The contraceptive implant – Everything you need to know

The contraceptive implant, also known by the brand name ‘Nexplanon’, or simply as ‘the implant’, is a tiny plastic rod which releases the hormone progestogen and works around the clock to prevent unwanted pregnancies. This method of contraception is often a firm favourite for busy women and those that just don’t have the time to or the memory be taking a pill every single day.

What is the contraceptive implant?

The contraceptive implant is a long-acting form of contraception. The contraceptive is made from a small soft flexible rod, which contains ethylene vinylacetate copolymer (plastic) and is placed under the skin on the inside of your upper arm. Conveniently for users, once in place you do not need to worry about it for 3 years.

How effective is the implant?

The implant is 99% effective against preventing pregnancies, meaning fewer than 1 in 100 women will get pregnant in one year of using it. Unfortunately it won’t protect you against sexually transmitted infections (STIs) so for this you need to use a condom. Read more about the chances of getting pregnant on the implant in our blog here.

How does the contraceptive implant work?

The birth control implant releases the hormone progestogen gradually into your bloodstream. This prevents pregnancy in three ways – stopping ovulation, making the fluid in your cervix thicker (which makes it more difficult for sperm to enter the womb), and preventing the lining of your womb thickening enough for an embryo to grow in it – how clever.

What does the implant look like?

^{Video of Dr Becky inserting an implant}

How do I get the contraceptive implant fitted?

During your appointment, your doctor or nurse will chat to you about your medical history and make sure that you’re not pregnant. It’s helpful to know that you can have the implant fitted at any time in your menstrual cycle. If it’s fitted within the first five days of your cycle, you will be protected from pregnancy straight away. Any other time in your cycle and you’ll need to use condoms or other contraception for seven days. You can have the implant fitted straight away after giving birth, or after having an abortion or miscarriage.

Your doctor or nurse will get you to lie down and give you a local anaesthetic as an injection or spray to numb the part of your upper arm where the implant will be inserted. They use a pencil-like applicator to put it in your arm. If the thought of that is making you cringe– rest assured that it feels very similar to having an injection and you won’t need any stitches (which is always positive).

The doctor or nurse will then check your arm to make sure that the implant is in place. You’ll be shown how to feel the implant with your fingers so you can check this too. They will put a dressing on it to keep it clean and dry – ensure this is kept on for a few days and try not to knock your arm. The area may be tender for a day or two and may be bruised and slightly swollen.

When first inserted, you may feel some bruising, tenderness or swelling around the implant. Your periods may become irregular, lighter, or stop altogether. There is also a chance they may become heavier or last longer. At the time of updating this blog (April 2021), 49% of Lowdown users stated that it made their periods irregular and 34% said it stopped their periods altogether. The effect of stopping your periods has no long term impact and is something lots of women consider to be a major plus! 

Does the implant work to protect against pregnancy straight away?

The implant can be fitted at any time during your cycle as long as you’re not pregnant. If fitted in the first 5 days of your cycle you are protected against pregnancy straight away. If fitted at any other time within your cycle you will need to use condoms for the first 7 days. As soon as the implant is removed you are no longer protected from pregnancy and your fertility will return to what is normal for you.

See our Lowdown page for more user reviews and related stats about the implant and possible side effects. Also see our guide on implant fitting for more information.

Contraceptive implant removal

The implant lasts for three years and must be removed and replaced after three years to continue providing you with protection from pregnancy. You will need to go back to your doctor or nurse to get the implant removed – the procedure is fairly simple and usually only takes a few minutes. If you decide you want another device to be inserted, this can be done immediately after the original one is removed. However if you chose not to replace the implant, you will not be protected from pregnancy anymore, so if you’re not looking to get pregnant, you’ll need to be prepared with another form of contraception.

They will inject your arm with a local anaesthetic, then make a tiny cut in your skin and gently pull the implant out. They will put a dressing on the arm to keep it clean and dry and to help reduce any bruising. Check out our survey results to see how long it took most women’s cycles to return to ‘normal’ after having the implant removed, and read about other effects they’ve experienced.

See more in our guide to implant fitting and removal.

What to do if I can’t feel the implant?

You should always be able to feel your implant. If you can’t feel your implant, use another method of contraception like a condom, the combined pill (if you’re eligible) or progestogen-only pill. The pills are safe to take alongside the implant. Take a pregnancy test and book an appointment with your GP or local sexual health service.

You healthcare professional will also make sure you’re not pregnant and check you’re using an alternative form of contraception. They will arrange imaging, usually an X-ray of your arm, to try and find the implant. If it can be seen, you can stop the other method of contraception and still reply on the implant for 3 years. If the implant can’t be seen, you’ll have some more imaging to find if it has moved, although this is very rare!

If your implant can’t be felt, when it’s time to remove or replace it, you should be referred to a specialist service to do this, rather than at your GP, so speak to your local sexual health clinic before.

What do I do if my implant is expiring or has expired?

If you implant is about to expire, (remember it lasts for 3 years!) you can start thinking about your next birth control option. Our recommender is a great place to start if you want a switch. Or if you’re planning a pregnancy, check out our fertility tips. If you would like the implant replacing, simply book in with your GP or local sexual health service to have it changed.

If your implant has already expired, or you can’t get an appointment before the expiry date. Firstly, make sure you aren’t pregnant. Then continue to use barrier protection like condoms or avoid sex until you can speak to a healthcare professional about changing or removing the implant or starting another contraceptive method.

Pros and cons of the contraceptive implant

Pros

• Effective for 3 years
• Doesn’t interrupt sex and you don’t have to remember to use it (you do have to remember to get it changed after 3 years though!)
• It is an option if you can’t use oestrogen based contraception, such as the combined pill, contraceptive patch or vaginal ring
• It’s safe to use while you’re breastfeeding
• It may reduce heavy periods and improve painful periods
• Your fertility returns to what is normal for you as soon as you have it removed

Cons

• You need to have a small procedure to have it fitted and removed
• You need to remember when it is due to run out
• Occasionally, the implant is difficult to feel under the skin and may make it more difficult to remove
• It doesn’t protect you from STIs (only condoms do this)
• Your periods may change in a way that is unacceptable to you
• Some temporary side effects from the contraceptive implant can include headaches, mood changes, libido changes and breast tenderness.
• Acne may worsen
• It can be affected by some medicines called enzyme-inducing drugs (such as rifampicin and rifabutin, St John’s wort and some anti-epilepsy drugs)

Who should use the contraceptive implant?

Those who:

• want a long-lasting contraceptive
• may find it difficult or don’t want to remember to take contraception daily
• can’t use contraception containing oestrogen

Who shouldn’t use the contraceptive implant?

Those who: 

• think they might already be pregnant
• don’t want their periods to change
• take other medicines that may affect the implant
• have breast cancer, liver disease, arterial disease or a history of heart disease or stroke
• have unexplained vaginal bleeding (such as bleeding in between periods or after you have sex)

Where can I get the implant?

In the UK you can get the birth control implant for free (even if you’re under 16) from contraception and sexual health clinics, GP surgeries and some young people’s services. Some (but not all) GPs or practice nurses are able to fit and remove implants, but be sure to check with your GP surgery.

Most sexual health clinics will also be able to do this for you, click to find your nearest one.