A short guide to sub-dermal implants [SDI]
Types: Only one type of sub –dermal implant is available in UK – Nexplanon.
When to fit:
1] A SDI can be fitted within the first 5 days of the onset of menses and will start working
immediately
2] A SDI can be fitted at any time in a menstrual cycle if there is NO RISK OF PREGNANCY, but extra
precautions will be required for the first 7 days after insertion.
3] No follow up is required after insertion, women should only return if they experience problems.
4] Advice women to return if any of the following applies:
- the woman cannot feel the implant, also advice extra precautions until the location
of the implant is identified - the implant appears to have changed shape
- if the woman notices any skin changes or pain around insertion / removal site
- if the woman becomes pregnant with implant in-situ
5] Use of Liver Enzyme Inducers [LEI] which includes ST JOHNS WORT, may reduce the efficacy of the
implant. The woman must be advised to switch to an alternative, effective method or to use barrier
methods for the time the woman is on the LEI and for 28 days after the LEI is stopped.
When to remove:
1] At any time if pregnancy is desired, fertility will return to normal within 2-6 weeks
2] A SDI can be replaced immediately, if it is within 3 years of insertion, without the need for extra
contraceptive precautions.
3] After removal of a SDI, effective contraception is required if pregnancy is NOT desired.
Who can insert and remove SDI:
1] Health professionals should be appropriately trained, hold appropriate certification, maintain
competencies and attend regular updates.
Bleeding patterns:
1] Women may experience the following patterns:
25% will have regular bleeds
33% will have infrequent bleeding
20% will become amenorrhoeic
25% will have prolonged or frequent bleeds
2] Altered bleeding patterns are likely to remain irregular
3] Troublesome bleeding on a SDI can be treated with the oral contraceptive pill for 3 months
initially, either cyclically or continuously if there are no contra-indications to its use.
For more information please follow this link:
http://www.fsrh.org/pdfs/CEUGuidanceProgestogenOnlyImplants.pdf