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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjA0NzIxNy1vdmVydmlldw==\nDrugs & Diseases > Clinical Procedures\nContraceptive Implant Placement\nAuthor: Megan Brady Shannon, MD; Chief Editor: Michel E Rivlin, MD more...\nSections Contraceptive Implant Placement\nPeriprocedural Care\nPatient Education & Consent\nPre-Procedure Planning\nPatient Preparation\nMonitoring & Follow-up\nMedication Summary\nProgestins\nLocal Anesthetics, Amides\nThe contraceptive implant is a popular form of long-acting reversible contraception (LARC). Norplant, the first contraceptive implant, became available in 1983 [1] but was later removed from the market owing to patient dissatisfaction with adverse effects that ultimately led to several lawsuits against the manufacturer. It was also difficult to remove. [2]\nThe currently available implant, Nexplanon, is a rod that contains the progestin etonogestrel and is intended for subdermal implantation in the non-dominant arm. It is the second-generation of the device; the first-generation was called Implanon. The currently available device differs from its first-generation counterpart in that the implant itself is radiopaque and its applicator design is improved so as to prevent placement deeper than the intended subdermal location.\nThe advantage of an implantable form of contraception is that it provides effective long-term contraception that does not depend on the recipient’s daily compliance. The implant has become a popular choice among adolescents and young women, and is appropriate for both nulliparous or parous women. [3]\nThe most recent generation of implantable devices is the most effective form of birth control available and can usually be inserted by trained practitioners in less than one minute. [4, 5, 6, 7] The pregnancy rate with the implant is 0.05%, which is slightly lower than the levonorgestrel intrauterine device (0.2%) and the copper intrauterine device (0.6%). [8, 9]\nA release rate of 25-30 µg/day of etonogestrel is required to suppress ovulation. With this device, the initial rate of release is 60-70 µg/day, which slowly decreases over time, to about 30 µg/day. Maximum serum levels are attained the fourth day after insertion, on average.\nAfter removal of the implant, etonogestrel serum levels become undetectable within one week. [1, 6, 10]\nThe contraceptive implant is currently approved for contraception in women, including nulliparous women, adolescents, and breastfeeding mothers. [8] The implant is approved for immediate postpartum use. It may be inserted as soon as 10 minutes after placental delivery, thus providing safe and effective reversible contraception prior to hospital discharge. The insertion technique does not differ for immediately postpartum placement. [11]\nThe contraceptive implant is an etonorgestrel implant, which works by the same mechanism as other progesterone-only methods: by inhibiting ovulation, thinning the endometrium, and thickening cervical mucus. [5, 12]\nThe US Medical Eligibility Criteria for Contraceptive Use, published by Centers for Disease Control and Prevention, guides practitioners about the safety of contraceptive implant use in patients with other medical conditions. The contraceptive implant is safe or the risks of harm are thought to be outweighed by the contraceptive benefit in the following situations [8] :\nCigarette smoking\nCurrent infection with or history of sexually transmitted diseases or pelvic inflammatory disease\nObesity (Note: the contraceptive implant has been studied in women up to 130% of ideal body weight; the effectiveness of the implant in obese women is still being investigated. [10, 13] )\nHistory of deep vein thrombosis or pulmonary embolism\nMild cirrhosis\nHistory of bariatric surgery\nBreastfeeding [14, 15]\nPostabortion (first or second trimester)\nThe contraceptive implant should not be used in the following situations:\nLiver disease, including severe cirrhosis or liver tumors\nPersonal history of breast cancer\nUndiagnosed abnormal vaginal bleeding\nAllergy or hypersensitivity to any of the implant materials\nThe pregnancy rate with the implant is 0.05%, which is slightly lower than the levonorgestrel intrauterine device (0.2%) and the copper intrauterine device (0.6%). [8, 9]\nPotential complications\nThe most common procedural complication is pain at the insertion site, which occurs in less than 3% of users, according to one study. [7] Pain is usually transient and resolves with time. Other uncommon complications include the implant being retained in the needle applicator, bleeding or redness at the insertion site, and hematoma formation. [7, 6] Bruising after insertion is possible and should resolve within a few days.\nSide effects of the etonorgestrel implant, unrelated to implant insertion, have been reviewed in an analysis of 11 major international clinic trials that include 942 subjects. The most common reason (13.6%) for a woman to discontinue use of the implant was an adverse side effect such as headache, weight gain, acne, breast pain, emotional lability, and abdominal pain. Another 11% of women cite undesirable bleeding irregularities as their reason for discontinuation. The most common irregularity was infrequent bleeding (33.3%), followed by amenorrhea (21.4%), prolonged bleeding, and frequent bleeding. [7]\nPeriprocedure\nMeirik O, Fraser IS, d'Arcangues C. Implantable contraceptives for women. Hum Reprod Update. 2003 Jan-Feb. 9(1):49-59. [Medline].\nMedWatch The FDA Safety Information and Adverse Event Reporting Program Accessed 2-13-12. Norplant. [Full Text].\nAbraham M, Zhao Q, Peipert JF. Young Age, Nulliparity, and Continuation of Long-Acting Reversible Contraceptive Methods. Obstet Gynecol. 2015 Oct. 126 (4):823-9. [Medline].\nLevine JP, Sinofsky FE, Christ MF. Assessment of Implanon insertion and removal. Contraception. 2008 Nov. 78(5):409-17. [Medline].\nCroxatto HB, Urbancsek J, Massai R, Coelingh Bennink H, van Beek A. A multicentre efficacy and safety study of the single contraceptive implant Implanon. Implanon Study Group. Hum Reprod. 1999 Apr. 14(4):976-81. [Medline].\nFunk S, Miller MM, Mishell DR Jr, Archer DF, Poindexter A, Schmidt J, et al. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception. 2005 May. 71(5):319-26. [Medline].\nDarney P, Patel A, Rosen K, Shapiro LS, Kaunitz AM. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril. 2009 May. 91(5):1646-53. [Medline].\nU S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep. 2010 Jun 18. 59:1-86. [Medline].\nMommers E, Blum GF, Gent TG, Peters KP, Sørdal TS, Marintcheva-Petrova M. Nexplanon, a radiopaque etonogestrel implant in combination with a next-generation applicator: 3-year results of a noncomparative multicenter trial. Am J Obstet Gynecol. 2012 Nov. 207(5):388.e1-6. [Medline].\nWenzl R, VanBeek, A, Schnabel P, Huber J. Pharacokinetics of Etonogestrel Released from the Contraceptive Implant Implanon. Contraception. 1998. 58:283-288. [Medline].\nCommittee Opinion No. 670 Summary: Immediate Postpartum Long-Acting Reversible Contraception. Obstet Gynecol. 2016 Aug. 128 (2):422-3. [Medline].\nMäkäräinen L, van Beek A, Tuomivaara L, Asplund B, Coelingh Bennink H. Ovarian function during the use of a single contraceptive implant: Implanon compared with Norplant. Fertil Steril. 1998 Apr. 69(4):714-21. [Medline].\nHigginbotham S. Contraceptive considerations in obese women: release date 1 September 2009, SFP Guideline 20091. Contraception. 2009 Dec. 80(6):583-90. [Medline].\nTaneepanichskul S, Reinprayoon D, Thaithumyanon P, Praisuwanna P, Tosukhowong P, Dieben T. Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. Contraception. 2006 Apr. 73(4):368-71. [Medline].\nBrito MB, Ferriani RA, Quintana SM, Yazlle ME, Silva de Sá MF, Vieira CS. Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study. Contraception. 2009 Dec. 80(6):519-26. [Medline].\nACOG Practice Bulletin No. 121: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2011 Jul. 118(1):184-96. [Medline].\nImplanon (etonogestrel implant) [package insert]. Merck. 2006, 2009. Available at [Full Text].\nNexplanon, Highlights of Prescribing Information [package insert]. Whitehouse Station, NJ: Merck. 2011. Available at [Full Text].\nShokeir T, Amr M, Abdelshaheed M. The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study. Arch Gynecol Obstet. 2009 Sep. 280(3):437-43. [Medline].\nWalch K, Unfried G, Huber J, Kurz C, van Trotsenburg M, Pernicka E, et al. Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis--a pilot study. Contraception. 2009 Jan. 79(1):29-34. [Medline].\nCroxatto HB. Mechanisms that explain the contraceptive action of progestin implants for women. Contraception. 2002 Jan. 65(1):21-7. [Medline].\nPatient's wrist is parallel to her ear or her hand is positioned next to her head.\nThe insertion site, which is at the inner side of the nondominant upper arm about 8cm above the medial epicondyle of the humerus.\nThe transparent protection cap should be removed by sliding it horizontally away from the device.\nWith your free hand, use countertraction on the skin as you insert the needle at a 30 degree angle.\nOnce the needle has punctured the skin, hold the applicator horizontal to the skin, and tent the skin upwards as you slide the entirety of the needle into the subdermal space.\nWhile holding the applicator in place, unlock the purple slider with your index finger by pushing the slider downwards and backwards until it locks.\nAt this point the needle is inside the applicator and the applicator can be removed from the field.\nThe practitioner and patient should palpate the implant immediately after insertion.\nMegan Brady Shannon, MD Fellow in Female Pelvic Medicine and Reconstructive Surgery, Loyola University Hospital\nMegan Brady Shannon, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Urogynecologic Society\nDavid Chelmow, MD Leo J Dunn Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center\nDavid Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Council of University Chairs of Obstetrics and Gynecology, Phi Beta Kappa, Sigma Xi, Society for Academic Specialists in General Obstetrics and Gynecology, Society for Reproductive Investigation\nMichel E Rivlin, MD Former Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine\nMichel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, Royal College of Surgeons of Edinburgh, Royal College of Obstetricians and Gynaecologists\nencoded search term (Contraceptive Implant Placement) and Contraceptive Implant Placement\nOral Contraceptive Pill (Birth Control Pill) Hormonal Activity\nEmergency Postcoital Contraception\nWomen's Health and Epilepsy\nBreast Cancer Epidemiology and Risk Factors\nLow Energy Availability in Female Athletes\nStroke and MI Risk With Newer Hormonal Contraceptives\nPrescriptions for Selective Cyclooxygenase-2 Inhibitors, Non-selective Non-steroidal Anti-inflammatory Drugs, and Risk of Breast Cancer in a Population-based Case-control Study\nYoung Women With RA at High Risk for Fractures\nHPV Diseases: From Cutaneous to Anogenital to Epidermodysplasia Verruciformis\nAccording to Obstetrician / Gynecologists\nMen's Marijuana Use Linked to Elevated Miscarriage Risk\nVirginia Ob-Gyn Accused of 'Deeply Disturbing' Unneeded Surgeries\nOmega-3s and CVD Prevention:\tA Promising Future?\nLifetime Estrogen Exposure and Cognition in Late Life\nReassuring Data on Antidepressant Use in Pregnancy\n2002 2172310-overview Tables & Protocols\nTables & Protocols Oral Contraceptive Pill (Birth Control Pill) Hormonal Activity\nProcedures Contraception\nTables & Protocols Emergency Postcoital Contraception\nNews U.S. Scientists Test First Monthly Contraceptive Pill in Pigs"