This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
Changing to Implanon
Reflection
A 37 year old patient, I will call Cara to protect her identity (NMC 2004), attended the clinic seeking advice on which contraceptive methods were suitable for her. She had previously been on the pill in her 20s and also had a Norplant implant until age 29 when her partner had a vasectomy. She was now in a new relationship and wanted a reliable method of contraception. She had no change in her medical history, having had no incidence of venous thromboembolism, or other cardiovascular disorders. She had no history of focal migraines, a low BMI of 20 and BP 110/70 however she smoked 20 cigarettes per day.
Smoking and being over the age of 35 is a major contraindication of taking the COC. Smoking itself is known to increase the risk of Myocardial Infarction (MI) and stroke added to which the increased risk of having an MI or stoke from both the COC and with increasing age (FFPRHC Guidance 2003) makes the COC an unsafe option for Cara.
Cara then mentioned that she was quite interested in the implant, as she had liked it when she had Norplant previously although the new Implanon implant is different. Implanon is currently the only implant licensed in the UK (Porter and Rees 2002). It is a single rod containing 68mg of the progestogen etonogestrel. It is inserted subdermally and is effective for 3 years (Funk et al 2005).
The procedure involves numbing the inner aspect between the triceps and biceps of the non-dominant arm with local anaesthetic, where the 4cm long rod is then inserted subdermally using a disposable introducer (Funk et al 2005). A pressure bandage can be applied to help minimise bruising, and should remain in place for 24 hours. It can be inserted on any day of the cycle as long as the woman is certain she is not pregnant, she must use extra precautions or abstain for 7 days following insertion if inserted after day 5.
Edwards and Moore (1999) found the main drawback to the implant was irregular bleeding, which can be prolonged or heavy and affect 50% of women for up to 3 months, although it reduces to about 30% by 6 months. In a more recent study by Funk and colleagues (2005) this was found still to be the case, and the main reason given for discontinuing with the device. It is therefore imperative that individuals considering the implant must be made totally aware of the possible altered bleeding habit.
Implanon which is over 99% efficient works in 3 ways:-
Benefits of using Implanon
Risks, drawbacks and side effects
Cara was really eager to try this out and asked if it could be inserted straight away, as she was certain she was not pregnant. Because she was on day 6 of her cycle she was offered condoms, as she may not be covered contraceptively for the next 7 days.
Cara should return in 3 months to check the implant site and assess how she is getting with the implant.
New Learning
Although I felt happy with this consultation I felt I did not know enough about the implant, however when my assessor came to assist me I discovered I had covered most of the important information. I was then able to complete a consultation soon after in which I felt able to gain the relevant information and give the relevant advice.
last updated 05/06/07
Copyright © Lynda Luke 2006 Lulu 2001-2007
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1. Its primary effect inhibits ovulation
2. It alters cervical mucus to make it impenetrable by sperm
3. It makes the endometrium unfavourable to implantation
Highly effective
Easily reversed
Long term (last 3 years)
Low user failure
Does not interfere with intercourse
Requires specialist insertion and removal
Irregular bleeding or amenorrhoea
Can cause headaches, acne, weight gain, mood changes or vaginitis
Does not protect against STIs
Uncertain risk of hypo-oestrogenism
May interact with certain drugs particularly enzyme inducers.
Possible discomfort, reaction