant, Implanon, was approved by the FDA in 2006, but was eventually phased out six years later by Nexplanon. The Nexplanon implant came with a new insertion device, designed to lower insertion failures. I felt assured that the newer, improved implant would be inserted correctly and somewhat painlessly, especially compared to the cramping and pain often experienced during and after the insertion of an IUD.

It also gave me peace of mind knowing that I would always be able to tell where exactly the implant is—I can poke at it and feel it inside my right arm. Plus, it kind of made me feel like a cyborg.

The last thing that helped convince me was that the implant is one of the few birth control methods whose failure rates in perfect use and typical use are the same. Perfect use refers to when the contraception is used correctly every time, like in a clinical setting. Typical use is everyday use, which probably isn’t perfect every time. Once the implant is in your arm, it works perfectly every day with a failure rate of 0.05%. The pill, on the other hand, has a perfect use failure rate of 0.3% and a typical use failure rate of 9%. That’s nine in 100 women who become pregnant on the pill each year. It seemed like a no brainer to me.

Was the implant worth it for me?

My experience with the implant hasn’t been all rainbows and unicorns. The first two years were great—other than a gigantic bruise on my arm for the first month or so, I didn’t really have any unwanted side effects. In fact, my periods quickly disappeared and I didn’t bleed for two whole years. But then I started noticing I was spotting more and more, which eventually turned into heavy periods that lasted two to three weeks at a time.

I talked to my doctor and she said this was not surprising given women with the implant are prone to irregular bleeding. The return of periods after not having them for the first couple of years is also common as hormone levels in the implant start getting lower. The implant still works to prevent pregnancy, but the shift in hormones can be enough to kick-start bleeding again. Some women opt to get additional birth control pills to help regulate their periods, some replace their implants early and some just let the implant run its course.

I was happy enough with the implant that I didn’t hesitate to have it replaced when the time came. My periods didn’t go away as I expected them to, though. They stayed irregular but are not nearly as frequent as before. I personally feel this is a small price to pay for not having to worry about getting pregnant, and I definitely plan on keeping the implant for the foreseeable future.

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