Should You Get the Birth Control Implant?

Quita Christison intended to get an intrauterine device, or IUD. The 26-year-old had gone off her birth control pills and heard IUDs -- which are inserted into the uterus to prevent pregnancy for up to 10 years -- revered by her graduate school professors, who were experts in women's health and had the devices themselves.

"They were like, 'We think everyone should get an IUD!'" says Christison, who graduated in May from Boston University's School of Public Health and now works at a children's health advocacy nonprofit in Boston.

But after doing more research and talking to a nurse practitioner, Christison discovered another option might suit her even better: the birth control implant, a matchstick-sized rod inserted between the bicep and tricep that continuously releases a hormone to prevent pregnancy for up to three years.

"It's an underappreciated method, but it's definitely on the upswing," says Dr. Laura MacIsaac, an OB-GYN and director of family planning for Mount Sinai Health System.

IUD or Implant?

Like an IUD, the implant is a form of long-lasting reversible contraception, meaning it prevents pregnancy -- but not sexually transmitted diseases -- for years but can be removed at any time should a woman decide to get pregnant. Merck & Co. is the only company that makes the implant, which comes in two varieties: Implanon and Nexplanon, a newer version of Implanon that is inserted using an improved applicator and is visible on X-rays and other medical scanning machines. More similar to the Depo-Provera birth control shot than a hormonal IUD, which releases a hormone directly into the uterus, the implant works by releasing a form of the hormone progestin, which suppresses ovulation, into the bloodstream.

Also like an IUD, the implant is "thoughtless birth control," says Dr. Stephanie Romero, an assistant professor of obstetrics and gynecology and maternal-fetal medicine at the University of South Florida Morsani College of Medicine. "It just goes in and you can completely forget it for three years and it will continue to work." You can't see it, though you can usually feel where it is under your skin if you touch your arm, according to the Association of Reproductive Health Professionals.

The implant's lack of maintenance was appealing to Christison, who was sick of trying to remember to take her birth control pill at the same time every day and fighting with insurance companies to get a pack in advance if she was going on vacation. "I just wanted something that I didn't want to worry about," she says.

Even better, the implant works exceptionally well -- failing only 0.05 percent of the time, according to the Association of Reproductive Health Professionals. "The effectiveness of it is better than tying your tubes," Romero says. IUDs, which come in two types (hormonal or copper), also have a less than 1 percent fail rate.

So what's holding women back from the implant? Most often, the potential side effects, which can include emotional changes, an increased appetite (and associated weight gain) and, most commonly, irregular bleeding, Romero says. According to Merck & Co., 1 in 10 women who get the implant eventually have it removed because of the change in their bleeding pattern. "The irregular bleeding can drive some women crazy," Romero says.

In McIsaac's practice, she's found that after inserting the implant, about one-third of women have lighter periods with a little spotting, another one-third feel the same as before and the last third have longer, heavier periods with spotting in between. "That's what you have to accept -- a change in your bleeding pattern that I can't promise you when it will go away," MacIsaac says. Any irregular bleeding from an IUD, on the other hand, almost always stops after the first three months, Romero says.

While some women, such as breast cancer patients or survivors, might be advised to avoid the implant or a hormonal IUD, for most women, the decision between the devices comes down to personal preference. Do you want a form of birth control that lasts up to three years (the implant or Skyla IUD), five years (the Mirena IUD) or 10 years (the ParaGard IUD)? Do you feel queasy about putting something in your uterus? (Go with the implant.) Do you have painful, heavy periods? (An IUD is probably a good fit since it usually reduces bleeding.)

In a Washington University study following 9,256 women using various forms of reversible birth control of their choice, researchers found that 88 percent of hormonal IUD users, 84 percent of copper IUD users and 83 percent of implant users were still on it after one year. Only 55 percent of women on the pill could claim the same thing. "The whole category [of long-acting reversible contraceptive methods] is really being discovered and celebrated by women," says MacIsaac, who chairs an American Congress of Obstetrics and Gynecology task force on LARC methods. "They're able to have good control, and they're really safe and really easy."

Three Minutes for Three Years

After Christison settled on an implant -- she wasn't comfortable with the idea of a device in her uterus and preferred the shorter timeline -- she made an appointment with her primary reproductive health provider, a nurse practitioner, to have it inserted in March.

The procedure, often performed by an OB-GYN, begins with a local anesthetic, which, Christison says, was "less painful than when you get your mouth numbed for a cavity." The health care provider then inserts the device via a tool that might look to patients like they're getting a vaccine, Romero says.

"From the time I laid on the table to when it was in my arm and I was standing was no more than three minutes," Christison says. "And I knew I was protected against any unwanted pregnancies for the next three years." The area was sore for a few days after, but otherwise, she hasn't had any problems -- save for slightly more breakouts when she's stressed. Her periods have gotten lighter and less frequent.

In three years -- or sooner, if Christison so chooses -- her implant should be removed just as simply. Providers numb the area again, make a small incision, push the rod out and grab it with tweezers, Romero says. Once it's removed, most women ovulate within a month. Compared to the Depo-Provera birth control shot, for example, "there's no delayed fertility," Romero says.

But Christison's not worried about that right now. "I'm just so glad I'm not on the pill anymore," she says. "That was such a pain."