Etonogestrel (intradermal)

Overview

The Etonogestrel implant is given to women who are trying to avoid becoming pregnant. This form of birth control comes as a matchstick-sized flexible plastic rod which is inserted just below the skin in your upper arm. It contains a hormone to help prevent pregnancy, and the implant is effective for three years following the initial insertion.

Do be aware that you cannot obtain the Etonogestrel implant without first obtaining a doctor's prescription. This prescription is only given to patients who have undergone a full consultation to decide whether or not this is suitable or not. There is a lot you need to be made aware of before being given this implant.

In particular, it is not a way to protect against sexually transmitted diseases. To protect against these diseases, which includes HIV and AIDS, you will still need to take other measures, such as using a condom.

Condition(is) treated

  • Preventing pregnancy

Type of medicine

  • Implant

Side Effects

As well as helping to prevent against unwanted pregnancies, the Etonogestrel implant can cause a number of unwanted side effects. Some of these side effects are more worrying than others and require emergency medical assistance. Directly below is a list of these more serious side effects. If you experience any of these after having received the implant you should contact your nurse or doctor immediately.

More common

  • General feeling of illness or discomfort

Less common

  • Difficulty with breathing

Rare

  • Deep, dark purple bruise at the injection site

As well as these more serious side effects, there is also the chance that you may experience less serious ones. Directly below is a list of these less worrying side effects which do not require emergency attention. Instead, you may simply find that they are temporary and that they will disappear as your body adjusts to the new implant. However, if these side effects are persistent and worrying you in any way, then you can still contact your doctor. They may be able to advise on means to reduce them.

More common

  • Hoarseness

Less common

  • Decreased interest in sexual intercourse

Though this list is fairly extensive, it is not necessarily complete. If you experience any other side effects that are not mentioned here, then you can still contact your doctor if they are causing you concern.

Dosage

The implant you receive will be prescribed by your medical professional and then inserted by a trained nurse or doctor. You will not need to worry about any sorts of ongoing dosages, as the implant will remain in place for 3 years.

Before you have the implant inserted it is very important that you tell your doctor if you have missed a period or think you might be pregnant. Tests will need to be done to ensure that all patients receiving the implant are not pregnant.

As well as consulting with your doctor regarding this implant, you will need to read some patient instructions that come with the implant. After reading this you will need to sign a USER card as well as a Patient Consent Form. The Consent Form outlines all potential risks associated with the implant and tells you exactly when you must have it removed. It is your personal obligations to ensure you understand everything that is in both of these documents before you sign. You should then keep your USER CARD safely stored with your health records in a place at home. If you have any questions regarding this then you should speak to your doctor.

To ensure that the implant was successful, you can gently press your fingertips over the skin in your arm where it was inserted. You will be able to feel the small rod as it is only placed beneath the skin.

Be aware that the implant is less effective in the first 7 days, so you should use other forms of birth control during this time (such as condoms). You can discuss other options available to you with your doctor.

The lifespan of the Etonogestrel is 3 years. After that, it must be removed. However, if you would like it removed at any other time in this period then your doctor can do this as well.

Once the 3 years has ended, you will no longer be protected by the implant. You will need to start using another form of contraceptive or have your doctor insert another implant straight after this one has ended.

Interactions

As with all drugs, the Etonogestrel implant has the ability to interact with other medicines you are taking. For this reason, your doctor will need to be aware of all other drugs you are currently taking so that they can assess whether or not an interaction is likely to occur. This includes all non-prescription and prescription drugs, as well as herbal vitamins and supplements. Directly below is a list of medicines with which it is not recommended you take whilst using the Etonogestrel implant. Doing so could lead to a more severe interaction.

  • Tranexamic Acid

As well as these, here is a list of drugs which it is usually not recommended you take whilst using the Etonogestrel Implant. In some cases, it may be necessary that you use these two drugs. If so, your doctor may need to alter the dosage of the second drug so as to avoid interactions as best as possible.

  • Sugammadex

Finally, if you take any of the following drugs whilst using the implant, you could be at a higher risk of certain side effects occurring. In many cases, taking both is still the best course of treatment for your condition. Either way, your doctor is best placed to advise on how to limit any side effects that are likely to occur.

  • Colesevelam

As well as drugs, there is the potential that the Etonogestrel implant will interact with other aspects of your daily dietary intake. This includes what you eat, drink, and smoke. Yoru doctor will likely ask you to give a run-down of your typical daily diet so that they can advise you of any possible interactions. In some cases, they may ask you to limit how much tobacco you smoke or alcohol you drink. In particular, taking high amounts of the following is likely to cause an increased chance of certain side effects. You, therefore, may need to adjust how much of the following you consume each day.

  • Caffeine

Finally, other medical problems you have could interact with the Etonogestrel implant. You should inform your doctor of all medical problems you have, but be extra careful in advising them if you have any of the following.

  • Hypertension (high blood pressure)

Warnings

Prior to receiving the implant, your doctor will give you a full medical examination to ensure that you are at no increased risks. As a part of this examination, they will need to understand any allergies you currently have. This includes allergies to animals, dyes, foods, preservatives, or to other drugs. You should be open and honest in disclosing any allergies so that your doctor can decide whether the implant is indeed suitable for you.

As of writing, suitable studies into the use of the implant in the pediatric population have not been performed. However, it is not expected that any particular problems would arise that would make the implant less effective for teenage females. Do be aware that it is not suitable for teenage females who not yet started menstruating.

Similarly, appropriate studies have not yet been performed on older female patients. However, it is widely recommended that the Etonogestrel implant is not used in elderly women.

As of writing, there are no adequate studies that have been performed on breastfeeding women receiving the Etonogestrel implant. Your doctor is best placed to advise you on any increased infant risk if you breastfeed whilst having this. They can weigh the benefits alongside any increased risks, or then advise on an alternate form of contraception.

As you will have this implant in place for 3 years, your doctor will likely need to see you at regular visits to check that the implant is working effectively. During these visits, they can see if any unwanted effects have arisen and advise you on any adjustments you can make to reduce these effects.

Do be aware that this form of contraception is not 100% effective. As such, there is the possibility that you can become pregnant during this time. If you do, then you should be aware that you have a slightly higher chance of having what is known as an ectopic pregnancy. This is where the pregnancy occurs outside of the womb. Such pregnancies are very dangerous as they can cause major internal bleeding. If you do become pregnant whilst using this implant then contact your doctor to have it removed as soon as possible.

If you are planning to start breastfeeding or are already breastfeeding, then you should tell your doctor. It is not recommended that you receive this implant if you had a baby less than 4 weeks ago.

Whilst you have the implant, you are not protected from Sexually Transmitted Diseases (STDs) or HIV and AIDS. To help protect against these then you will need to either abstain from sex or use condoms.

If you have ever had an allergic reaction to numbing agents of antiseptic skin cleanser, you should inform your doctor. Such medicines are used when the implant is inserted.

During insertion and removal, there is the chance of you experiencing bruising, scarring, pain, swelling, irritation, or other complications. You can discuss such risks with your doctor.

After receiving the Etonogestrel implant you are at higher risk of experiencing blood clots in the brain (stroke), legs (deep vein thrombosis), (heart attack), eyes (blindness), lungs (pulmonary embolism), or heart. Make sure your doctor is aware at least 4 weeks before if you are going to be on bed rest or are to have surgery. During such time, you are at higher risk of this occurring. The risk is also increased if you smoke cigarettes.

While you have the implant you are at higher risk of having high blood pressure, ovarian cysts, liver tumors, gallbladder problems, or irregular monthly periods.

If you experience any of the following symptoms then you should contact your doctor immediately as they may be indications of liver problems.

  • Yellow eyes or skin

If you also wear contact lenses and experience difficulty in reading, blurred vision, or experience any other change in vision, then you should inform your doctor right away. They may get you to have your eyes checked by an eye doctor (ophthalmologist).

The implant has the potential to affects your blood sugar levels. If you do notice any changes in your blood or urine tests, then you should tell your doctor.

Other medical tests that you have whilst having the implant could be affected. Tell the doctor assessing you that you have the implant.

Unless first approved by your doctor, you should not take any other medicines whilst you have the implant. This includes prescription and non-prescription drugs, as well as vitamin supplements or herbal medicines.

Storage

You will not be required to store the Etonogestrel implant at any time. Instead, after being prescribed by your doctor, it will be administered by a trained medical professional in a clinical setting.

Summary

If you are looking to avoid becoming pregnant, then the Etonogestrel is a fairly common form of birth control. However, before receiving it your doctor will need to give you an extensive medical examination. This is to assess whether this is indeed the correct form of birth control for you. There are many other forms of contraceptive available, and it may be that this one is not best suited to your circumstances.

As listed above, there is the possibility of experiencing a wide range of different side effects and interactions after you receive the implant. If this does occur, then you should inform your doctor immediately. Under many circumstances, they may need to remove the implant. It is important that you aware that no form of contraceptive is 100% effective, and that the implant in no way protects you against HIV/AIDS or STDs. For further advice on protecting against such things, you should consult with your doctor or nurse.