Birth Control Bingo: the Contraceptive Implant

Contraceptive implant research and development began at the Population Council laboratories in New York in 1966. The development of implants was made possible by the discovery of silicone and its bio-compatibility in the human body. Silastic tubes with sealed ends, filled with steroids, provided a sustained release of the steroids over months; these models were the precursors of today’s contraceptive implants. The first implant, Norplant, a system made of six small rods, came into the U.S. market for approved use in the 1990s, but was taken off the market in 2002. The implants we have now came back into the world market in 1998. other implant systems are currently in development, including some with biodegradable rods (cool!), rather than rods which need to be removed.

The implant is:

99+% effective in one year of either perfect or typical use⁠ ; less than one out⁠ of every 100 people will become pregnant

Additional Sources for Effectiveness Ratings and Use:

  • 99.95% typical and perfect use⁠ (clinical trials only) Contraceptive Technology, 20th Revised Edition; Hatcher, Trussell, Stewart, Nelson, Cates, Guest, Kowal: Ardent Media, 2011.
  • Over 99% typical and perfect use: World Health Organization
  • 99.9% typical and perfect use: Planned Parenthood

What's typical or perfect use mean? Effectiveness rates of contraceptive methods are all figured based on one full year of use, not for each single incident of sex⁠ or use of a method. Perfect, or proper, use of a method means that in one year, that method was always used, and always used following the directions for that method to the letter. Perfect use of most methods in one full year is unusual, except for methods like the IUD⁠ or implant where a user does not have to do anything. Typical use means that in one year, sometimes a method has not been used according to the directions, or was not always used. Typical use is called that because that is most typically how methods are used in a full year, since people aren't perfect.

The What, the Why, the Where, the When, and the How-to: The currently available contraceptive implant, Implanon, is a thin, plastic rod inserted subdermally (under the skin) by a healthcare provider⁠ in the non-dominant arm which emits small amount of the hormone progestin over time. That progestin prevents pregnancy⁠ by suppressing ovulation⁠ and thickening cervical mucus, making it difficult for sperm⁠ to swim to the cervix⁠ .

When inserted within the first five days of a menstrual period⁠ , the implant⁠ is effective immediately. A backup method of birth control⁠ is generally advised after insertion of the implant for seven days before using the implant alone, espeically if it has been inserted at a time other than within the first five days of a period⁠ .

One implant is effective for three years. If a person wants to stop using it, they can just have it removed. Once removed, people will soon resume their normal fertility⁠ cycles.

Pros of the implant include not having to think about a method for as long as three years at a time, a very high level of effectiveness⁠ , no chance of user error, reduction of painful periods, and a method which doesn't interrupt sexual⁠ activities.

The biggest complaint most users have with the implant is due to unpredictable spotting or bleeding which, for some, may be very frequent. Some people may stop getting their periods, and may have very irregular periods; some may have heavier, longer periods than usual. Other unfavorable side effects may include those typical with many hormonal methods like weight gain, vaginal dryness, reduction of sex drive, nausea or an increase in headaches. The implant can pose cardiovascular risks, irritation of the injection site, difficulty in removing the implant, and some people are not good candidates for the implant, possibly including diabetics, those with high blood pressure, those suffering from depression or epilepsy. Some other medications or drugs may reduce the effectiveness of the implant.

For more information about Implanon, see:

When Good Birth Control Does Bad Things: It's highly unlikely that an implant will fail, but if used with a medication that can decrease effectiveness it may fail, and if a person does not get a new implant in time when their old one has expired, pregnancy may occur.

What will/might you need to discuss or negotiate with a partner⁠ ?

  • If you or they are or are not okay with ejaculation⁠ inside the vagina⁠
  • Possible semen⁠ allergies or sensitivities (it is currently estimated as many as around 10% of people may have them), if not being combined with condom⁠ use
  • STI⁠ status and history, especially if not being combined with condom use

Other methods which can be used as a backup method with an implant: Implants are so effective and free of user error that unless using a medication known or suspected to decrease effectiveness, a backup is not likely needed after the first two weeks post-insertion. But if a backup is needed, it can be used with any non-hormonal method.

Other methods you might like if you like the implant: 

Why would an implant be a good option for me? If any of the following are true:

  • You want a method where it's nearly impossible for you to mess up
  • You don't want a method you have to think about before, during or after the time of sex, or know you can't remember to do that
  • You are looking for a hormonal method without estrogen⁠
  • You are looking for a method you rarely need to tend to
  • You want something which is very cost-effective long-term
  • You want something which is quickly reversible
  • You are currently breastfeeding

Want to start over with Birth Control Bingo? Click here.

Don't forget: Statistically, sexually active⁠ young adults⁠ are as, if not more, likely to acquire a sexually transmitted infection⁠ (STI) as you are to become pregnant. Although 15-24-year-olds represent only one-quarter of the sexually active population, they account for nearly half of all new STIs each year, and of the 18.9 million new cases of STIs each year, 9.1 million (48%) occur among 15-24-year-olds (AGI). Often people have some funny ideas about who is most likely to get an STI, but the fact of the matter is that younger people -- of any sexual orientation⁠ , any economic class, any kind of relationship⁠ -- have been the highest risk group for some time now.

Condoms are the only method of birth control which also provide protection against STIs. It's pretty typical for younger people to ditch condoms if they have another method of birth control, so just remember that STIs are still a risk if you're using another method. You can read all about safer sex⁠ here -- Safe, Sound & Sexy: A Safer Sex How-To -- but the rule of thumb most medical experts and prevention organizations suggest, which we also encourage at Scarleteen is six months of safer sex, six months of sexual monogamy, and then TWO full STI screenings for each partner -- once at the start of that six months, once at the end -- before ditching latex barriers.

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