From the Guidelines
When evaluating a Nexplanon (etonogestrel) implant, it is essential to ask about any side effects, inquire about satisfaction with the method, and perform a physical examination to ensure the implant is in place and the insertion site is free of complications, as recommended by the most recent guidelines 1.
Necessary Checks and Questions
The following checks and questions should be considered:
- Ask about any side effects such as irregular bleeding, mood changes, headaches, weight changes, or pain at the insertion site.
- Inquire about satisfaction with the method and any concerns.
- For physical examination, palpate the implant to ensure it's still in place - it should feel like a matchstick under the skin of the inner upper arm.
- If you can't feel it, ultrasound may be needed to locate it.
- Check the insertion site for signs of infection, irritation, or expulsion.
- Confirm when the implant was inserted to determine if replacement is needed, considering it is effective for up to 5 years.
Additional Considerations
- No routine follow-up visits are required after initial placement confirmation, but patients should return if they experience concerning symptoms or want the device removed.
- The implant works by releasing etonogestrel, a progestin that prevents ovulation and thickens cervical mucus to prevent pregnancy, with over 99% effectiveness that doesn't depend on user compliance like daily pills.
- Consider the potential interaction between the implant and certain medications, such as efavirenz-containing antiretroviral therapy, which may impair the efficacy of the implant 1.
Timing of Insertion
- The implant can be inserted at any time if it is reasonably certain that the woman is not pregnant, as stated in the guidelines 1.
- If the implant is inserted more than 5 days after menstrual bleeding started, the woman needs to abstain from sexual intercourse or use additional contraceptive protection for the next 7 days.
From the Research
Necessary Checks and Questions
When evaluating a Nexplanon (etonogestrel) implant, the following checks and questions should be considered:
- Training and experience of the healthcare provider: All healthcare providers must be trained on Nexplanon before performing insertions or removals of the implant 2.
- Patient eligibility: Nexplanon is indicated for use in certain women, while it is contraindicated in others 3.
- Insertion procedure: The implant should be inserted as an office-based procedure, and the healthcare provider should be aware of the possible complications, such as incorrect insertion 4.
- Alternative insertion sites: In some cases, alternative insertion sites, such as the scapular region, may be considered 5.
- Menstrual bleeding patterns: Patients should be informed about the possible changes in menstrual bleeding patterns, which can be a common adverse reaction 2, 6.
- Removal procedure: The implant should be removed by the end of the third year of use, and the healthcare provider should be aware of the possible challenges, such as encasement of the implant within fibrotic tissue 4.
Pre-Insertion Questions
Before inserting the Nexplanon implant, the following questions should be asked:
- Is the patient eligible for the implant 3?
- Has the patient been informed about the possible changes in menstrual bleeding patterns 2, 6?
- Has the patient been informed about the possible complications, such as incorrect insertion 4?
- Is the healthcare provider trained and experienced in inserting the implant 2?
Post-Insertion Checks
After inserting the Nexplanon implant, the following checks should be performed:
- Verification of the implant's position 4.
- Monitoring of menstrual bleeding patterns 2, 6.
- Evaluation of possible adverse reactions, such as change in menstrual bleeding patterns 2.
Removal Procedure
When removing the Nexplanon implant, the following considerations should be taken into account: