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Long Acting Reversible Contraceptives (LARCs) - Continued from previous page

Contraceptive Implant (Implanon and Nexplanon)

Implanon is a contraceptive implant that is inserted in the inner aspect of the arm. It is smaller than a match-stick measuring 4 cm (length) by 2 mm (thickness). It can be inserted with or without using a local anaesthetic. Typically, the actual insertion takes less than a minute.

Implanon contains a synthetic progestogen called Etonogestrel. Implanon works similar to the mini-pill in that it inhibits ovulation. However, it is much more effective than the mini-pill. It also has the effect of thickening the cervical mucus thereby inhibiting sperm penetration. This effect is also seen with Mirena. In fact, Implanon is the most effective form of contraception with the lowest failure rate. Its failure rate is lower than that of a vasectomy at 1 in 10,000

Implanon is effective for three years. After that it must be removed. Ofcourse it can be removed before that if the woman so desires. The most unpredictable aspect of Implannon is the pattern of vaginal bleeding. Those who decide to stop using Implanon will usually do so because of irregular and sometimes heavy or prolonged vaginal bleeding. This affects about 1 in 10 of users. About 1 in 5 users will have no periods at all after a few months. Temporary problems at the site of insertion include pain, swelling or hematoma (blood clot) formation. This affects about 1 in every 30 users.

There is no evidence that Implanon affects body weight, mood or libido. Fertility resumes within days of removal of the device. Implanon should not be used where there is active liver disease, stroke or migraine with aura.


Implanon is now being phased out and replaced by Nexplanon. There is no difference between Implanon and Nexplanon in terms of the active hormone. Nexplanon also contains Etonogestrel. The contraceptive effect is therefore exactly the same. The difference is in the method of insertion which is supposed to be even easier and also, Nexplanon is radio-opaque, meaning, if there is difficulty finding the implant for removal, an X-ray can be used to locate it. This is not possible with Implanon.

NuvaRing: A vaginal contraceptive ring

This is the so-called ‘pill through the vagina. NuvaRing has been around since 2001 and works exactly with the same principle as the combined pill. The difference is that the hormones are delivered via the vaginal canal rather than orally. NuvaRing is a soft flexible plastic ring measuring 54 mm in diameter. It is only 4 mm thick.


NuvaRing contains the hormones ethinyl estradiol (an estrogen) and etonogestrel (a progestogen). It is therefore similar to the combined pill except it requires only once a month insertion. The ring is left in place for three weeks. It should then be removed and the woman stays without one for a week when a withdrawal bleed (period) takes place. After the week without, a fresh ring is inserted. This method therefore involves the user more than other long acting reversible contraceptives in the sense that an action on her part is required every month.

Its other advantage over the combined pill is that the dose of hormone released daily is actually lower at ethinyl estradiol 15mg/day (etonogestrel rate is 120µg/day). The estradiol level is actually half of what is delivered when using a monophasic pill such as Microgynon.

The NuvaRing is inserted by the user herself and vaginal muscles will keep it in place. A minority of users have experienced problems with it. Reported problems include

Ø Increased vaginal discharge (leucorrhoea)

Ø A sensation of vaginal inflammation (vaginitis)

Ø Foreign body sensation in the vagina

Ø Headache

Ø Nausea

Ø Interference with sexual intercourse (partner awareness)

These unwanted effects are experienced by a minority of users (around 1 in 25). Use of NuvaRing does not cause change in body weight.

NuvaRing is sometimes expelled before it is due to be removed. This is usually associated with exertion such as in cases of constipation and the use of a tampon. However, in proper use, this should not really happen as the ring is supposed to have been removed at the time the period starts.

Despite the lower level of hormone delivered, there are fewer cases of irregular vaginal bleeding with NuvaRing compared to the combined pill. Efficacy of the ring is similar to the combined pill with a failure rate of around 0.8%.

…and when it is time to say ‘Goodbye To Al That’

Last update: Jan 31, 2013

Filshie clips female sterilisation

Female sterilisation usually involves occluding the fallopian tubes using titanium clips as seen in the image above. This is regarded as a form of permanent contraception. Female sterilisation using this method can technically be reversed but it is not and should not be used with that possibility in mind. The failure rate of this type of sterilisation ranges from 2 to 5 per thousand (0.2-0.5%)