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Although the implant is a long-acting method of contraception, it does only last three years, so eventually it needs to be removed entirely or replaced. For me, the decision to get mine replaced was kind of a no-brainer. Everything that factored into my original choice was still there: my desire not to have children at the moment, the other medications I'm on, the very high effectiveness rate, the fact that it requires pretty much no effort on my part. Plus, after three years, I knew what the side effects would be like for me, and in general, those have been pretty minimal. One of the main reasons people get the implant removed is irregular bleeding or spotting, and while I definitely don't have a regular cycle anymore, I'm not bleeding constantly and I've had only a little bit of spotting on occasion.
One interesting thing I did notice: as the level of hormones decreased slightly - which is what happens over time with the implant - I had bleeding more often. At the beginning of the three years, I had a period-like bleed once every three months or so, but those bleeds started happening more frequently in the last year or so. I'm a nerd, so I found that fascinating.
Since the first time I had it inserted, the technology of the implant has changed a little bit, for the better. When it was developed, Implanon was a thin plastic rod that couldn't be seen on x-rays - so if there was a question about whether it had been placed in the right spot, there wasn't really a way to tell. The insertion device was also pretty intimidating-looking.
Nexplanon, the newer version, has fixed both of those issues. The implant is still the same material, size and shape, but it's got a little something extra in it to make it visible on x-rays and CT scans. Sadly, it doesn't glow in the dark or anything cool like that, but maybe by the time I need another replacement it will. The insertion device is also much less scary-looking; instead of a huge syringe, it looks more like a stapler (which, I'll admit, doesn't sound like much of an improvement at all, but it really is).
So. Once I'd decided to get my implant replaced, I had to find a clinic. When I got my first one inserted, I was living in Queensland, but I've since moved to Melbourne, so I obviously couldn't go back to the clinic I'd used before! Instead, I chose one of the Marie Stopes clinics here in Melbourne, partly because of their reputation, but also in part because it was a convenient location. It's a private clinic, so that upped the cost a bit, but given how cheap the implant is when you take into account how long it lasts, I decided it was worth it.
As it turns out, Marie Stopes totally deserves their excellent reputation. All of the staff were friendly and knowledgeable, and I had a good chat about various sex-geeky topics with the doctor who did the procedure. In my experience, answering the question "So what do you do?" with "Well, I'm a PhD student researching homophobia and I also do sex education" tends to shut down any further conversation, but in a sexual health clinic, it results in awesome discussion.
The procedure itself wasn't exactly a breeze, although it was far from being the worst medical experience I've ever had, and from what I've read since, most people have a far easier time. My body just seemed to want to hold on to the old implant! In most cases, removal is pretty quick: after the local anesthetic has kicked in, the doctor makes a small incision in the same spot where the implant was inserted, right over one end of the little plastic rod, and then the idea is that it can just be gently pulled out. In most cases it comes out pretty easily, because after it's inserted, the body forms a kind of capsule around it, similar to the way that pierced ears heal around the jewelry so that it can be easily removed.
My body didn't quite get that that was the idea, however, and the implant got kind of...stuck. The anesthetic part was fine, the incision part was fine,and then things went a bit off the rails. It did eventually come out of my arm, but only after the initial cut was enlarged slightly and a lot of gentle tugging that lasted a lot longer than the whole process is supposed to.
After the old implant was out, however, sliding a new one into the same spot and bandaging up my arm took maybe a minute. Then I was shown to a recovery room - generally used by patients who have just had a surgical abortion - and told by the nurse there to chill out for as long as I needed, and have some juice or cookies if I wanted. This isn't really standard; implant insertion, removal and replacement are all very easy procedures and hanging around the clinic afterwards isn't medically necessary, but the nurse may have thought I needed to take some time to myself because having someone digging around in your arm for a good 20 minutes isn't hugely enjoyable. I didn't really need any recovery time, but I stayed for a bit anyway. (Mostly because there were cookies. Okay, it was entirely about the cookies.)
Even though my arm had taken a bit of a beating, it healed up fairly quickly. I did have a seriously big bruise (elbow to armpit) that got some odd looks on public transport, but that was pretty much it. No soreness, minimal scarring, no big deal. At this point it's been nearly a year, and I'm still confident that I made the right decision for me in choosing to continue with the implant.