11/13/24, 8\:16 PM Guide | Contraceptive implant counselling

Contraceptive implant counselling

Table of contents

Introduction

Contraceptive counselling often features in OSCEs, and it’s important to be familiar with the various methods of
contraception available.
This article focuses on counselling patients about the sub-dermal contraceptive implant (commonly referred to as “the
implant”), including the common questions patients ask, the information you’ll be expected to give and how best to structure
the consultation.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain the reason for the consultation\:
“ I u n d e r s t a n d y o u a r e i n t e r e s t e d i n u s i n g t h e i m p l a n t f o r c o n t r a c e p t i o n . I s t h a t c o r r e c t ?”
.
It is important to establish a good rapport and an open line of communication with the patient early in the consultation\:
h a v e a n y q u e s t i o n s a t a n y p o i n t , o r i f s o m e t h i n g i s n o t c l e a r , p l e a s e f e e l f r e e t o i n t e r r u p t a n d a s k m e .
”
“ I f y o u
Make sure to check the patient’s understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as ‘chunking and checking’).

Ideas, concerns and expectations

A key component of contraceptive counselling involves exploring a patient’s ideas, concerns and expectations (often referred
to as ICE).
In a contraceptive consultation, it is important to explore ICE, as many patients will have researched or have prior experience
with contraceptive methods. This will help you tailor the consultation and the advice you give regarding speci
important to identify any patient concerns and expectations early in the consultation, as this may a
method and subsequent contraceptive e
It can sometimes be challenging to use the ICE structure in a way that sounds natural in your contraceptive consultation, but
we have provided some examples for each of the three areas below.

Ideas

Explore what the patient currently understands about the implant\:
“ H a v e y o u h e a r d o f t h e i m p l a n t ?”
“ W h a t d o y o u a l r e a d y k n o w a b o u t t h e i m p l a n t ?”

Concerns

Ask if the patient has any concerns about the implant\:
" I s t h e r e a n y t h i n g t h a t w o r r i e s y o u a b o u t t h e i m p l a n t ?”

Expectations

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Explore the patient’s expectations of the implant\:
“ W h a t f a c t o r s h a v e m a d e y o u c o n s i d e r u s i n g t h e i m p l a n t ?”
“ W h y d o y o u t h i n k t h e i m p l a n t i s t h e b e s t c h o i c e f o r y o u ?”

Eligibility for the implant

Before starting any method of contraception, it is vital to check the patient's eligibility and for any contraindications.
The Faculty of Sexual and Reproductive Health (FSRH) produce the UK Medical Eligibility Criteria for Contraceptive Use
(UKMEC) which guides clinicians on the safety of di
characteristics and medical co-morbidities\:
UKMEC 1\: no restriction
UKMEC 2\: bene
UKMEC 3\: theoretical or proven risk generally outweighs the bene
UKMEC 4\: contra-indicated

UKMEC 4 criteria

UKMEC 4 criteria for the contraceptive implant include\:
Current breast cancer

UKMEC 3 criteria

UKMEC 3 criteria for the contraceptive implant include\:
Unexplained vaginal bleeding (suspicious for a serious cause, before assessment has occurred)
Past history of breast cancer
Severe decompensated cirrhosis
Benign hepatocellular adenoma
Malignant hepatocellular carcinoma

What is the contraceptive implant?

Using patient-friendly language, explain that the implant is a form of long-acting reversible contraception (commonly
referred to as LARC methods or ‘
The implant itself is a small,
also contains a small amount of barium, which means it can be visualised on an X-ray if required.
The only licenced implant in the UK is the Nexplanon, which lasts up to 3 years. In other countries, some implants are in use
that can provide contraception for up to 5 years.
Example
“ T h e i m p l a n t i s a s m a l l p l a s t i c d e v i c e , a s i m i l a r s i z e a n d s h a p e t o a m a t c h s t i c k , t h a t w i l l s i t u n d e r t h e s k i n o f y o u r u p p e r
a r m a n d a c t t o p r e v e n t p r e g n a n c y . I t i s t h e m o s t e
r e m e m b e r t o t a k e i t e v e r y d a y . I t l a s t s u p t o 3 y e a r s . A s t h e d e v i c e s i t s i n t h e a r m , i t r e q u i r e s a s m a l l p r o c e d u r e i n c l i n i c t o

”

How e

When counselling patients regarding contraception, it is very important to explain how e
any factors which may impact e
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Explain to the patient that the implant is the most e
e
Example
“ L e s s t h a n 1 i m p l a n t u s e r i n 1 0 0 w i l l ge t p r e g n a n t i n o n e y e a r .
”
“ I f 1 0 0 s e x u a l l y a c t i v e w o m e n d o n’ t u s e a n y c o n t r a c e p t i o n , 8 0–9 0 w i l l ge t p r e gn a n t i n a y e a r .
”

How does the contraceptive implant work?

Explain to the patient that the implant is embedded with the hormone etonogestrel, which is a progestogen. The etonogestrel
is slowly released from the implant over time.
The primary mechanism of action of the implant is to prevent ovulation. The progestogenic e
thicken cervical mucus and thin the endometrium, making passage of sperm into the womb more di
implantation.
Example
“ T h e h o r m o n e w i t h i n t h e i m p l a n t w o r k s t o p r e v e n t a n e g g f r o m b e i n g r e l e a s e d e a c h m o n t h . I t a l s o a c t s t o t h i c k e n t h e
m u c u s a t t h e e n t r a n c e t o t h e w o m b , a s w e l l a s t h i n n i n g t h e l i n i n g o f t h e w o m b . T h i s m e a n s t h a t i t i s m o r e d i
s p e r m t o t r a v e l i n t o t h e w o m b , a n d w o u l d a l s o b e m o r e d i
”

Advantages and disadvantages of the contraceptive implant

When discussing contraceptive options, it is important to give the patient enough information to make an informed
decision and direct them to reputable sources of further information.
When explaining potential advantages and disadvantages, you should consider the patient’s ideas, concerns and
expectations (identi
Signposting is important to help you structure the consultation\:
h a v i n g t h e i m p l a n t a n d s o m e o f t h e p o t e n t i a l d i s a d v a n t a ge s . “ N e x t , I’ d l i k e t o t a l k a b o u t s o m e o f t h e a d d i t i o n a l b e n e
I s t h a t o k ? .
”

Advantages of the contraceptive implant

Advantages of the contraceptive implant include\:
Highly e
Long lasting (3 years)
‘Fit and forget’
– no requirement to take a daily pill or attend regular appointments
Easily reversible (once removed, fertility returns instantly)
Does not contain oestrogen, therefore suitable for some patients who may be unable to have combined methods of
contraception due to their medical history
Prevents ovulation and may help patients who experience premenstrual symptoms
Safe in breastfeeding
Example
“ T h e i m p l a n t c a n l a s t u p t o 3 y e a r s a n d i s o v e r 9 9 % e
u n t i l y o u w a n t t o s t o p u s i n g t h e m , o r y o u go t h r o u g h t h e m e n o p a u s e . O n e o f t h e r e a s o n s w h y i t i s s o e
d o n o t n e e d t o r e m e m b e r t o u s e i t .
"
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" I t i s a p r o g e s t o g e n-o n l y m e t h o d o f c o n t r a c e p t i o n a n d d o e s n o t c o n t a i n o e s t r o ge n . l a r g e r p r o p o r t i o n o f p e o p l e . B e c a u s e t h e p r o ge s t o ge n i n t h e i m p l a n t s t o p s o v u l a t i o n , p r e m e n s t r u a l s y m p t o m s ( P M S ) y o u e x p e r i e n c e . A s s o o n a s t h e i m p l a n t i s r e m o v e d , F o r t h a t r e a s o n , i t i s s a f e t o u s e f o r a
i t m a y h e l p t o r e d u c e a n y
f e r t i l i t y r e s u m e s a s n o r m a l .
”

Disadvantages of the contraceptive implant

Potential disadvantages of the contraceptive implant include\:
Unpredictable e
Does not protect against sexually transmitted infections
Requires a procedure to
the arm)
Possible hormonal side e
E
Small increased risk of breast cancer
Example
“ I t i s v e r y u n p r e d i c t a b l e h o w t h e i m p l a n t m a y a
i n t h e
l o n g e r t e r m , s o m e p e o p l e c o n t i n u e t o h a v e t h e i r p e r i o d s i n t h e i r u s u a l p a t t e r n , s o m e m a y h a v e n o p e r i o d s a t a l l , a n d
o t h e r s m a y e x p e r i e n c e e i t h e r f r e q u e n t o r i n f r e q u e n t i r r e gu l a r b l e e d i n g . T h e r e i s n o w a y t o k n o w h o w t h e i m p l a n t w i l l
a
”
“ U n f o r t u n a t e l y , t h e i m p l a n t d o e s n o t p r o t e c t y o u f r o m s e x u a l l y t r a n s m i t t e d i n f e c t i o n s ( S T I s ) . c o n d o m s ) a r e t h e o n l y m e t h o d o f c o n t r a c e p t i o n t o a l s o p r o v i d e p r o t e c t i o n f r o m i n f e c t i o n s .
”
B a r r i e r c o n t r a c e p t i o n ( e .g.
“ T h e i m p l a n t r e q u i r e s a s h o r t p r o c e d u r e t o
”
a s t h e r e a r e a f e w t h i n gs y o u n e e d
“ A f t e r
m o n t h s . T h e s e o f t e n s e t t l e a f t e r t h e
s k i n o r m o o d .
”
“ T h e r e a r e a s m a l l n u m b e r o f o t h e r m e d i c a t i o n s t h a t c a n r e d u c e t h e c o n t r a c e p t i v e e
a l w a y s a g o o d i d e a t o c h e c k w i t h y o u r d o c t o r a b o u t t h i s i f y o u a r e s t a r t e d o n a n y n e w m e d i c a t i o n s w h i l s t u s i n g t h e
i m p l a n t .
”
“ T h e r e i s s o m e e v i d e n c e t o s u g g e s t t h a t t h e i m p l a n t m a y b e l i n k e d w i t h a s m a l l i n c r e a s e i n r i s k o f b r e a s t c a n c e r . T h e
e v i d e n c e s u g g e s t s t h a t t h i s r i s k r e d u c e s b a c k t o b a s e l i n e a ga i n w h e n y o u s t o p u s i n g t h e m e t h o d”
.

How is the contraceptive implant

Fitting of a contraceptive implant

An implant can be inserted at any point during the menstrual cycle. Insertion of an implant can be done in a community clinic
and requires a trained
The procedure involves injecting local anaesthetic to numb the insertion site, followed by the
the skin. This is done using a speci
to explore their ideas and concerns regarding the procedure.
Risks of implant insertion include\:
Pain and discomfort, although local anaesthetic is used to reduce this
Bruising and bleeding
Infection
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Deep insertion and neurovascular insertion
Scarring
healing process.
It is important to give safety netting advice to the patient so that they know what to expect and what is not normal during the
If it is
If
should use extra precautions (such as condoms) for those 7 days. If the patient is switching from another form of contraception,
it may be e
Using patient-friendly language, explain the procedure for
Example
“ A s w e’ v e d i s c u s s e d , i n s e r t i n g a n i m p l a n t i n t o t h e a r m r e q u i r e s a s h o r t p r o c e d u r e . N o r m a l l y i t i s i n s e r t e d i n y o u r n o n-
d o m i n a n t a r m , b u t a s e v e r y o n e' s a n a t o m y i s d i
i m p l a n t i n y o u . T h e p r o c e d u r e i n v o l v e s h a v i n g s o m e l o c a l a n a e s t h e t i c t o n u m b t h e a r e a w h e r e t h e i m p l a n t w i l l b e
T h i s m e a n s t h a t t h e i n s e r t i o n o f t h e i m p l a n t i t s e l f s h o u l d n o t b e p a i n f u l . I f y o u h a v e a n i n j e c t e d l o c a l a n a e s t h e t i c , y o u w i l l
e x p e r i e n c e a s t i n g i n g s e n s a t i o n w h e n i t i s i n j e c t e d , b u t t h i s s h o u l d f a d e q u i c k l y .
”
“ F o l l o w i n g t h i s , t h e c l i n i c i a n w i l l t h e n i n s e r t t h e i m p l a n t j u s t b e n e a t h t h e s k i n o f y o u r a r m . Y o u s h o u l d a l w a y s b e a b l e t o
f e e l t h e i m p l a n t u n d e r y o u r s k i n a n d t h e c l i n i c i a n w i l l s h o w y o u h o w t o d o t h i s . I t i s a b o u t t h e s i z e o f a m a t c h s t i c k .
”
“ T h e w h o l e p r o c e d u r e s h o u l d n o t t a k e m o r e t h a n 1 0 m i n u t e s . D e p e n d i n g o n w h e n y o u r l a s t p e r i o d w a s , t h e i m p l a n t c a n
t a k e 7 d a y s t o s t a r t w o r k i n g f o r c o n t r a c e p t i o n . T h e c l i n i c i a n w i l l t a l k t o y o u a b o u t t h i s o n t h e d a y s o t h a t y o u k n o w w h e n
y o u w i l l b e p r o t e c t e d”
.
“ T h e a r e a w h e r e t h e i m p l a n t w a s i n s e r t e d w i l l b e d r e s s e d u s i n g a b a n d a ge a n d t h e c l i n i c i a n w i l l gi v e y o u i n s t r u c t i o n s o n
w h e n t h i s s h o u l d b e r e m o v e d . I t i s i m p o r t a n t t h a t y o u k e e p t h e a r e a c l e a n a n d d r y w h i l s t t h e b a n d a ge i s o n , t o r e d u c e t h e
r i s k o f i n f e c t i o n a n d h e l p w i t h t h e h e a l i n g p r o c e s s .
”
“ T h e a r e a w h e r e t h e i m p l a n t w a s i n s e r t e d m a y b e s l i g h t l y t e n d e r , b r u i s e d o r s w o l l e n f o r a c o u p l e o f d a y s f o l l o w i n g t h e
p r o c e d u r e . I f y o u e x p e r i e n c e a n y p a i n t h a t i s n o t c o n t r o l l e d w i t h s i m p l e p a r a c e t a m o l , a n y u n u s u a l c h a n ge i n s e n s a t i o n t o
y o u r a r m o r h a n d , o r i f y o u h a v e a n y c o n c e r n s a b o u t i n f e c t i o n o r h e a l i n g , d o n o t h e s i t a t e t o s e e k a d v i c e .
”

Removal of a contraceptive implant

An implant is removed during another short procedure. Whilst the implant can provide contraception for up to 3 years, the
patient can have it removed at any point if they wish.
Risks of implant removal include\:
Pain and discomfort, although local anaesthetic is again used to reduce this
Bruising and bleeding
Infection
Damage to surrounding structures
Scarring
Di
Example
“ T h e i m p l a n t p r o v i d e s c o n t r a c e p t i o n f o r u p t o 3 y e a r s . I f y o u d e c i d e y o u d o n o t w a n t t o c o n t i n u e t o u s e t h i s m e t h o d o f
c o n t r a c e p t i o n , a t r a i n e d h e a l t h c a r e p r o f e s s i o n a l c a n r e m o v e t h e i m p l a n t a t a n y t i m e .
”
“ J u s t l i k e w i t h t h e i n s e r t i o n , y o u’ l l b e g i v e n a l o c a l a n a e s t h e t i c t o n u m b t h e a r e a s o t h a t t h e r e m o v a l i t s e l f w i l l n o t b e
p a i n f u l . A s m a l l c u t w i l l b e m a d e i n y o u r a r m o v e r o n e e n d o f t h e i m p l a n t , a n d t h e i m p l a n t w i l l b e r e m o v e d t h r o u g h t h i s .
T h i s s h o u l d o n l y t a k e a c o u p l e o f m i n u t e s . O n c e r e m o v e d , y o u r f e r t i l i t y r e t u r n s i m m e d i a t e l y .
”
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“ T h e a r e a w h e r e t h e i m p l a n t w a s r e m o v e d w i l l b e d r e s s e d u s i n g a b a n d a ge a n d t h e c l i n i c i a n w i l l gi v e y o u i n s t r u c t i o n s o n
w h e n t h i s s h o u l d b e r e m o v e d . I t i s i m p o r t a n t t h a t y o u k e e p t h e a r e a c l e a n a n d d r y w h i l s t t h e b a n d a ge i s o n , t o r e d u c e t h e
r i s k o f i n f e c t i o n a n d h e l p w i t h t h e h e a l i n g p r o c e s s .
”
“ T h e a r e a w h e r e t h e i m p l a n t w a s r e m o v e d m a y b e s l i g h t l y t e n d e r , b r u i s e d o r s w o l l e n f o r a c o u p l e o f d a y s f o l l o w i n g t h e
p r o c e d u r e . I f y o u e x p e r i e n c e a n y p a i n t h a t i s n o t c o n t r o l l e d w i t h s i m p l e p a r a c e t a m o l , a n y u n u s u a l c h a n ge i n s e n s a t i o n t o
y o u r a r m o r h a n d , o r i f y o u h a v e a n y c o n c e r n s a b o u t i n f e c t i o n o r h e a l i n g , d o n o t h e s i t a t e t o s e e k a d v i c e .
”
“ O c c a s i o n a l l y , t h e r e c a n b e s o m e d i
”
I f t h i s i s t h e c a s e , y o u w i l l b e r e f e r r e d t o a s p e c i a l i s t

Aftercare

Checking the implant

Explain to the patient that they should always be able to feel the implant under their skin. They will be shown where to feel for
this and what to feel when their implant is

Safety netting

Patients should be informed to seek medical advice if\:
They are unable to feel their implant
They experience ongoing pain after the
They experience an unexpected/ unwanted change in their bleeding pattern
They experience unusual redness or swelling around the site of insertion, or fever, which could indicate infection relating to
the device
There is a change to their medical history
Example
" Y o u s h o u l d a l w a y s b e a b l e t o f e e l t h e i m p l a n t u n d e r y o u r s k i n . Y o u w i l l b e s h o w n w h e r e t o f e e l f o r t h i s a n d w h a t i t f e e l s
l i k e w h e n y o u h a v e y o u r i m p l a n t i n s e r t e d .
"
" I f y o u c a n n o t f e e l t h e i m p l a n t t h e n d o n o t r e l y o n i t f o r c o n t r a c e p t i o n , a n d y o u s h o u l d b o o k a n a p p o i n t m e n t f o r a c l i n i c i a n
t o r e v i e w i t s p o s i t i o n t o m a k e s u r e t h a t i t i s s t i l l i n t h e c o r r e c t p o s i t i o n . A d d i t i o n a l l y , i f y o u e x p e r i e n c e o n go i n g p a i n a f t e r

i n s e r t i o n , f e v e r o r a c h a n g e i n y o u r m e d i c a l h i s t o r y , t h e n p l e a s e s e e k m e d i c a l a d v i c e .
”

Closing the consultation

Close the consultation by summarising what you have discussed. This allows you to emphasise the key points of the
consultation to ensure patient understanding.
Ask the patient if they have any further questions or concerns that haven’t been addressed.
If the patient is not currently using contraception, o
insertion of the implant.
Finally, thank the patient for their time and o
(e.g. Sexwise implant lea).
Dispose of PPE appropriately and wash your hands.
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Reviewer

Dr Ashley Je
Community Sexual and Reproductive Health Registrar

References

FSRH. Progestogen-only Implant. Published 2023. Available from [LINK]
Source\: geekymedics.com
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