Contraceptive Implant

How it works

Etonogestrel suppresses ovulation, thickens cervical mucus and thins the endometrium. Together, these three effects prevent pregnancy. It is absorbed into the bloodstream, but the dose is low. Its effect ends quickly after removal; fertility usually returns within 7–14 days. Once inserted, there is nothing to remember every day.

Who it is suitable for

• Those who want long-term protection with a low risk of forgetting
• Those who do not want an IUD or who have a uterine abnormality
• Those who cannot use estrogen (migraine with aura, history of thrombosis, breastfeeding)
• Those who cannot take an oral pill regularly
• Those who can start on the same day after giving birth or after a miscarriage

Contraindications: active breast cancer, unexplained vaginal bleeding, severe liver disease, known thrombosis, or allergy to progestin. The CDC US MEC 2024 criteria are used. Effectiveness may be slightly lower in people with obesity; this is discussed.

The insertion process

Insertion is done under local anesthesia. A spot on the inner upper arm, between the elbow and the shoulder, is chosen. The skin is cleaned, the anesthetic is given, and the rod is placed under the skin with a special applicator. The procedure takes a few minutes. Two bandages are applied afterwards. The top bandage stays on for 24 hours, the lower one for 3–5 days. Keep the area dry.

After insertion, you should be able to feel the implant with your fingers. If it cannot be felt, it is checked with ultrasound or X-ray. Backup protection may be needed for the first 7 days, depending on timing. If it is inserted within the first 5 days of your period, it is effective immediately. It can be used safely during breastfeeding and after giving birth.

Changes in bleeding

The most common side effect is a change in bleeding pattern. It is hard to predict in advance. Possibilities:

• Amenorrhea (no periods): about 22%
• Infrequent bleeding: about 34%
• Frequent bleeding: about 7%
• Prolonged bleeding: about 18%

Spotting and irregularity are more common in the first 3–6 months. In many women they decrease over time. If the bleeding is bothersome, short-term treatment (tranexamic acid or a short course of the combined pill) can be discussed. With heavy or ongoing bleeding, pregnancy, infection and cervical disease are ruled out. About 11% have the implant removed because of bleeding; this is explained in advance.

Side effects

Common:

• Irregular bleeding or amenorrhea
• Headache
• Acne
• Breast tenderness
• Mood changes
• Weight change (a direct causal link is not clear)

Rare risks:

• Infection or hematoma at the insertion site
• Deep placement or migration of the implant (rare)
• Difficult removal (with deep placement)
• Thrombosis (very rare)
• Ectopic pregnancy (absolute risk is low)

Severe headache, chest pain, leg swelling, shortness of breath, or redness and discharge at the implant site need urgent evaluation. If you cannot feel the implant, a check-up is arranged.

How it differs from the gold IUD and hormonal IUD

At SoftCare, the gold IUD is our first choice. The contraceptive implant may be preferred in these situations:

• A patient who does not want an IUD or has a uterine abnormality
• A patient who cannot use estrogen and for whom the oral pill is not suitable
• A patient at high risk of forgetting who wants LARC

The gold IUD is hormone-free and may make periods heavier. The hormonal IUD reduces bleeding. The implant changes the bleeding pattern in an unpredictable way. None of the three methods protects against STIs; a condom should be added. The decision is based on patient preference, bleeding profile and medical eligibility.

The removal process

Removal is done under local anesthesia. The implant site is marked and the implant is removed through a small incision. The procedure takes a few minutes. Mild bruising and tenderness afterwards are normal. Fertility returns quickly. A new method can be started the same day. A deeply placed implant may need ultrasound-guided removal or a referral. Removal is scheduled at SoftCare; complicated cases are referred to an appropriate center.

Pregnancy and breastfeeding

If pregnancy is suspected, the implant is removed. If it is not removed in early pregnancy, the risks are discussed. It can be used while breastfeeding; it does not affect milk supply. It can be inserted right after giving birth. It can be started the same day after a miscarriage or abortion.

Follow-up

• Implant check (by touch) within 1 week after insertion
• Annual gynecological examination
• An extra visit for abnormal bleeding, pain, or if the implant cannot be felt
• A replacement plan before it expires
• STI testing if there is a risk

At SoftCare, patients who have an implant inserted receive written information on what bleeding to expect and when to seek urgent care.

Our approach at SoftCare

At SoftCare Clinic, assessment for the contraceptive implant starts with your gynecological history and bleeding profile. The gold IUD is our first recommendation; the implant is discussed with patients who do not want an IUD or for whom it is not suitable. Insertion is done in the clinic under local anesthesia. Changes in bleeding during the first 3–6 months are explained. If there are worrying symptoms, a check-up and, if needed, removal are arranged. If there is an STI risk, condoms and testing are recommended. At removal, the implant can be replaced with a new method in the same visit.

Appointments: +90 212 241 30 10 · softcareclinic.com

References

• 1. American College of Obstetricians and Gynecologists (ACOG). Long-Acting Reversible Contraception: IUD and Implant.
• 2. Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.
• 3. Organon. Nexplanon Prescribing Information and bleeding pattern data.
• 4. Winner B, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366:1998–2007.
• 5. Society of Family Planning. Guidance on deep and nonpalpable contraceptive implant removal. 2026.
• 6. UpToDate. Contraception: Etonogestrel implant.
• 7. T.C. Sağlık Bakanlığı. Gebeliği Önleyici Yöntemler – İmplanon bilgilendirmesi.
• Note: Approved durations may vary by country. At SoftCare, the gold IUD is our first choice; the contraceptive implant is discussed with selected patients. This reference list is for information purposes.

A citation does not mean that SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026