Advice to patient before fitting a contraceptive implant (Nexplanon)
Who is it for?
This page is written for women who are planning to have an implant fitted. It tells you about tests we may recommend before the insertion and about the timing of appointments to make the fitting as safe and comfortable as possible.
Contraception before implant insertion
It is very important that there is no chance of you being pregnant at the time the implant is inserted.
- Please use effective contraception, or do not have sex from your last period, until the fitting.
- If you are using condoms/cap, you should avoid intercourse from day one of your period until your next appointment
- If you are taking the pill, continue to take it as instructed up until the day of fitting and for at least a week after.
- If you have had a contraceptive injection, you will need to have your implant inserted before the injection runs out (14 weeks since the last injection) or abstain from sex or use an alternative method of contraception.
- If you already have a coil in place, we will prefer to fit the implant before removing the coil.
- The coil can then be removed after 7 days. It is quite safe to have both methods running together.
- If you have recently had a baby, you should start using reliable contraception 21 days after giving birth. You can have an implant inserted from three weeks after the birth.
- If you are not having regular periods, and not using a reliable method of contraception, as above, YOU MUST AVOID INTERCOURSE FOR AT LEAST 7 DAYS before your appointment. We will perform a pregnancy test before fitting your implant
If you are unsure about this information, please make a telephone appointment to discuss this with Dr Nelson (RCS) or Dr Costales and Dr Goldstein-Jackson (PRESTON).
If you already have an implant in place, and we are removing it and inserting a new device, please abstain from sex or use a condom reliably in the 7 days before the appointment.
You will not need a prescription or need to bring the Nexplanon as we stock it at the surgery.
What to expect on the day?
- Please allow at least 30 minutes for the appointment. You are welcome to bring a friend/partner with you but please be aware that you will be asked some personal questions.
- The procedure will be explained to you prior to the implant insertion. There will be time for any questions you may have.
- Please wear a top with short sleeves.
- You will be asked to lie down on the couch, and you will be given pain relief in the form of a local anaesthetic injection.
- The implant is then injected just under the skin of the inner side of your upper arm.
- You will be asked to feel the implant once it has been inserted so that you know where it is.
- You will have a very small wound on your skin at the point where the implant was inserted. This will be covered with a dressing that you need to leave on for around 3 days. You will be left with a very small scar.
- The implant takes 7 days to become effective, so we recommend you continue with alternative contraception for the first 7 days after it has been inserted. For example, use condoms, or if on the pill, take a further 7 pills after the insertion, and then stop.
- Your arm may be bruised, have some swelling and feel sore after the insertion but it won’t prevent you from doing anything after your appointment. You should avoid lifting anything very heavy until the wound has healed.
Contraceptive Intra-uterine Device (coil)
This information is for women considering a contraceptive intra-uterine device (‘coil’). It covers hormonal intra-uterine systems (IUS eg Mirena) and non-hormonal devices (IUD ‘copper coil’).
Fitting procedure Coils are fitted by Dr Eleanor Costales or Dr Kimberley Goldstein Jackson, with the help of one of our nursing team. Normally it takes 20-30 minutes in total, but occasionally can take a bit longer. Please allow at least an hour, to allow for any late running etc.
- A coil can be fitted at any time during your menstrual cycle, as long as there is no risk of pregnancy.
- At the appointment, the doctor will examine inside your vagina to check the position of your womb.
- She will then insert a plastic speculum (like during a smear test) to hold the vagina open.
- If you are due a cervical smear, it can be taken at this stage.
- A clip is attached to your cervix to help stabilise it, and the size of your womb is measured.
- The coil is inserted through the cervix and into the womb
- Having a coil fitted can be uncomfortable but usually only for a very short time.
- You may get period-type cramps afterwards, but painkillers can ease the cramps.
- You may also bleed for a few days after having a coil fitting.
- Once a coil has been fitted, it will need to be checked by a nurse after 6-8weeks
We will sometimes arrange swabs before fitting a coil to exclude certain infections you will be advised if these are needed when your appointment is booked.
The procedure is very safe, but there are some rare but important risks you should be aware of:
Sometimes we are unable to fit the coil. This also occasionally happens when a coil is being changed- in these cases we would usually be able to easily fit the second one at a separate appointment in a week or two, but you would need to use alternative contraception in the meantime. If we have been completely unable to fit a coil but you still wish this form of contraception, we would refer you to the local Sexual Health clinic.
Infection (usually in the first 20 days after insertion)
This would cause heavier pain / bleeding or a temperature / smelly discharge after the coil insertion and would require treatment with antibiotics
About 1 in 20 coils fall out – this is not dangerous, but you would no longer be protected against pregnancy. We advise women to check for their coil threads to ensure the coil is still in place. Expulsion is most common during the first year of having a coil, and particularly during the first 3 months.
Rarely some women feel faint and their heart rate drops a bit during coil fitting. This usually settles as soon as the coil is fitted, but sometimes we might have to stop the fitting, or very occasionally take the coil back out again. Very, very rarely, if doesn’t settle, we might need to give an injection to raise your blood pressure again.
A rare occurrence when a small hole is made in the lining of the womb during the coil insertion. This would cause heavier pain / bleeding after the coil insertion and may require surgical removal of the coil. This occurs in less than 1 in 1000 coil fittings, but may be more likely if you have recently given birth or are breastfeeding. The doctors are trained in insertion techniques to minimise this risk.
No contraceptive option is 100%, however, failure rate of both kinds of coils is very low - less than 1%. This is equivalent to (or even better) than sterilisation.
In the very unlikely event of a woman falling pregnant with a coil in place, there is greater risk of this being an ectopic pregnancy (a pregnancy developing outside the womb). But this method of contraception is so reliable that falling pregnant with a coil in place is extremely unlikely.
It is extremely important that there is no chance of early or potential pregnancy at the time we fit the coil. If we have any doubt about this then we will have to postpone the appointment to another date.
Please read the information below carefully.
If you have any questions or concerns, please ask to speak to Dr Costales Walker or Dr Goldstein Jackson in good time before the fitting.
- Your appointment is for 20 minutes. It will be with a female doctor with one of our nurses to assist them. You may also be asked if you mind a trainee doctor being present.
- Please turn up on time for your appointment.
- Please bring a urine sample (for pregnancy test) even if you do not think there is any risk of pregnancy – it is our policy to do a pregnancy test before any coil fit.
- Please continue using your current method of contraception until advised you can stop this is usually at least 7 days AFTER the coil is fitted.
- Do not have unprotected sex for at least 21 days before your appointment.
- If attending for a coil change, please do not have sex for 7 days before your appointment. This is to protect you in case we are unable to re-fit the coil on the same day. If your original coil is out of date please do not have unprotected sex for 21 days before your appointment.
- Please note there is no need to cancel your appointment if you are having your period at the time of the coil fit-we can still do coil fits during this time
- We have a waiting list for appointments. If you are unable to attend your coil fitting appointment, please inform reception so that we can offer the appointment to another patient.
- Please have something light to eat before your appointment- there is no need to fast.
- Please take some painkillers 30-60 minutes before your appointment to help the discomfort that can be associated with coil fitting. Paracetamol or Ibuprofen are good options if you can take these.
- If you have any concerns after your coil fit please contact the practice for advice.
After coil fitting
- You are likely to have some light bleeding or spotting for a couple of days.
- Seek medical advice if you have severe or increasing pain, heavy bleeding, smelly discharge or you are concerned the coil may have come out.
- If you cannot feel the threads or are concerned about the coil coming out, use alternative contraception until told otherwise.
You can see further information on coils and other contraception options at the NHS website.
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