[HOW TO] Avoid Pregnancies: Implanon®, A New Innovation in Contraceptive Methods in the Philippines

Hormonal Contraceptive Implant

›       In the Philippines, adolescent fertility rate is moderate at 44.4 reported births per 1,000 women aged 15–19 years.

Most of the early and adolescent pregnancies occur in young Filipino women in the ages of 15-19.

Between the years 2000 - 2010, the National Statistics Office reported a 65% increase in adolescent and early pregnancies.

28.7% of adolescents age 15-19 use contraceptives. 19.8% of the 28.7% uses modern methods of contraception whereas 8.8% uses traditional methods.Source: 2006 Family Planning Survey (FPS), DOH (Philippine Health Statistics 2009)

Injectables (DMPA) and pills are widely used in the country of many women to control and plan for their families. How about implants? Do you hear any about of these? Do you experience painful menstruation? Or do you want to change your daily routine taking pills? Let’s find out how this implant may help you.

What is Implanon and What it is used for?

Implanon is a small, bendy plastic rod, 4cm in long and 2mm thick, which contain an active substance etonogestrel, preloaded in an applicator. The rod is preloaded in the needle of the applicator, which allows the medical or health care professional to insert the implant just under the skin of the upper arm. Etonogestel is an artificial female hormone similar to progesterone and it is gradually released to inhibit ovulation.  The rod size is alike to a matchstick and made out of ethylene vinyl acetate copolymer, a plastic that will not liquefy in the body. It is approved by the FDA in July 2006 and introduce in the country late 2011.

Illustration of the location of Implanon after insertion

Basically, Implanon is inserted just below the skin under local anesthetics. The active hormone component works in two ways (1) it prevents the release of an egg cell form the ovaries and (2) changes in the cervix which make the sperm difficult to enter the womb. As a result, this implant will guard you from pregnancies for up to three (3) years. Implanon is very reliable unlike the combined pills that you have to remember to take it religiously every day.
You do not have to worry if it would be evident when you raise your arm. You can feel the implant under your skin which gives a guarantee that it does not pass through anywhere inside your body. It would stay in the same site where it is set in. Implanon doesn’t guard you from any of the sexually transmitted infections and HIV infection (AIDS). 

What are the conditions not suitable to use Implanon?

The following conditions listed are the contraindication to use of Implanon:

1. Allergic to etonogestrel or any of the other ingredients of Implanon
2. Thrombosis (a formation of the blood clot in a blood vessel) for example Deep Vein Thrombosis and Pulmonary Embolism
3. Jaundice (yellowing of the skin)) or sever liver disease
4. Cancer of the breast or of the genital organs
5. Unexplained vaginal bleeding
6. Pregnant or think you might be pregnant
7. Using other medicines (these may interfere the implant to work properly)
8. Anti-epileptic drugs (phenytoin, barbiturates, carbamazepine, primidone, oxcarbazepine, carbamazepne)
9. Tuberculosi (rifampicin)
10. HIV infections (ritonavir, nelfinavir, nevirapine)
11. Other infectious diseases (griseofulvin)
12. Depressive moods (herbal remedy of St. John’s wort)

Implanon Insertion

Here is a video presentation on actual Implanon insertion. Note: This is for presentation purposes only, credits to the owner. 

What are the possible side effects?

The most frequent side effect is menstrual irregularity; ammenorhea occurs in 30-40% of patients within one year. It is similar to not having monthly bleeding during pregnancy but the blood is not building up inside the womans body. Vaginal bleeding may occur at irregular intervals. This may be just slight staining which may not require a pad or heavier bleeding, which looks rather scanty period and requires sanitation pad.Implant site complications are experienced by 3.6% patients and include swelling, redness, hematoma and pain. (PFPS & POGS, CPG on Family Planning, 1^st Ed November 2012, p48)

Very Common	Common	Uncommon
Headache	Depressive moods	Anxiety, insomnia
Acne	Decreased sexual drive, nervousness	Migraine
Increase in body weight	Increase appetite	Constipation, vomiting, diarrhea
Breast tenderness and pain	Abdominal pain	Back pain, muscle pain, musculoskeletal pain
Irregular bleeding pattern	Hot flushes, influenza like symptoms	Difficulty in urination
Infection of the vagina	Painful menstruation	Genital discharge, breast enlargement

Like all medicines, Implanon can cause side effects too but not all individual may gets them.  This can be use while on current breastfeeding. Milk production or the quality of the milk is not affected. Dysmenorrhea tends to improve using the Implanon.

When it is the best time to start?

Breastfeeding, partially breastfeeding and non‐breastfeeding clients:
The implant may be inserted immediately after delivery, before discharge from the facility.                                      ~ US and UK Medical Eligibility Criteria Category 2

What are the Advantages and Disadvantages?

Advantages:

1. Dysmenorrhea will improve
2. Highly effective and long-acting
3. Compatible with breastfeeding
4. Effective immediately and
5. Immediate return to fertility after removal
6. The procedure is easy to learn

 
Disadvantages:

1. Altered menstrual pattern is the norm
2. Headache
3. Weight gain
4. Acne
5. Breast pain and discomfort
6. Emotional lability
7. Abdominal pain
8. Requires trained provider to insert

Known Health Benefits

Help protect against:

1. Risk of Pregnancy
2. Symptomatic pelvic inflammatory disease

May help decrease risk of

1. Iron-deficiency anemia

Things to remember!

Credits: Dr. A. Ruaro's slide presentation

1. After insertion, it is advisable to practice abstinence (no sex at all) for about 7 days.
2. If cannot control, use back up method (use condoms)
3. Do not wet the insertion site (bruising, swollen and pain is expected)
4. Change your band-aid every day for 3 days.
5. If you experience the JACHES, see your healthcare provider as soon as possible.
6. Fertility resume immediately after removal

PSORHN on Implanon

Actual insertion of the implant during the practicum phase

We, the Philippine Society of Sexual & Reproductive Health Nurses (PSORHN) are lucky enough to join the training for Implanon insertion last August 30, 2013 held at Mutuc Hall, Ortoll Center for Reproductive Health, University of the Philippines – Philippine General Hospital together with other service provider. This is the batch where there are nurses’ trains for the insertion.
The training is a 1 day training (half day for didactic and half day for practicum). The training aims to equip health care providers who are working in the community as service provider. This Implanon is given to those women in low economic status especially for those womens who are multigravida and cannot afford to contraceptive methods.  Each trainees must do the insertion at least three (3) patients during the practicum and remaining seven (7) as skills enhancement to be certify as proficient.

One of our facilitator said, if the telephone companies in the Philippines is offering Unlimited Call and Text, Implanon have it too, Implanon offers “Unlimited Sex” in cheerful way.

My relatives and neighbor pose for a picture right after Implanon insertion

Last year, during my stay in our hometown, I’d bring the Implanon unit with me to introduce it to my neighbors and relatives. At first, they are hesitant to avail it, but right after the testimonial and experience they received from the person undergo on the process. The following day, they are the one calling my attention and my siblings that they are interested for insertion. Overall, I inserted six (6) of the on separate dates.

Recently, when I came back home, my neighbor approached me and said “Hindi din pala totoo yung sinabi mong unlimited sex na yan, kasi ako mismo ang nagsasawa kasi nakakapagod. Wala din akong nararamdaman na iba sa katawan ko, tumaba lang ako oh! Tignan mo!. Parang ang pangit ko na.” Mrs. V. Verdadero, mother of four.  “May mga gusto pang magpatusok sa iyo ng katulad ng sa akin” (pointing to her implant) she added.

Another story of Ms. dela Cruz, 19 years old experiencing severe painful menstruation every time she have it, after a few months of Implanon use her dysmenorrhea was improved. Now she can sleep well and saved her money from using sanitary pads for about 3-4 days of her previous menstrual cycle. For now, in my hometown, they are eager and wanted to have the implant as their method in family planning and waiting for me to insert again.

On the other hand, Erick Bernardo, my colleague trained also on Implanon insertion, inserted an implant to Janina Santos, owner of www.theironyofnonsense.blogspot.com last December 2013 and I asked her about her experience during the insertion? “Apart from when the anesthesia was injected, there was no pain at all. I was made comfortable by the nurse who inserted the contraceptive. The insertion of the Implanon was quick, easy, and painless”, she tells.

A week after, she doesn’t feel any untoward reaction of the implant aside from the normal side effect of oral contraceptive she taken except the spotting. There is also a bit of pain few days after insertion but it is subsided after a while.
According to her, as a rape prevention and survival advocate, “Implanon is a safe, long-acting, temporary method of contraception. If you wish to properly space your family, prevent unwanted pregnancies, and have a safe, satisfying sex life for a long time but would like to regain fertility immediately, this method is probably the best for you. Talk to your health care provider and learn about its other benefits. I had no qualms on having the implant and I have no regrets in getting it. I am responsible, I am safe, and I took a step to assure myself of a future of possibilities. You should too.”

Where I can avail the Implanon?

Implanon is not yet available in many drug stores nationwide. It is only distributed by MSD (Merck Sharp & Dohme Philippines) through a partnership of Department of Health (DOH) together with Philippine Society of Responsible Parenthood (PSRP) and funded by the United Nation Population Fund (UNFPA).
You may visit Ortoll Center for Reproductive Health at Philippine General Hospital, Taft Avenue, Malate Manila to avail these for FREE. Likhaan Center for Women’s Health in Manila is also offering this service for FREE from Tuesday to Saturday, 8:30 in the morning up to 3:00 in the afternoon.  

Map of Likhaan Clinics in Manila

Have a safe and satisfying sex life. Enjoy the unlimited offer! Hurry! Have your own implant with you until supplies last.
 

References:

• Philippine Family Planning Society, Inc and Philippine Obstetrical and Gynegological Society, Clinical Practice Guidelines on Family Planning, 1^st Edition, November 2012
• Family Planning: A Global Handbook for Health Care Provider, 2011 P109-130
• 2012-2014 Managing Contraception on the Go, June 2012
• US and UK Medical Eligibility Criteria
• Implanon® Insert Leaflet
• University of  California – San Francisco, Contraception: Choices, Culture and Consequences
• Lecture, Coursera, March 2013
• Contraceptive Implant for FREE! Get you Implanon NOW!