Nexplanon® and Subdermal Implant

Nexplanon ® is a birth control implant that is placed under the skin on the inside of your non-dominant upper arm during a simple office procedure by a trained professional. The subdermal implant is a small, soft, flexible rod that’s about the size of a matchstick. It's great for women who can not tolerate an IUD, can not use an IUD
viz. repeated expulsion, abnormality of the uterine cavity viz. bicornuate uterus  or anyone who prefers  not to to have a pelvic examination or is afraid of getting an IUD.
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It is a long active reversible contraceptive which means that it can provide birth control for up to 3 years. 

Reversible means that if you want to stop using the Nexplanon birth control implant, it can be removed at any time and you may be able to get pregnant as early as 1-3 weeks after the implant is removed.

Nexplanon contains a hormone called etonogestrel which is a type of progesterone. It does not contain estrogen. This IUD implant continuously releases a small amount of etonogestrel into your blood.

It works in two ways to prevent pregnancy:

• It stops the release of an egg from your ovaries (ovulation).
• It causes changes in your cervical mucus, making it hard for sperm to enter your uterus.

Your period may change after Nexplanon® insertion.
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For 30 % of Nexplanon users the period stops altogether or becomes infrequent. However, for 40-50% owomen the period can become prolonged and/or more frequent which is not dangerous or unhealthy but may be annoying .

If your bleeding pattern changes, it does not mean that Nexplanon® does not suite you or is not working. Generally speaking, the bleeding pattern that you have at the end of 3 months may give you an idea of your future bleeding pattern. Everyone is different.

• You may experience bruising, pain, numbness, bleeding, infection or scarring at the site after Nexplanon® insertion/removal
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• Migrated implant: It is extremely rare that Nexplanon® implant could move from the original insertion site in your arm to a blood vessel or in the lung. This might happen if it is not inserted correctly or it is dislodged as a result of extreme force, like during contact sports. If the implant moves you may need a bigger incision or surgery to remove it.  If your implant cannot be found in the arm, your doctor may use x-ray or other imaging methods to find it.
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• Broken or bent IUD implant: The implant could break or bend while in your arm. This should not affect how the implant works.

Besides changes in your menstrual bleeding patterns, other side effects may occur while on Nexplanon ®. It is helpful to know what may possibly happen and what to look out for . Side effects can include hormonal side effects ( mood swings, depression, anxiety, weight gain, acne or headache ). Hormonal side effects are usually mild and temporary disappearing after a few cycles - this is because after it is inserted, there is a surge of the hormone in the bloodstream which returns to baseline after a few cycles when these symptoms resolve. However. for a few patients they might persist in which case you should be speak to your primary health care provider.
‍Remember everyone is different. Be sure to tell your doctor about any side effects that you are concerned about.

The timing of insertion is important and will depend on:

• Your menstrual cycle
• Whether you are using other types of birth control
• If you have recently had a baby, miscarriage or abortion

We are here to help you determine the best timing.

Before insertion, tell your doctor if you are pregnant or think you might be pregnant (e.g. You had unprotected sex during the current menstrual cycle).

Unless you are switching from another type of birth control, Nexplanon is usually placed between Day 1 and Day 5 of your menstrual cycle. This is to avoid the chance that you will be pregnant. If it is inserted after the 5th day you must use another form of birth control like condoms until your Nexplanon® has been placed. If you are not on any birth control, it is best to avoid unprotected intercourse two weeks before your appointment by abstaining from sex or using condoms.

Nexplanon® can be inserted and removed in the clinic by Dr. Michelle Gerber who has completed the necessary training to perform the procedure - this  takes about 5 to 10 minutes.
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The Nexplanon® implant is inserted on the inner, upper side of your non-dominant arm, which is the arm you do not write with. The exact position is first marked on your skin using a surgical marking pen. The area is then cleaned, and a small injection of local anesthetic is given to numb the skin. Once the area is frozen, the Nexplanon® applicator is used to gently puncture the skin with a fine needle. The implant is placed just under the skin by sliding the needle through the marked area, leaving the small plastic device in place. While the implant cannot be seen, you will be able to feel it under the skin after the procedure.

Immediately after the nexplanon insertion, you'll be shown how to feel for the implant in your arm. You should be able to feel both ends between your thumb and finger.
This  area is then covered by 2 bandages.

• A small waterproof bandage over the insertion site must be left on for 5 days and the arm should be kept out of water (consider only bathing or wrapping the arm in plastic wrap or a small towel).
• A pressure bandage which is applied to help minimize bruising is left on for 24 hours post insertion.

Once the bandages are removed, it is normal for the insertion site to look bruised and feel tender . This should improve as the area heals, but keep an eye on it and contact us or your local health care provider if you have any concerns.From time to time, gently feel for your Nexplanon® implant under the skin. If at any point you cannot feel it, use  condoms and see a health care provider as soon as possible.It is also important to remember that Nexplanon® does not protect against sexually transmitted infections (STIs), including HIV/AIDS.

Certain medications, vitamins, and herbal supplements — as well as grapefruit — may reduce the effectiveness of Nexplanon®. These include some drugs used to treat epilepsy, tuberculosis, HIV, Hepatitis C, and other infectious diseases, as well as medications taken after organ transplants, certain anti-emetics used during chemotherapy, and the herbal supplement (St. John’s Wort) , which is often used for low mood or depression.If you are prescribed any of these medications while using Nexplanon®, it is recommended to use a backup method of birth control (such as condoms) during treatment and for 28 days after the last dose.