·         Abortion
·         General Procedure
·         Health Risks and Side Effects
·         Infertility
·         Menstrual Bleeding
·         Sexual Pleasure
·         Who Can Use the Method
Myth: Abortion
Some women who seek family planning believe that implants interrupt a pregnancy by causing an abortion.
Implants work primarily by thickening cervical mucus, which blocks sperm from meeting an egg, and by disrupting the menstrual cycle and preventing ovulation.
Implants do not interrupt pregnancy. Good evidence shows that implants will not affect the pregnancy or harm the fetus if a woman is already pregnant when implants are inserted or becomes pregnant while using implants.
Counseling Messages:
Implants do not cause abortion or birth defects, since there is no evidence of this based on women who used implants. Besides, the doctor will check you first to ensure that you are not pregnant before inserting the implant. (Indonesia)
Myth: Complications with Method
Some women who seek family planning believe that implants can cause complications in the arm in which they are inserted or that they can travel from the insertion site to other parts of the body.
Implants cannot travel to other parts of the body. They remain where they are inserted until they are removed. In rare cases, a rod may start to come out of the skin, usually during the first four months since insertion. This typically happens because the implants were not inserted well or because of an infection at the insertion site. If expulsion occurs, the woman should return to the clinic as soon as possible and use a back-up family planning method in the meantime. Providers can replace the rods.
Counseling Messages:
After the effect of the local anesthetic has worn off there may be some discomfort and/or swelling at the site of its insertion for 1 to 2 days. Also, you must keep the site of the insertion dry for a few days. (Egypt)
Implants will be inserted under the skin on your arm and will not travel to other parts of your body because your skin tissues will keep them in place. Implants contain progesterone hormones that will influence your reproductive organs and therefore they do not cripple your arm or reduce the strength of your hand. (Indonesia)
An implant cannot travel within the body and that the implant will stay in place until removed by a doctor. (Denmark)
Myth: General Procedure
Some women who seek family planning believe that the insertion of implants requires surgery or that insertion is painful and causes infection. They may also have misconceptions about the removal of implants.
Health professionals with specific training perform a minor surgical procedure to insert implants. The provider gives the patient an injection of local anesthetic under the skin of her arm to prevent pain while the implants are inserted. This injection may sting. The woman remains fully awake during the procedure. Insertion takes an average of 4 to 5 minutes for Norplant, 2.5 minutes for Jadelle, and 1.5 minutes for Implanon. Insertion can take more or less time, depending on the skill of the provider.
The incision is small and stitches are not required. In most cases, insertion does not leave a noticeable scar. Once inserted, the outline of the implants underneath the skin can be felt and sometimes seen. The woman may have bruising and feel pain or soreness for a few days afterward.
Infection at the insertion site can occur, but is uncommon. When infection occurs, it is usually within the first two months after insertion. In rare cases, implants may start to come out of the skin. When this occurs, it is usually due to improper insertion or infection.
A woman can have her implants removed at any time. Similar to insertion, implant removal is done by a specifically trained provider using local anesthesia and does not require stitches. Removal takes an average of 10 to 15 minutes for Norplant, 5 to 8 minutes for Jadelle, and 3 minutes for Implanon. Removal can take more or less time, depending on the skill of the provider.Difficulties with removal are rare if the implants were properly inserted and the provider is skilled.
Counseling Messages:
A minor surgical procedure is required to insert and remove the implant, but it will not be too painful because the doctor will make the insertion area numb before the procedure. After insertion of the implant you have to keep the insertion area on your arm dry for a few days to avoid infection. You also can ask the doctor to remove the implant anytime before five years and you will be free form the effect of the implant’s hormones immediately. (Indonesia)
Implants are inserted just below the skin in the woman’s upper arm or forearm by a minor surgical procedure under local anesthesia with a strict antiseptic technique. We will remove implants without unnecessary delay when you make a request for it to be done or when indicated. (Egypt)
Yes, the needle used is large, but there will be a local anesthesia and you won't feel the insertion. The implant is set just under the skin, so you will feel it and it will be easy for the service provider to pull it out when you want it removed. (Switzerland)
It is not painful after local anesthesia is administered to make the arm numb before insertion. (Nigeria)
Even though the effect can last five years, you can decide to remove the implants at any time before the five years if you want to be pregnant. (Ghana)
Implants shouldn’t be very painful or difficult to insert or remove. (Austria)
Myth: Health Risks and Side Effects
Some women who seek family planning do not want to use implants because they have misconceptions about implants causing illness or problems such as cancer, blindness, or birth defects.
In addition to changes in menstrual bleeding, the most common side effects of implants are headaches, abdominal pain, and breast tenderness. These side effects are not an indication of illness and usually lessen or go away within the first year of use. Studies have not shown increased risk of cancer, blindness or birth defects with the use of implants.
Implants have several known health benefits. They have been shown to greatly reduce the risk of ectopic pregnancy and protect against symptomatic pelvic inflammatory disease. Implants may also help protect against iron-deficiency anemia.
Counseling Messages:
You will not have cancer, blindness or birth defects from using implants. If you become pregnant during implant use the doctor will remove it and your baby will stay healthy. (Indonesia)
If you have or have had breast cancer, you should not use implants [you should choose a method without hormones]. You should seek an annual follow-up, including a breast examination. Clinicians should advise clients on instructions for breast self-examination. (Egypt)
This is not true. Implants do not cause cancer. (Nigeria)
Myth: Infertility
Some women who seek family planning believe that using implants will cause infertility, delay the return of fertility after the implants are removed, or cause ectopic pregnancies (pregnancyin which the fertilized egg implants in tissue outside the uterus).
Implants stop working once they are removed and their hormones do not remain in the woman’s body. Implant use does not affect a woman’s ability to become pregnant, although fertility decreases with a woman’s age. One major study found that women who have had their implants removed can become pregnant as quickly as women who have stopped using nonhormonal methods.
Implants substantially reduce the risk of ectopic pregnancy. In the United States, the rate of ectopic pregnancy among women who are not using a contraceptive method is 650 ectopic pregnancies per 100,000 women per year. The rate of ectopic pregnancy among women using implants is 6 ectopic pregnancies per 100,000 women per year.
Even in the very rare cases when implants fail and pregnancy occurs, the great majority of these pregnancies are not ectopic. Only 10 to 17 of every 100 pregnancies due to the failure of implants are ectopic.
Counseling Messages:
Your fertility will return immediately after removal of the implants and if you use implants you may also be protected from pregnancy outside the womb [ectopic pregnancy]. (Indonesia)
Sometimes women do not know that the implant may change their cycles; when they hear that, they sometimes fear for their fertility. Cycles and fertility will come back just as before the insertion, very soon after the removal of the implant. (Switzerland)
If the implant is removed or when the implant no longer has any steroidal contents, fertility is not affected. (The Netherlands)
If fertility doesn’t return after one year from removal of implants, there must be another cause. (Egypt)
Myth: Menstrual Bleeding
Some women who seek family planning incorrectly believe that using implants will cause harmful changes to menstrual bleeding.
Changes in menstrual bleeding commonly occur with implant use, but some women do not experience any change. Typically, changes in bleeding patterns are more dramatic during the first year of use and either lessen or stop after the first year. Prolonged or heavy bleeding (lasting over eight days or generating twice as much blood as normal) due to implants generally is not harmful. Menstruation may also cease after one or two years of implant use, which is not harmful either—blood will not build up inside the woman.
Counseling Messages:
Changes in menstrual bleeding like light spotting, prolonged bleeding or amenorrhea are normal in the first months of implant use. These side effects are common and are not signs of sickness. Some women will continue having amenorrhea, and it will prevent them from having anemia. (Indonesia)
Implants may, in some women, cause amenorrhea or heavier bleeding and it is not prolonged. And if it is prolonged, the user may remove the implants. (Nigeria)
The most frequent side effect is disruption of the menstrual cycle, including spotting between periods, amenorrhea and prolonged bleeding. But, in general, the total monthly blood loss is less than in a normal menstrual period. But some women may experience heavy bleeding. (Egypt)
Implanon may cause irregular menstrual bleeding or amenorrhea. If bleeding is heavy or prolonged, clients are then advised to return for a medical consultation. (Malaysia)
Implants may cause amenorrhea. (Austria)
The Danish implant may cause amenorrhea, heavier, prolonged or irregular menstrual bleedings. This is quite ordinary for this product. (Denmark)
Spotting and break through bleedings are the major problems with progesterone-only contraceptives and may also be a reason to remove the implants earlier than needed. (The Netherlands)
Myth: Sexual Pleasure
Some women who seek family planning believe that implants will reduce a woman’s libido or affect a couple’s sexual life in some way.
There is no evidence to suggest that implants can reduce a woman’s libido. Some women using implants report negative changes in mood and sex drive, while some report improved mood and sex drive. Such changes could be caused by many other factors, so it is difficult to attribute them to implant use. A large majority of implant users do not report any change.
Counseling Messages:
The implant will not reduce your sex desire, but rather it may increase sexual enjoyment because you don’t need to worry about pregnancy. (Indonesia)
Myth: Who Can Use the Method
Some women who seek family planning believe that implants should not be used by women who are young or who have not had children.
Nearly all women can use implants safely and effectively. Implants are suitable for women of any age, regardless of whether they have had children or not. Implants do not make women infertile—fertility returns as soon as implants are removed. Breastfeeding women can use implants if at least six weeks have passed since they have given birth.
Implants may not be suitable for women who require a family planning method without hormones. For example, women who have or have had breast cancer and women with active, serious liver disease should choose an alternative method.
Counseling Messages:
All women, even those who are young and don’t have children, can use implants safely and effectively. Implants will not cause negative effects to the body and your fertility will return as soon as they are removed. (Indonesia)
This is not true, as fertility resumes after the removal of implants. (Nigeria)
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