Session I, Slide #11

Contraceptive ImplantsSession I: Characteristics of Implants

Session I, Slide #22

Objectives

At the end of this session, participants will be able to:

1. Describe the characteristics of implants in a manner that clients can understand:

a. What implants are and how they work (mechanism and onset of action)

b. Effectiveness

c. Side effects

d. Non-contraceptive health benefits

e. Possible health risks (complications)

f. Other characteristics (STI/HIV protection, ease of use, return to fertility, when to initiate and discontinue)

Session I, Slide #33

Objectives (continued)

2. Demonstrate the ability to:

a. Screen clients for medical eligibility for implants

b. Explain to clients the insertion, removal, and follow-up procedures

c. Explain when to return to the clinic

d. Address common concerns, misconceptions, and myths

e. Conduct follow-up for implant clients in a way that enhances continuing safety, satisfaction, and acceptance

3. Describe when to initiate use of Implants (postpartum, switching from another method).

7. Demonstrate on anatomical models how to insert and remove implants.

4. Explain how to manage side effects.

5. Identify conditions that require switching to another method.

6. Identify clients in need of referral for implant-related complications.

Session I, Slide #44

What Are Implants?

Progestin-filled rods (each about the size of a match stick) that are inserted under the skin

– Jadelle: 2-rod system, effective for 5 years

– Sino-implant (II): 2-rod system, effective for 4 years (possibly 5)

– Implanon: 1-rod system, effective for 3 years

– Norplant: 6-capsule system, effective for 5 years (possibly 7); no longer manufactured but some women are still using it

Session I, Slide #55

Key Points for Providers and Clients

What it is:– Small tubes placed under the skin of inner, upper arm.

– Hormones from the tubes blocks sperm from reaching egg and prevents release of egg.

How to use:– Specially trained provider inserts and removes implants.

– Nothing to remember to do after insertion.

What to expect:– Changes in monthly bleeding including irregular bleeding, spotting,

heavier bleeding or no monthly bleeding, are common and safe.

Important to remember:– Use another method if waiting for appointment.

– Use condoms if you need protection from STIs or HIV/AIDS.

Session I, Slide #66

Key Points for Clients

• Safe to use

• One of the most effective methods

• Lasts for 3 to 5 years

• Can be removed any time if you want to get pregnant

Session I, Slide #77

Effectiveness of Implants

In this progression of effectiveness, where would you place implants?

Male Sterilization

Female Sterilization

IUDs

Progestin-Only Injectables

Combined Oral Contraceptives

Male Condoms

Standard Days Method

Female Condoms

SpermicidesLess

effective

More effective

Less effective

More effective

Implants

Session I, Slide #88

Relative Effectiveness of FP Methods

Method # of unintended pregnancies among1,000 women in 1st year of typical use

No method 850

Withdrawal 220

Female condom 210

Male condom 180

Pill 90

Injectable 60

IUD (CU-T 380A / LNG-IUS) 8 / 2

Female sterilization 5

Vasectomy 1.5

Implant 0.5

Source: Trussell J., Contraceptive Failure in the United States, Contraception 83 (2011) 397- 404, Elsevier Inc.

Session I, Slide #99

Implants: Mechanism of Action

Thickens cervical mucus to block sperm

Implants work in two ways

Implants have no effect on an existing pregnancy.

Suppresses hormonesresponsible forovulation

Session I, Slide #1010

Implants: Characteristics

• Have side effects

• Require minor surgery to insert and remove

• Cannot be initiated and discontinued without provider’s help

• Provide no protection from STIs/HIV

Source: Hatcher, 2007; WHO, 2010; CCP and WHO, 2011.

• Very safe and 99.95% effective

• Easy to use

• Fertility returns without delay when removed

• Can be used by breastfeeding women

• Offer health benefits

Session I, Slide #1111

Implants: Health Benefits

• Reduced risk of symptomatic pelvic inflammatory disease (PID)

• Reduced risk of iron-deficiency anemia

• Reduced risk of ectopic pregnancy– 6 per 100,000 in implant users

– 650 per 100,000 in women using no contraception

Source: CCP and WHO, 2011; Task Force for Epidemiological Research on Reproductive Health, 1998.

Session IVA, Slide 12

Some users report changes in bleeding patterns:

Possible Side Effects of Implants (part 1)

First several months:

• Lighter bleeding and fewer days of bleeding

• Irregular bleeding

• Infrequent bleeding

• No monthly bleeding

After about one year:

• Lighter bleeding and fewer days of bleeding

• Irregular bleeding

• Infrequent bleeding

How would you feel about these side-effects?*Implanon users are more likely to have

no monthly bleeding than irregular bleeding.

Session I, Slide #1313

Possible Side Effects of Implants (part 2)

• Headaches

• Lower abdominal pain

• Acne (can improve or worsen)

• Weight change

• Breast tenderness

• Dizziness

• Mood changes

• Nausea, nervousness

Session I, Slide #1414

Group Activity

Implants Fact Sheet

Review the fact sheet.

What additional questions or comments do you have about the characteristics of implants?