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A contraceptive implant is an implantable
medical device A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...
used for the purpose of
birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only be ...
. The implant may depend on the timed release of
hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...
s to hinder
ovulation Ovulation is an important part of the menstrual cycle in female vertebrates where the egg cells are released from the ovaries as part of the ovarian cycle. In female humans ovulation typically occurs near the midpoint in the menstrual cycle and ...
or
sperm Sperm (: sperm or sperms) is the male reproductive Cell (biology), cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm ...
development, the ability of
copper Copper is a chemical element; it has symbol Cu (from Latin ) and atomic number 29. It is a soft, malleable, and ductile metal with very high thermal and electrical conductivity. A freshly exposed surface of pure copper has a pinkish-orang ...
to act as a natural
spermicide Spermicide is a contraceptive substance that destroys spermatozoon, sperm, inserted vaginally prior to Sexual intercourse, intercourse to prevent pregnancy. As a contraceptive, spermicide may be used alone. However, the pregnancy rate experienc ...
within the
uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...
, or it may work using a non-hormonal, physical blocking mechanism. As with other contraceptives, a contraceptive implant is designed to prevent
pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...
, but it does not protect against
sexually transmitted infection A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is Transmission (medicine), spread by Human sexual activity, sexual activity, e ...
s.


Women


Implant

The contraceptive implant is hormone-based and highly effective, approved in more than 60 countries and used by millions of women around the world. The typical implant is a small flexible tube measuring about in length. It is most commonly inserted subdermally in the inner portion of the upper, non-dominant arm by a trained and certified health care provider. After insertion, it prevents pregnancy by releasing progestin which inhibits ovulation. The two most common versions are the single-rod etonogestrel implant and the two-rod levonorgestrel implant. Brands include: Norplant, Jadelle (Norplant II), Implanon, Nexplanon, Sino-implant (II), Zarin, Femplant and Trust.


Benefits

Some brands of the contraceptive implant, including Nexplanon, are over 99% effective. The benefits of the contraceptive implant are dependent on the active ingredients. Depending on the type of implant, benefits of the implant may include fewer, lighter periods, improved symptoms of
premenstrual syndrome Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Symptoms v ...
, long-lasting up to three to five years, and the convenience of not needing to remember to use it every day. The implant is also useful for women who cannot use contraception that contains oestrogen. The implant can also be removed at any time and natural fertility will return very quickly. Text was copied from this source, which is available under a
Open Government Licence v3.0
© Crown copyright.


Side effects

When the implant is first inserted, it is common to have some bruising, tenderness or swelling around the implant. In some cases, adverse effects do occur, the most common being irregular bleeding or
amenorrhea Amenorrhea or amenorrhoea is the absence of a menstrual period in a female organism who has reached reproductive age. Physiological states of amenorrhoea are most commonly seen during pregnancy and lactation (breastfeeding). In humans, it is wher ...
. Although irregularity in bleeding can be troublesome for some women, this also allows for use in treatment of
dysmenorrhea Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in th ...
,
menorrhagia Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB). Abnormal uterine bleeding can be caused by structural abnorm ...
, and
endometriosis Endometriosis is a disease in which Tissue (biology), tissue similar to the endometrium, the lining of the uterus, grows in other places in the body, outside the uterus. It occurs in women and a limited number of other female mammals. Endomet ...
. Less common symptoms include change in appetite, depression, moodiness, hormonal imbalance, sore breasts, weight gain, dizziness, pregnancy symptoms, and
lethargy Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness, or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overw ...
. Although rare, there is also a risk of complications occurring during insertion or removal of the implant. In rare cases, the area of skin where the implant has been inserted can become infected, which can require antibiotics. Most commonly reported from the levonorgestrel-releasing intrauterine system LNG-IUG contraceptive; breast tenderness, headaches, swelling, and skin irritation. contraceptive also corresponds with earlier waking, frequent mood swings, impaired concentration, and strain. Irregular vaginal uterus lining shedding is a common pattern with Norplant users; if this occurs it will be seen during the first 60 days of use but it can subside or disappear over time. The Implanon also has these negative side effects causing a considerable amount of vaginal bleeding irregularities, and amenorrhea in about 30–40% of its users during the following 90 days of starting use.


Postpartum use

With regard to helping women space their pregnancies appropriately, there is some debate about the most effective time to insert contraceptive implants after pregnancy. It is likely that implant insertion immediately following childbirth increases the number of postpartum implant users compared to when insertion occurs four to six weeks after childbirth (because some patients do not return for their six-week checkup). However, there may be little or no difference between immediate and delayed insertion in terms of continued use of implants at six months or in terms of women's satisfaction, even though some studies found higher continuation rates at six months if the implant was inserted immediately after childbirth. Progestin containing implants (specifically etonogestrel) are safe for immediate insertion in both postpartum individuals and those post-abortion.


Intrauterine device

An intrauterine device (IUD) is a small contraceptive device, often T-shaped, which is implanted into the uterus. They can be hormonal or non-hormonal, and are long-acting, reversible, and the most effective types of reversible birth control. As of 2011, IUDs are the most widely used form of reversible contraception worldwide. Among types of birth control they, along with birth control implants, result in the greatest satisfaction among users. IUDs also tend to be one of the most cost-effective methods of contraception for women. Cons of intrauterine devices, similarly to implants, is the need for a trained healthcare professional for both insertion and removal. Brands include: Paragard, Kyleena, Liletta, Mirena, and Skyla.


Hormonal IUD

Hormonal IUDs contain the hormone
levonorgestrel Levonorgestrel is a hormonal medication used in a number of birth control methods. It is combined with an estrogen to make combination birth control pills. As an emergency birth control, sold under the brand names Plan B One-Step and Julie, ...
which is a progestin. Most commonly, products are inserted for 5 years, allowing them to release a low dose of hormones over that time frame. The mechanism of action of both hormonal and non-hormonal IUDs is similar, plus the additional benefit of progestin causing a thickening of the cervical mucus. The levonorgestrel IUD is highly efficacious and has a failure rate of only 0.2% in the first year of use. An additional benefit of hormonal IUDs is decreased blood loss, which 20-30% of patients will experience
amenorrhea Amenorrhea or amenorrhoea is the absence of a menstrual period in a female organism who has reached reproductive age. Physiological states of amenorrhoea are most commonly seen during pregnancy and lactation (breastfeeding). In humans, it is wher ...
. Within 1–3 months of removing the intrauterine device, however, patients should experience a return to their normal menstrual cycle. The most common side effect of levonorgestrel containing IUDs is spotting during the first 3 months. Use in patients immediately postpartum can be discussed but the greater potential for expulsion and perforation must be carefully considered.


Non-hormonal IUD

Non-hormonal IUDs, also known as copper IUDs, are a hormone-free option of contraception available and work by two main mechanisms of action. They are thought to slow the rate at which
sperm Sperm (: sperm or sperms) is the male reproductive Cell (biology), cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm ...
reaches the
fallopian tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (: salpinx), are paired tubular sex organs in the human female body that stretch from the Ovary, ovaries to the uterus. The fallopian tubes are part of the female reproduct ...
s or decreases
fertilization Fertilisation or fertilization (see American and British English spelling differences#-ise, -ize (-isation, -ization), spelling differences), also known as generative fertilisation, syngamy and impregnation, is the fusion of gametes to give ...
of the egg. An increase of
copper Copper is a chemical element; it has symbol Cu (from Latin ) and atomic number 29. It is a soft, malleable, and ductile metal with very high thermal and electrical conductivity. A freshly exposed surface of pure copper has a pinkish-orang ...
ions, along with other cells and enzymes, is what affects functioning of the sperm and the prevention of pregnancy. Although they do have a higher risk of pregnancy compared to hormonal IUDs, failure rates with the copper IUD are still only approximately 0.8%. They also provide protection from anywhere between 2.5 and 10 years depending on the brand and manufacturer. Potential adverse effects of copper IUDs include heavier
menses Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...
and increased menstrual cramping. Copper IUDs have the ability to be inserted anywhere from 10 minutes to 48 hours postpartum. The disadvantage of this immediate insertion is the associated higher risk of expulsion or
uterine perforation Uterine perforation is a potential complication of any intrauterine procedure. It may be associated with injury to surrounding blood vessels or viscera such as the bladder or intestine. If not diagnosed at the time of the procedure it can occasi ...
, however, the benefits greatly outweigh any potential risk. They also are safe to use in
lactation Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process ...
. An additional benefit of copper IUDs is their use in
emergency contraception Emergency contraception (EC) is a birth control measure, used after sexual intercourse to prevent pregnancy. There are different forms of EC. Emergency contraceptive pills (ECPs), sometimes simply referred to as emergency contraceptives (ECs), ...
. Not only are they able to be used as a form of emergency contraception but a Cochrane review noted that they are the most effective method of emergency contraception as well. When inserted within 7 days of unprotected intercourse, they are able to reduce the risk of pregnancy by 99% and provide the added benefit of ongoing contraception in the patient too.


Men

Several barriers exist to expanding research into implantable and other contraceptive methods for men, including vague regulatory guidelines, long device development timelines, men's attitudes towards convenience, and a significant lack of funding. Several implantable devices have been attempted, both hormonal and non-hormonal.


Research

In 2001, Dutch pharmaceutical company
Organon The ''Organon'' (, meaning "instrument, tool, organ") is the standard collection of Aristotle's six works on logical analysis and dialectic. The name ''Organon'' was given by Aristotle's followers, the Peripatetics, who maintained against the ...
announced clinical trials of its implantable etonogestrel-based male contraceptive would begin in Europe and the U.S., anticipating a marketable product as early as 2005. Despite promising results, research development stopped, with outside speculation that lack of marketability was a factor. Organon representative Monique Mols stated in 2007 that " spite 20 years of research, the development of a ormonalmethod acceptable to a wide population of men is unlikely". Schering/
Bayer Bayer AG (English: , commonly pronounced ; ) is a German multinational pharmaceutical and biotechnology company and is one of the largest pharmaceutical companies and biomedical companies in the world. Headquartered in Leverkusen, Bayer' ...
had been working on a similar annual implant with quarterly injections but cancelled the research in 2006/2007, declaring that men would most likely view it as "not as convenient as a woman taking a pill once a day." In 2005, a collaboratory project led by the
Population Council The Population Council is an international, nonprofit, non-governmental organization. The Council conducts research in biomedicine, social science, and public health and helps build research capacities in developing countries. One-third of its re ...
, the
University of California, Los Angeles The University of California, Los Angeles (UCLA) is a public university, public Land-grant university, land-grant research university in Los Angeles, California, United States. Its academic roots were established in 1881 as a normal school the ...
, and the Medical Research Council began researching a matchstick-sized implant that contains MENT (7α-methyl-19-nortestosterone or trestolone), a "synthetic steroid that resembles testosterone." Clinical trials were set to begin in 2011 or 2012, and the project was ongoing as of 2016, with hopes of gaining approval as the first reversible male contraceptive. In 2006, Shepherd Medical Company received FDA approval for a clinical trial of its non-hormonal implant called an intra vas device (IVD), which consists of two plugs that block sperm flow in the vas deferens. Working on the success of its pilot study and solid results from its clinical trials, the company announced it would expand its trials to three U.S. cities later that year. Questions remained about how reversible the procedure would be in the long-term; however, it was expected to be more reversible than a vasectomy. In 2008, the company disbanded due to the economic crisis but has stated it would restart its research with proper funding. In January 2016, news broke of a non-hormonal, implantable valve—the Bimek SLV. It included a switch that attaches to the
vas deferens The vas deferens (: vasa deferentia), ductus deferens (: ductūs deferentes), or sperm duct is part of the male reproductive system of many vertebrates. In mammals, spermatozoa are produced in the seminiferous tubules and flow into the epididyma ...
, allowing the owner to stop and resume the flow of sperm on demand. A clinical trial of 25 participants was announced to further test the efficacy of the device.


Other animals

Implantable contraception is also an option for animals, particularly for animal managers at zoos and other captive animal facilities who require reversible contraception methods for managing population growth in limited captive habitat. The
Association of Zoos and Aquariums The Association of Zoos and Aquariums (AZA), originally the American Association of Zoological Parks and Aquariums (AAZPA), is an American 501(c)(3) nonprofit organization founded in 1924 and dedicated to the advancement of zoos and public aqu ...
' (AZA) Reproductive Management Center (formerly known as the AZA Wildlife Contraception Center) at the Saint Louis Zoo in
St. Louis St. Louis ( , sometimes referred to as St. Louis City, Saint Louis or STL) is an independent city in the U.S. state of Missouri. It lies near the confluence of the Mississippi and the Missouri rivers. In 2020, the city proper had a populatio ...
, Missouri, has played a major role in researching and disseminating contraception information, via its Contraception Database. It houses over 30,000 records for hundreds of species. One of the most popular contraceptive methods used by zoos (as well as in domestic animals) is the melengestrol acetate (MGA) implant, a
progestin A progestogen, also referred to as a progestagen, gestagen, or gestogen, is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. A progestin is a '' synthetic'' progestogen. ...
-based hormonal contraceptive developed in the mid-1970s. Other progestin-based implants that have been placed in animals include Norplant, Jadelle, and Implanon.
Androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...
-based implants that use
agonist An agonist is a chemical that activates a Receptor (biochemistry), receptor to produce a biological response. Receptors are Cell (biology), cellular proteins whose activation causes the cell to modify what it is currently doing. In contrast, an R ...
(stimulating)
gonadotropin-releasing hormone Gonadotropin-releasing hormone (GnRH) is a releasing hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. GnRH is a tropic peptide hormone synthesized and rele ...
(GnRH) and, to a lesser degree, IUDs have also seen use in several domestic and exotic species. Whatever the implant, some care must be taken to minimize the risk of implant migration or loss.


References

{{Birth control methods Articles containing video clips Birth control Implants (medicine) Methods of birth control