Session III, Slide #1 Contraceptive Implants Session III: Providing Implants.

Session III, Slide #1

Contraceptive Implants

Session III: Providing Implants


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)


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


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


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


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

Session III, Slide 7

• 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.

Implant Insertion and Removal

Session III, Slide 8

See a nurse or doctor if:

• Yellow skin or eyes

• May be pregnant, especially if pain or soreness in belly

• Unusually heavy or long bleeding

• Infection or continued pain in the insertion site or sees rod coming out

• A bright spot in your vision before bad headaches

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.


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.


Management of Implant Side Effects:

Bleeding Changes

Problem Action/ManagementHeavy or prolonged bleeding

• Reassure the client that this is common and not harmful

• Recommend a 5-day course of ibuprofen (up to 800 mg 3 times per day for 5 days)

• If no relief, offer COCs for 3 weeks

• If bleeding is heavy, iron tablets may prevent anemia

Amenorrhea • Reassure client

• For short-term relief offer ibuprofen or indomethacin 2 times daily after meals for 5 days

Counseling and reassurance are key

Source: CCP and WHO, 2011.



Non-Menstrual Problems

Problem Action/ManagementCommon headache

• Reassure and suggest painkillers; evaluate headaches that worsened since implant initiation

If side effects persist and are unacceptable to the client, counsel about non-hormonal methodsMild

abdominal pain

• Reassure; suggest painkillers; follow-up if needed

Breast tenderness

• Recommend a supportive bra, compresses, or painkillers

Weight change

• Inform about healthy eating habits and exercise



Problem Action/ManagementPain after insertion or removal

• Check that the bandage or gauze is not too tight; replace bandage; avoid pressing on site

• Give painkillers for a few days

Infection • Clean the infected area• Give antibiotics for 7–10 days• Remove implants if no improvement

Abscess • Clean, cut open, and drain the abscess• Treat the wound• Give antibiotics for 7–10 days• Remove implants if no improvement

Expulsion or partial expulsion

• Expulsion or partial expulsion of the implants often follows an infection

• Ask the client to return for follow-up care if she notices an implant coming out


Problems Related to Insertion



Problems That May Require Switching from Implants to Another Method (Part 1)

Problem Action/ManagementUnexplained vaginal bleeding

• Refer or evaluate by history and pelvic exam• If an STI is diagnosed, treat with implants in place• If no cause can be found, consider removing

implants to make diagnosis easier

Migraines • If the client develops migraines with aura after implants are inserted, the implants should be removed

• Help client choose a method without hormones

Blood clots, liver or heart disease, stroke, or breast cancer

• Remove implants• Help client choose a method without hormones• Treat or refer to a specialist for treatment



Problems That May Require Switching from Implants to Another Method (Part 2)

Problem Action/ManagementHeart disease due to blocked or narrowed arteries (ischemic heart disease)

A woman who has one of these conditions can safelystart implants. If, however the condition develops whileshe is using implants:

• Remove the implants or refer for removal

• Help her choose a method without hormones

• Refer for diagnosis and care if not already under care

Suspected pregnancy

• Assess for pregnancy, including ectopic pregnancy

• Remove the implants or refer for removal if she will carry the pregnancy to term

• There are no known risks to a fetus conceived while a woman has implants in place



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



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.


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.


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.


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

Session III, Slide #1 Contraceptive Implants Session III: Providing Implants.

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