Side Effects of Contraceptive Implants and Their Management
The most common side effect of contraceptive implants like Nexplanon (etonogestrel) is irregular bleeding patterns, which can be managed with short-term treatments such as NSAIDs or hormonal therapy if the woman desires intervention. 1
Common Side Effects
Menstrual Bleeding Changes
- Irregular bleeding patterns: The most frequently reported side effect
- 22% of women experience amenorrhea
- 34% experience infrequent spotting
- 7% report frequent bleeding
- 18% report prolonged bleeding 1
- These bleeding changes are generally not harmful and may or may not decrease with continued use
- Heavy or prolonged bleeding is uncommon with implant use
Other Common Side Effects
- Mood changes and mood swings 2, 3
- Headaches 4
- Weight gain or changes 1
- Acne 5
- Upper limb neuropathies 4
- Dizziness 4
- Skin conditions 4
- Decreased libido 5
Management of Side Effects
Irregular Bleeding Management
Rule out underlying gynecological problems if clinically indicated:
- Interactions with other medications
- STIs
- Pregnancy
- Pathologic uterine conditions (polyps, fibroids) 1
Treatment options if no underlying problem is found and woman wants treatment:
- NSAIDs for short-term treatment (5-7 days)
- Hormonal treatment with low-dose COCs or estrogen for short-term treatment (10-20 days) 1
For persistent irregular bleeding that is unacceptable to the woman:
- Counsel on alternative contraceptive methods
- Offer another method if desired 1
Amenorrhea Management
- Amenorrhea does not require medical treatment; provide reassurance
- If regular bleeding pattern changes abruptly to amenorrhea, consider ruling out pregnancy if clinically indicated
- If amenorrhea persists and is unacceptable, counsel on alternative methods 1
Weight Changes
- Assess weight changes during follow-up visits
- Provide counseling for women concerned about weight changes associated with their contraceptive method 1
Mood Changes
- Mood-related side effects show wide inter-individual variability
- Serum etonogestrel concentrations do not appear to correlate with mood changes 3
- If mood changes are severe or unacceptable, consider removal and alternative contraception 2
Special Considerations
Drug Interactions
- Hepatic enzyme-inducing drugs (acting on cytochrome P450) may impair efficacy:
Rare but Serious Complications
- Ectopic pregnancy: Although extremely rare with implants, it can occur and should not be ruled out in women with symptoms 6
- Implant insertion site complications: Rarely, vaginal/cervical erosion or ulceration has been reported 7
- Gallbladder disease and hypertension: Small increased risk (1.5 and 1.8 times greater, respectively) compared to women not using hormonal contraception 4
Follow-Up Recommendations
No routine follow-up visit is required specifically for the implant
Advise women to return if they:
- Experience side effects or problems
- Want to change methods
- Need implant removal or replacement 1
During routine visits:
- Assess satisfaction with the method
- Discuss any concerns about method use
- Assess changes in health status that might affect appropriateness of the implant
- Consider assessing weight changes if the woman is concerned 1
Preventing Discontinuation
Comprehensive pre-insertion counseling is crucial:
Provide support after insertion:
- Be responsive to concerns about side effects
- Avoid delays when removal is requested 2
- Offer management strategies for bothersome side effects
Despite side effects, implants have high continuation rates compared to other reversible contraceptives, suggesting that the contraceptive effectiveness outweighs the dissatisfaction from side effects for many women 4.