Art by Marta Pucci
The birth control implant: myths and misconceptions
Birth control 101
Top things to know
A change in your bleeding pattern is a common side effect of the implant
People are able to get pregnant quickly after implant removal
Over a three-year period of implant use, mood swings were one of the most commonly reported side effects
The implant is a type of long-acting reversible contraception (LARC) that is placed just under the skin in the upper arm. There is one type of implant available in the U.S. It is a flexible rod, about the size of a matchstick, that contains a type of progestin called etonogestrel (1). Other implant types made up of two rods and containing the progestin levonorgestrel are available in other parts of the world (1,2).
Implants are highly effective birth control.
Out of 100 people using the implant as birth control over the course of a year, less than 1 will become pregnant (1). Compare this to the typical use of the birth control pill (meaning not taking them perfectly), where 7 pregnancies would occur in a year among 100 users (1).
Once it’s placed, it can be used for 3 to 5 years depending on the type (2,3).
Even though it is highly effective and easy to use, it’s common to have questions and concerns about a birth control method that is placed inside your body. Among a group of Australian women who had never used the implant, some of them had positive impressions about the reliability and convenience of the method, but some also had concerns about side effects, long-term effects such as fertility, or pain with the placement and removal (4). Some people report feeling uncomfortable with the idea of a “foreign body” inside of them (5).
Read on to learn more about what to expect when you have an implant as we separate myth from reality.
Does it hurt to have it inserted?
Before the implant is placed, medication is used to numb the insertion area (2,3). You may feel a pinch from the needle if the medication is injected and a stinging or burning for a few seconds from the medication. After that, the area will be numb so you shouldn’t be able to feel the implant being placed. Once the implant is placed, the area may feel bruised or sore for a day or two.
If the implant continues to cause pain or discomfort after the first few days, get in touch with your healthcare provider. In a study of 301 people who had the implant placed, 11% of them experienced bruising and/or pain at the site following placement (6). Another study of 330 people using the implant for up to 2 years, less than 3% of them reported occasional minor pain at the implant site (7).
Will it affect my long-term fertility?
Between 76 and 100% of people are able to get pregnant in the first year after implant removal, which is similar to pregnancy rates for people stopping other types of birth control (8). There is no increased risk for birth defects or poor infant health for pregnancies conceived after implant removal (8).
Can it get lost inside of me?
Occasionally, there can be problems with how the implant is placed. If an implant is placed too deeply, it could be hard to feel under the skin and more difficult to remove.
The etonogestrel implant inserter was redesigned to make deep placement less likely (1). In some rare instances, it may be that the implant wasn’t “lost,” but that it was never placed to begin with. The healthcare provider should feel for the implant immediately after insertion to ensure that it’s actually there (1). If an implant can’t be felt (either right after the procedure or later), an ultrasound or x-ray can be used to locate it (1).
After being placed, a majority of implants will move by a few millimeters or not at all (9). There have been special cases reported where the implant moved a few centimeters or even through a blood vessel to the lungs (1,10-12), but these cases are rare.
Will it make me depressed or affect my mood?
Over a three-year period of implant use, mood swings were one of the most commonly reported side effects (5.8%) (13). In a study looking at 942 implant users worldwide, about 4% stopped using the implant due to changes in their mood or mental health, including mood swings, nervousness, and depression (13).
The rates of implant removal due to reported mental health changes were higher among implant users in the U.S. compared to other countries (13).
In the study of 330 implant users in the U.S., about 14% reported mood swings and 7% experienced depression related to the implant (7). For those who had the implant removed, 6% did so because of mood swings and 2% because of depression (7).
Will my period become very irregular?
A change in your bleeding pattern is a common side effect of the implant. Usually bleeding is lighter with the implant, but some people may experience heavier bleeding—especially at the beginning (1). The average number of days that bleeding and spotting occur is typically less with the implant compared to someone having natural menstrual cycles, but the bleeding or spotting can be unpredictable (1,14).
Prolonged or frequent bleeding or spotting is most common in the first few months of implant use (1).
About 11% of implant users remove their implant due to bleeding irregularities, with frequent or prolonged bleeding being the two most common reasons for having an implant removed (14). Almost a quarter of implant users experience no bleeding and a third experience on average less than one episode of spotting or bleeding per month (14). Most people using the implant will develop a “satisfactory” bleeding pattern after six months of use, but about a third of users will still have an “unsatisfactory” bleeding pattern after six months (1).
If your bleeding pattern on the implant is bothering you, talk to your healthcare provider about options to manage it. If you want to keep the implant, you may be able to use medications like ibuprofen, combined hormonal contraception, or estrogen for short-term bleeding control (15).
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Will my partner know I’m using the implant?
The outline of the implant typically can’t be seen, although it will leave a small scar and can be felt under the skin (1). After the implant is placed, it will be bandaged for a few days (2,3). Insertion of the implant can also leave a bruise on the arm that may take days to go away (1).
Final Thoughts
The implant is a good option for a lot of people because most people can use it safely, it is effective, and convenient (1). As with any medication, there are potential side effects that are important to understand before having the implant placed. It’s important to remember that everyone’s experience will not be the same.
Tracking symptoms in Clue can help you determine if you are having side effects from a new birth control. In the case of the implant, Clue can also help you see if the bleeding pattern is changing or improving after it is placed.
