Contraceptive Implants

1. Contraceptive Implants Session III: Providing Implants

2. When to Start Implants(A Review) • What if this client, who has no medical conditions that would preclude implants use, wants to initiate implants? • Client situation: • In day 4 of menstrual cycle • Condom user in day 8 of menstrual cycle • 2½ weeks postpartum, not breastfeeding • 2½ weeks postpartum, breastfeeding • Injectable user, amenorrheic, within reinjection window • IUD user, mid-cycle, had sex since last menses • After taking emergency contraceptive pills (ECPs)

3. Key Counseling Topics for Implant Users • Safety and efficacy • How Implants work • Health benefits • Possible side effects • No protection from STIs/HIV • Inform provider she has an implant in case of serious new health problem • Reasons to return: questions, concerns or experiencing any warning signs

4. Correcting Rumors and Misunderstandings • Implants stop working once they are removed. Their hormones do not remain in a woman’s body. • They can stop monthly bleeding, but this is not harmful. It is similar to not having monthly bleeding during pregnancy. Blood is not building up inside the woman. • Implants: • Do not make women infertile • Do not move to other parts of the body • Significantly reduce a woman’s risk for ectopic pregnancy

5. Counseling about Implants:Additional Key Counseling Topics • Explain the insertion and removal procedure • Provide post-insertion instructions • Explain the length of protection and when to return for removal or replacement • Describe reasons to return for follow-up

6. Counseling About Side Effects • Before insertion, describe possible side effects: • Changes in bleeding pattern (most common) • Headaches, breast tenderness, mild abdominal pain (less common) • Explain that side effects: • Are not signs of illness • Often subside within the first year • Encourage the client to come back with questions or concerns • If the client cannot tolerate side effects, management or discontinuation may be necessary

7. Implant Insertion and Removal • Insertion and removal should be quick and easy. • Injection prevents pain. • Provider puts 1 or 2 rods just under the skin of inside upper arm. • Provider bandages opening in skin and wraps the arm—no stitches. • Need to be removed after 3 to 5 years, depending on the type of implant and your weight.

8. What to Remember • Keep the insertion area dry for 4 days. • Expect a bit of soreness and bruising. • Come back when it is time to have the implants removed. • Side effects are common but rarely harmful Come back if they bother you. • Come back any time if you have problems or want implants removed. See a nurse or doctor if: • A bright spot in your vision before bad headaches • Yellow skin or eyes • Infection or continued pain in the insertion site or sees rod coming out • May be pregnant, especially if pain or soreness in belly • Unusually heavy or long bleeding

9. Helping Continuing Implant Users • No routine visit required, but if she returns, ask: • Whether satisfied with method or has questions. • If she is concerned about bleeding changes. • About new health problems or major life changes (plans for more children, change in STI/HIV risk). • Significant weight changes. • If she wants to continue using implant and has no new medical condition, remind her how much longer her implant will protect her.

10. Management of Implant Side Effects:Bleeding Changes Counseling and reassurance are key Source: CCP and WHO, 2011.

11. Management of Implant Side Effects:Non-Menstrual Problems Source: CCP and WHO, 2011.

12. Management of Implant Side Effects:Problems Related to Insertion Source: CCP and WHO, 2011.

13. Problems That May Require Switching from Implants to Another Method (Part 1) Source: CCP and WHO, 2011.

14. Problems That May Require Switching from Implants to Another Method (Part 2) Source: CCP and WHO, 2011.

15. Complications from Implants Are Uncommon or Rare • Infection at insertion site • If occurs, most likely within the first 2 months • Difficult removal • Rare if inserted properly and removed by a trained provider • Expulsions • Rare; most occur within the first 4 months Source: CCP and WHO, 2011.

16. Counseling about Implants:Explain Removal Procedure to Client Prior to removal, the provider should tell the client that: • An injection of local painkiller is given. The client stays awake. • A small cut is made near the implant. • A special instrument is used to pull out each implant. The client may feel tugging or slight pain. • The site may be sore for a few days. • The cut is closed with an adhesive bandage; no stitches. • The cut is covered and wrapped with gauze. Source: CCP and WHO, 2011; Bayer.

17. Infection Prevention:Prior to Implant Insertion or Removal Getting ready • Have the client wash her arm • Cover the procedure table • Prepare a clean instrument tray • Open the sterile instrument pack Before insertion/removal • Wash hands thoroughly and put on gloves • Clean the insertion/removal site • Use a sterile drape with a hole over the site • Use a new disposable syringe and needle Source: INFO Reports, 2007.

18. Infection Prevention:After Implant Insertion or Removal • Stop any bleeding with gauze and clean the insertion/removal site • Apply a sterile adhesive bandage • Place sharps in a safety container • Decontaminate instruments • Dispose of contaminated objects • Sterilize instruments and gloves • Decontaminate all surfaces • Wash hands with soap Source: INFO Reports, 2007.

19. Implants: Summary • Implants are a new option that fulfills an unmet need for many women • Provides long-term protection • Safe and easy to use • Highly effective and readily reversible • Appropriate for most women, including young and nulliparous • Little is required of the client once the implant is in place • Irregular bleeding patterns may be a problem for some women • Thorough counseling is essential