Implanon Insertion and Management
Timing of Insertion
- Implanon can be inserted at any time if it is reasonably certain that the woman is not pregnant, as recommended by the Centers for Disease Control and Prevention 1
- For postpartum women (not breastfeeding) who are ≥21 days postpartum and have not experienced return of menstrual cycles, Implanon can be inserted immediately, according to the Centers for Disease Control and Prevention 1
- The Centers for Disease Control and Prevention supports immediate postpartum insertion of implants as a safe and effective practice that removes barriers to care 2, 3
Need for Back-Up Contraception
- If the spotting represents the return of menstrual cycles and it has been >7 days since menstrual bleeding started, the woman needs to use additional contraceptive protection for the next 7 days after insertion, as recommended by the Centers for Disease Control and Prevention 1
- If inserting during the first 5 days of menstrual bleeding, no additional contraceptive protection is needed, according to the American Academy of Pediatrics 4
Counseling About Bleeding Patterns
- Before implant insertion, provide counseling about potential changes in bleeding patterns, as recommended by the Centers for Disease Control and Prevention 5
- Enhanced counseling about expected bleeding patterns has been shown to reduce discontinuation rates, according to the Centers for Disease Control and Prevention 5
Management of Bleeding Irregularities
- If irregular bleeding persists and becomes unacceptable to the patient, treatment options include NSAIDs for short-term treatment (5-7 days), as recommended by the Centers for Disease Control and Prevention 5
- Hormonal treatment with low-dose combined oral contraceptives or estrogen for short-term treatment (10-20 days) if medically eligible, is also an option, according to the Centers for Disease Control and Prevention 5