Implanon nxt implant - Information, specialists, frequent questions.

Usage of Implanon nxt implant

This leaflet provides information that may help you in your decision to start using Implanon NXT. It will also advise you how to use Implanon NXT properly and safely. It answers some common questions about Implanon NXT. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you using Implanon NXT against the benefits they expect it will have for you.

If you have any concerns about using this medicine, ask your doctor or pharmacist.

Please read this leaflet carefully before you decide to have Implanon NXT inserted.

Keep this leaflet. You may need to read it again. It is important to stay alert on matters that do not affect you now, but may affect you in the future.

What does it contain?

Implanon NXT is a contraceptive implant preloaded in a disposable applicator. The implant contains 68 mg of the active substance etonogestrel. Etonogestrel is a synthetic female hormone resembling progesterone. A small amount of the hormone etonogestrel is continuously released into the bloodstream for three years. The rod itself is made of ethylene vinylacetate copolymer, a plastic that will not dissolve in the body. It also contains a small amount of barium sulfate which renders it visible under X-ray.

Although the implant may be removed at any time, it must be removed no later than three years after insertion.

How does Implanon NXT work?

Implanon NXT is used to prevent pregnancy.

Implanon NXT is placed directly under the skin of the non-dominant upper arm.

Implanon NXT prevents pregnancy in two ways:

  • It prevents the release of an egg cell from the ovaries (ovulation)
  • It causes changes to cervical mucus that makes it difficult for sperm to enter the womb.

As a result, Implanon NXT protects you against pregnancy for a period of three years, but if you are overweight the doctor may advise you to replace the implant earlier. Implanon NXT is one of several means of preventing pregnancy. Another frequently used birth control method is the combined Pill. Implanon NXT differs from combined Pills in that it contains no oestrogen and you do not have to remember to take a pill every day.

Implanon NXT has several important advantages:

  • It is one of the most reliable birth control methods (over 99% effective).
  • It does not interfere with having sex.
  • Once you stop using it you can expect your previous fertility to return quickly.

Furthermore, compared to the combined Pill, Implanon NXT has some additional advantages, but also some disadvantages:

Advantages

  • You do not have to worry about taking a tablet each day; the implant should be replaced every 3 years.
  • Implanon NXT may be used by women who do not tolerate oestrogens.
  • In some circumstances Implanon NXT may be used by breast-feeding women. Check with your doctor for advice.

Disadvantages

  • Your menstrual bleeding may change and become absent, irregular, infrequent, frequent, prolonged, or rarely heavy. The bleeding pattern that you experience during the first three months generally indicates your future bleeding pattern. (see also 'Menstrual bleeding')
  • On rare occasions, the implant moves from its original position. This may complicate removal (see also 'Insertion and removal related events').
  • If in rare cases the implant is not inserted correctly or is not inserted at all, you may not be protected against pregnancy.
  • Implanon NXT must be inserted and removed by a doctor. A small scar may remain.

A doctor's prescription is required to obtain this medicine.

Before you have Implanon NXT inserted or removed, confirm that your doctor is familiar with the technique. For uncomplicated removals, it is necessary that Implanon NXT be inserted directly under the skin. Incorrect insertion may lead to complicated removals that may result in scarring.

Ability to drive

There are no indications of any effect of Implanon NXT on alertness and concentration.

How should Implanon NXT be inserted and removed?

Tell your doctor if you are pregnant or think you might be pregnant before Implanon NXT is inserted (e.g. if you had unprotected intercourse during your current menstrual cycle).

Implanon NXT should only be inserted and removed by a doctor who is familiar with the technique.

The doctor will decide in consultation with you the most suitable time for insertion. This depends on your personal situation (e.g. on the birth control method that you are currently using). Unless you are switching from another hormonal contraceptive method, insertion should be done on day 1-5 of your normal menstrual bleeding to rule out pregnancy. Your healthcare professional will advise you (see 'When to insert Implanon NXT').

Before inserting or removing Implanon NXT, your healthcare professional will give you a local anaesthetic. Implanon NXT is inserted directly under the skin, on the inside of your upper non-dominant arm (the arm that you do not write with). The insertion of Implanon NXT is not generally painful if performed with a local anaesthetic and only takes the time required for an injection.

To help you remember when and where Implanon NXT was inserted, and when Implanon NXT must be removed at the latest, your healthcare professional will give you a User Card that shows this information. Store the card in a safe place!

At the end of the insertion procedure, the healthcare professional will ask you to feel the implant by palpation. A correctly inserted implant should be clearly palpable by the healthcare professional as well as by you, certainly if both ends can be lifted between thumb and finger. It should be realised that palpation is not suitable for 100% verification of the presence of the implant. In case of the slightest doubt you have to use a barrier method (e.g. a condom) until the healthcare professional and you are absolutely sure that the implant has been inserted. In rare cases the healthcare professional may have to use X-rays, ultrasound or magnetic resonance imaging, or may have to take a blood sample, to make sure that the implant is inside your arm.

In case you would like to have Implanon NXT replaced, a new implant may be inserted immediately after the old implant is removed. The new implant may be inserted in the same arm and at the same site as the previous implant. Your healthcare professional will advise you.

You should avoid playing with the rod after insertion to prevent it from moving from its original position.

Implanon NXT should be removed or replaced no later than three years after insertion. Failure to do so may increase your risk of ectopic pregnancy.

Removal requires a small incision under local anaesthetic. Occasionally removal may be complicated because the rod has moved from its original position or was inserted too deeply.

Special precautions

When you must not use it

Do not use Implanon NXT if you have any of the conditions listed below. If any of these apply to you, tell your doctor BEFORE Implanon NXT is inserted. Your doctor can tell you whether Implanon NXT is suitable for you or not and may advise you to use a non-hormonal method of birth control.

  • If you are pregnant or think you might be pregnant
  • If you have a thrombosis. Thrombosis is the formation of a blood clot in a blood vessel [e.g. in the legs (deep venous thrombosis) or in the lungs (pulmonary embolism)].
  • If you have jaundice (yellowing of the skin) or severe liver disease.
  • If you have (had) a cancer that grows under the influence of progestagens.
  • If you have any unexplained vaginal bleeding.
  • If you have or suspect you have cancer of the breast, ovary or womb.
  • If you have benign or malignant liver tumours.
  • If you are allergic to any of the ingredients of Implanon NXT; see list of ingredients at the end of this leaflet.

If any of these conditions appear for the first time while using Implanon NXT, tell your doctor immediately.

Do not use Implanon NXT if the expiry date printed on the pack has passed.

Do not use Implanon NXT if the packaging is torn or shows signs of tampering.

General notes

If you are concerned about contracting a sexually transmitted infection (STI), ask your partner to wear a condom when having sexual intercourse with you.

As with all contraceptive medicines, Implanon NXT does not protect against HIV infection (AIDS) or any other sexually transmissible infection. Only condoms and safe sex practices can protect you from these diseases. Your doctor may suggest the additional use of condoms in certain circumstances to reduce risk of such transmission.

Before you start with Implanon NXT

You must tell your doctor or family planning counsellor if you have any of the conditions listed below. You may need to be kept under close observation. Your doctor can explain this to you.

Tell your doctor if:

  • you have had breast cancer.
  • you have or have had a liver disease.
  • you have ever had a thrombosis.
  • you have diabetes.
  • you are overweight.
  • you suffer from epilepsy.
  • you suffer from tuberculosis.
  • you have high blood pressure.
  • you have or have had Chloasma (yellowish-brown pigmentation patches on the skin, particularly of the face); if so avoid too much exposure to the sun or ultraviolet radiation.

Tell your doctor if you have a condition that occurred for the first time or worsened during pregnancy or previous use of sex hormones:

  • jaundice or itching.
  • gallstone formation.
  • porphyria (metabolic disease).
  • systemic lupus erythematosus (SLE), a disease affecting the skin all over the body).
  • haemolytic uraemic syndrome (HUS), a disorder of blood coagulation causing failure of the kidneys.
  • Sydenham's chorea (a neurological disease).
  • Herpes gestationis.
  • hearing loss.

Hormonal contraceptives and cancer

Breast cancer has been found slightly more often in women using oral combined pills, but it is not known whether this is caused by the treatment. For example, it may be that tumours are found more in women on combined pills, because they are examined by the doctor more often. This slight increase in the numbers of breast cancer diagnoses gradually disappears during the course of the 10 years after stopping use of the Pill.

It is important to regularly check your breasts and you should contact your doctor if you feel any lump in your breasts. You should also tell your doctor if a close relative has or ever had breast cancer.

In rare cases, benign and even more rarely malignant liver tumours have been reported in women using the Pill.

If you experience severe abdominal pain, you should contact your doctor immediately.

In women using the Pill less cases of cancer in the womb or ovaries have been reported. It is not clear whether this is also the case for women using Implanon NXT.

This information has been obtained in studies with women who daily take an oral combined contraceptive Pill. It is not known whether these observations are also applicable to women who use a different hormonal contraceptive, such as implants containing only a progestagen.

Hormonal contraceptives and thrombosis

Thrombosis is the formation of a blood clot. A blood clot in a vein (known as a 'venous thrombosis') can block the vein. This can happen in veins in the leg (deep venous thrombosis, DVT), the lung (a lung embolus), or other organs. Using any combined hormonal contraceptive increases a woman's risk of developing such clots compared with a woman not taking any combined hormonal contraceptive. The risk is not as high as the risk of developing a blood clot during pregnancy. The risk with progestagen-only methods like Implanon NXT is believed to be lower than in users of Pills that also contain oestrogens.

If you notice any signs of a thrombosis, you should see a doctor immediately (see 'While you are using Implanon NXT' for symptoms of thrombosis).

Menstrual bleeding

Like with other progestagen-only contraceptives, your menstrual bleeding pattern may change when using Implanon NXT. You may experience a change in frequency (absent, less, more frequent or continuous), intensity (reduced or increased) or in duration. Absence of bleeding was reported in about 1 of 5 women while another 1 of 5 women reported frequent and/or prolonged bleeding. Occasionally heavy bleeding has been observed. In clinical trials, bleeding changes were the most common reason for stopping treatment (about 11 %). The bleeding pattern that you experience during the first three months generally indicates your future bleeding pattern.

A changing bleeding pattern does not mean that Implanon NXT does not suit you or is not giving you contraceptive protection. In general, you do not need to take any action. You should consult your doctor if menstrual bleeding is heavy or prolonged. It is important to have regular medical check ups, because while irregular bleeding is a common side effect of Implanon NXT, it may rarely be caused by other medical conditions.

Insertion and removal related events

The implant may migrate from the original insertion site, if not correctly inserted or too deeply inserted and/or due to external forces (e.g. manipulation of the implant or contact sports). In these cases localisation of the implant may be more difficult and removal may require a larger incision. If the implant cannot be found, and there is no evidence it has been expelled, contraception and the risk of progestagen-related undesirable effects may last longer than you want.

Ovarian cysts

During the use of all low-dose hormonal contraceptives, small fluid-filled sacs may develop in the ovaries. These are called ovarian cysts. They usually disappear on their own. Sometimes they cause mild abdominal pain. Only rarely, they may lead to more serious problems.

Ectopic pregnancy

Ectopic pregnancy is a pregnancy outside the womb. Because Implanon NXT effectively protects you against pregnancy for 3 years it can also protect you against having a pregnancy outside the womb, but this effect is not as good as with the combined Pill. Failure to remove (and if appropriate reinsert Implanon NXT) after 3 years may increase your risk of an ectopic pregnancy.

Implanon NXT and pregnancy

Tell your doctor immediately if you are pregnant or think you are pregnant while you are using Implanon NXT.

Implanon NXT must not be used by women who are pregnant, or who think they may be pregnant. In case you doubt whether you are pregnant or not, you should perform a pregnancy test before starting to use Implanon NXT.

Implanon NXT and breastfeeding

Implanon NXT may be used while you are breastfeeding. Although a small amount of the active substance of Implanon NXT passes into the breast milk, there is no effect on the production or the quality of breast milk, nor on the growth and development of the child.

If you are breastfeeding and want to use Implanon NXT, you should contact your doctor.

Taking other medicines

Tell your doctor if you are taking or have recently taken any other medicines or herbal products you buy without a prescription from a pharmacy, supermarket or health food shop.

Some medicines may stop Implanon NXT from working properly. These include:

  • medicines for epilepsy (such as primidone, phenytoin, barbiturates, carbamazepine, oxycarbamazepine, topiramate, felbamate)
  • medicines for tuberculosis (e.g. rifampicin and rifabutin)
  • medicines for HIV infections (e.g. ritonavir, nelfinavir, nevirapine)
  • medicines for other infectious disease (e.g. griseofulvin)
  • medicines for depressive moods (the herbal remedy containing St. John's wort).

Implanon NXT may also interfere with the working of other medicines; e.g. increase the activity of cyclosporin and decrease the effect of lamotrigine.

You should tell any other doctor or dentist who prescribes another medicine that you are using Implanon NXT. Your doctor or family planning counsellor can tell you if you need to take extra contraception precautions (such as a condom or cap plus spermicide) and if so for how long. They may also advise you to have the implant removed.

If you want to use herbal products containing St. John's wort while you are already using Implanon NXT you should consult your doctor first.

When you are using Implanon NXT, you should arrange for regular check-ups by your doctor. He or she should pay special attention to your blood pressure and your breasts and give you a regular examination of the pelvic organs (including a cervical smear).

Consult your doctor promptly if any of the following happen:

If you have any of the signs of a blood clot, as below:

  • Sudden severe pain in the chest, whether it reaches to the arm or not.
  • If you suddenly become breathless.
  • If you suddenly lose vision, partially or completely, or if you see double.
  • If you have an unusual, severe or prolonged headache.
  • If your speech is abnormal.
  • If you experience dizziness.
  • If you have a fainting attack or you collapse.
  • If one side or part of your body suddenly becomes very weak or numb.
  • If you suffer severe pain in one of your calves.

Storage

Store Implanon NXT in a cool dry place where the temperature stays below 30°C.

Do not use after the expiry date stated on the blister and outer box. Your doctor will not use Implanon NXT after the expiry date, which is the last date for insertion.

Do not use Implanon NXT if the packaging is worn or torn, or if the product does not look quite right.

Do not open the sterile plastic box containing the applicator.

Disposal

Your doctor will arrange disposal of Implanon NXT upon removal of the old implant.

Adverse and side effects

Various undesirable effects that have been associated with the hormones used for birth control are similar to those that may occur during pregnancy. The reason for this is the similarity between these hormones and the natural hormones produced in extra large amounts during pregnancy. These effects can also occur during the use of Implanon NXT but are not necessarily caused by it.

Tell your doctor or pharmacist as soon as possible if you do not feel well while using it.

Like all medicines, Implanon NXT can have side effects. Sometimes they are serious, most of the time they are not.

Serious side effects

Serious reactions associated with the use of Implanon NXT, as well related symptoms, are described in the following sections: 'Before you have Implanon NXT inserted', 'Hormonal contraceptives and thrombosis', 'Hormonal contraceptives and cancer'.

Please read the following sections for additional information and consult your doctor at once where appropriate.

Other possible side effects

  • acne
  • headache
  • breast tenderness and pain
  • weight gain
  • irregular bleeding
  • hair loss
  • dizziness
  • depression
  • emotional lability or mood swings
  • nervousness
  • libido decreased
  • abdominal pain
  • nausea
  • gas in stomach and intestines
  • painful menstruation
  • implant site pain and/or reaction
  • itching
  • vomiting

Apart from these side effects, a rise in blood pressure has occasionally been observed. Also oily skin has been observed.

You should see your doctor immediately if you experience symptoms of angioedema such as:

  1. swollen face, tongue or throat;
  2. difficulty to swallow; or
  3. hives and difficulty with breathing.

Insertion and removal related effects

During the insertion or removal of Implanon NXT, some bruising, pain or itching and in rare cases infection may occur.

Occasionally, fibrous tissue may appear at the implantation site, or a scar or abscess will be formed. Rarely, numb feeling or sensation of numbness (or lack of feeling) may occur. Expulsion or migration of Implanon NXT is possible, especially if the implant has not been inserted properly. Minor surgical intervention might be necessary when removing Implanon NXT.

Tell your doctor or family planning counsellor if any side effect becomes troublesome or continues. It is also important to tell them if you experience any other unusual or unexpected symptoms during the use of Implanon NXT.

Questions about Implanon nxt implant

Our experts have answered 3 questions about Implanon nxt implant

Dr. Stephen Elgey
Dr. Stephen Elgey
Gynaecologist
Sunnybank
Anything is possible. The Implanon is licensed and sold as a device that provides reliable contraception for 3 years. The effect doesn't simply stop at 3 years however but day by day there…
2 answers

Dr. Stephen Elgey
Dr. Stephen Elgey
Gynaecologist
Sunnybank
I'm not sure why you would want an Implanon in one month and out the other. If you want short term contraception then the oral contraceptive pill may be better than going through the cost…
2 answers

Dr Philip Thomas
Dr Philip Thomas
Gynaecologist
Brighton East
Implanon is not effective as a contraceptive after three years; this should be removed if necessary with prior ultrasound localisation.
3 answers

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