Contraceptive implants are small, flexible rods or capsules containing synthetic progestin hormones that are placed just beneath the skin of a woman's upper arm. Once inserted, they continuously release a low, steady dose of hormone into the bloodstream, providing long-acting reversible contraception.
The primary way implants prevent pregnancy involves three distinct physiological actions:
Students often wonder if the hormone causes weight gain. While individual experiences vary, the primary action remains strictly local and hormonal on the reproductive organs rather than systemic metabolic disruption.
In Nigerian clinical practice, two main brands of subdermal implants are widely distributed through public health facilities and private clinics: Jadelle and Implanon NXT. Understanding their structural differences and duration of action ensures safe and effective client management.
| Feature | Jadelle | Implanon NXT |
|---|---|---|
| Number of rods | Two flexible rods | Single flexible rod |
| Active hormone | Levonorgestrel | Etonogestrel |
| Duration of use | Up to 5 years | Up to 3 years |
| Insertion tool | Reusable metal trocar | Pre-loaded, disposable applicator |
Both devices offer extremely high efficacy rates, comparable to female sterilization, but with the distinct advantage of being fully reversible once removed by a trained healthcare provider.
Before any implant procedure, a thorough health assessment is mandatory to rule out pregnancy and screen for medical eligibility using the World Health Organization Medical Eligibility Criteria for Contraceptive Use.
Take a detailed medical history focusing on:
Counselling must cover expected changes in menstrual bleeding patterns, as spotting or amenorrhea is normal and harmless. Emphasize that implants do not protect against sexually transmitted infections, making dual protection with condoms vital.
Proper insertion and removal demand strict aseptic technique and precise anatomical placement on the inner side of the non-dominant upper arm, about 8 to 10 cm above the medial epicondyle of the humerus, avoiding the sulcus where major blood vessels and nerves lie.
Removal requires a small incision near the tip of the implant, gentle pushing toward the incision, and extraction using mosquito forceps.
Subdermal implants rank among the most effective reversible contraceptives available, with failure rates of less than one percent in typical use. Because the method does not rely on daily user compliance, its real-world effectiveness matches clinical trial data closely.
Clients frequently experience benign side effects that require reassurance rather than medical intervention:
Reassure clients that these side effects are generally harmless and tend to decrease over the first few months of use.
While implants are safe, occasional complications require skilled midwifery management. Localized infection at the insertion site can present with increasing pain, warmth, and purulent discharge; treat this promptly with warm compresses, local wound care, and appropriate antibiotics. If an infection fails to resolve or the implant begins to extrude spontaneously, removal may be necessary.
Deep insertion—where the rod cannot be felt under the skin—is a rare complication usually caused by faulty technique. Do not attempt blind dissection in the clinic; refer the client to a specialized center where ultrasound or X-ray guidance is available.
Encourage clients to return whenever they have concerns, wish to remove the device, or reach its expiration date.