Let me start this by laying out the reason for my extreme prejudice against the Pill, and hence my search for alternatives: my sister and I, however loved once we were on the scene, were unplanned – in fact, we were actively being planned against. Since the Pill failed my mother not once, but twice (and she maintains she was using it correctly), hopefully it’s understandable that I am wary.
When I was considering my options, the most popular option was obviously the Pill with the Depo Provera three-monthly progestin injection and Mirena-style inter-uterine devices (IUD) competing for a distant second. The newcomer on the scene was Implanon, a small rod impregnated (pardon the pun!) with a progestin thst is slowly released over a three year period. The Nuva ring, a small flexible ring placed in the vagina that releases a progestin and an estrogen over a three-week period, was still a twinkle in some pharmaceutical company’s eye. My other extreme prejudice is against needles, so the three-monthly needle was unappealing, and the IUD was still lingering under the might-make-you-sterile cloud (which has since dissipated). So – Implanon!
[An aside here: my motivation for writing this article is that Implanon seems to be relatively unpopular/unknown in the U.S., and I wanted to give a first-person account to demystify it somewhat. I’m on my fourth go-round now, so evidently it works for me.]
First, some numbers. How effective is Implanon? Why would I consider inserting an inanimate object under my skin for three years? Well, it’s right up there with sterilization (except that it’s fully and quickly reversible!). Something like 0.4 to 1 women out of 1000 fall pregnant using Implanon, and the majority of those cases are due to incorrect insertion or insertion while pregnant. That was enough to convince me on its own; again, I am petrified of what happened to my mother!
How expensive is Implanon? Here is one reason why I think Implanon is less common in the U.S. In Australia, I paid about $20 every 3 years, which was the cost of filling the prescription for the rod itself. In the U.S., I paid over $300, which was definitely a harder pill to swallow (the puns are coming thick and fast!). I can see that being discouraging as a lump sum, but you have to consider it as a three year investment; at that rate, it is less than $10 a month.
So, what’s it like actually getting the rod implanted? Well, it’s not a walk in the park, but mostly that’s the fear of needles speaking. You get a local anaesthetic in the arm, and that’s the worst part done. The rod is contained in a small, sharp metal tube, like a large needle, which is inserted under the skin. The tube is then withdrawn, leaving the rod behind. If they’re thoughtful, the staff will provide you with a compression bandage to minimise the bruising, but be warned – there will be bruising, for a week or two. So if you’re self-conscious, plan on wearing long sleeves for awhile. The scar, at least in my case, is a very small (about 2mm) white circle. Changing the rod after three years is slightly more complicated. Again, they give you a local anaesthetic, then they make a small (about 5mm) incision and use small forceps to remove the existing rod. If you’re lucky, at the same appointment they’ll be able to put in the new rod, and Bob’s your uncle, you’re set for another three years! For my most recent change, they made me spread it over two appointments. So far they have been able to minimise the total scarring by making the new incision over the previous small, thin scar.
For me, Implanon has worked great. I haven’t noticed any of the possible side effects of hormonal birth control – mood swings, weight gain, acne, headaches, etc. My periods are erratic – sometimes long, sometimes short, sometimes non-existent for months at a time. When I kept track for a year or so, I calculated that I was bleeding 20% of the time, so about 5.6 days per 28 days, which is about on par for a normal cycle. However, in all my championing of Implanon to my friends and family, this has been the biggest issue people have experienced. A significant fraction of Implanon users (one site I found said 13%) will have prolonged periods of bleeding that are sufficiently long for them to get the rod removed. However, one big advantage of Implanon is that the body’s hormones return to normal within days of removal of the rod, so the issues of bleeding and other side effects and importantly, fertility, are restored to normal extremely quickly. Also, many users will experience light to no bleeding over the three years, so there’s that.
In summary, the pros and cons of Implanon. Pros: extremely effective, with very little room for user error; minimal effort involved, since you only have to think about it every three years; no long-term effects on fertility, with a very short timescale for returning to normal; and (in Australia) very cost-effective. Cons: irregular bleeding (makes planning romantic getaways tricky); having a minor surgical procedure every three years; small amounts of scarring; and (in the U.S.) more expensive. It’s not for everyone, but it is for me, and it might be for more people if they considered it.