Long acting reversible contraception (LARC) include intrauterine contraceptive devices and contraceptive implants. From a population healthcare perspective their advantage is the reduction in the unintended pregnancy rates, primarily due to improved compliance. Individuals may appreciate many other advantages and these methods should be made available to all women. The original subdermal implant, Norplant, is no longer available however it paved the way for a much better product: the etonogestrel implant (Implanon), approved by the FDA in 2006, it is currently the only available device of this type in the U.S.
It is a single rod subdermal implant that measures 4 centimeters in length and 2 millimeters in diameter. The rod consists of an ethylene vinyl acetate copolymer core filled with 68 mg of etonogestrel surrounded by skin of the same material which allows for a slow release of the hormone over 3 years. The device is latex free but not radiopaque or biodegradable. It must be removed once the medication is utilized. The etonogestrel is the active metabolite of desogestrel which is used in many combination oral contraceptive pills.
Contraception is achieved through the suppression of ovulation. If the egg isn’t released then it is available for fertilization. The pregnancy rate with this device is 0.05% making it the most effective method of reversible contraception. Other hormonal effects include thickening the cervical mucus and thinning the endometrial lining, situations which also prohibits pregnancy. The effects on menstruation varies but can include a complete cessation of bleeding (amenorrhea), infrequent bleeding, and more frequent or prolonged bleeding. If the later occurs, the bleeding is usually light but quite annoying. Given the effects on menstruation, the implant could also be used to manage painful periods, endometriosis, adenomyosis and other menstrual disorders.
The complication rates of insertion and removal are low at 1-1.7% and include pain, bruising, bleeding, difficult insertion, unrecognized non-insertion, device breakage and inability to locate the device at the time of removal. Once it is in place, dissatisfaction with the device tends to be related to side effects. Abnormal bleeding as mentioned earlier is the most common undesirable event. Weight gain, acne, headaches and breast pain are the other complaints. Weight gain occurs in about 6-12% of users while the acne is appreciated in 10-14%. Others may experience improvement in acne or no change at all. Fertility rapidly returns once the device is removed.
The contraceptive subdermal implant should be considered in women who need long term contraception. It is effective for 3 years, the side effects are minimal and complications rates are low. An unintended pregnancy is more costly and risky. If you are interested in the implant, then take the time to find a health care provider who is trained in the insertion techniques. This will minimize the chance of an adverse event.
I hope this article has provided you with information that will help you make wise choices, so you may:

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