Weight gain with implanon


Implanon is the brand name of an implant that releases the hormone etonogestrel, which prevents pregnancy.

The Food and Drug Administration (FDA) approved Implanon in 2006, but the Implanon implant is no longer being marketed by its manufacturer (Merck) and has been replaced by another etonogestrel implant, Nexplanon.

The implant containing etonogestrel is a flexible plastic rod about the size of a matchstick. A healthcare provider inserts it under the skin of your arm.

Implanon prevents the release of an egg from the ovary.

It also changes the texture of mucus that lines the cervix and the inside of the uterus, which hinders the ability of sperm to pass into the uterus or implant there.

Implanon and Weight Gain

While weight gain is one of the most common side effects of Implanon, women using Implanon don’t usually gain as much weight as they do with other forms of hormonal birth control.

In clinical trials, the average woman using Implanon gained 2.8 pounds during the first year and 3.7 pounds after two years.

Less than 3 percent of women studied had the implant removed because of weight gain.

Implanon Warnings

The FDA required an update on Implanon labeling in 2009 that informs women complications can occur during implant insertion and removal.

Your healthcare provider must make sure the implant has been properly inserted underneath your skin.

If not, you will have to use a barrier form of birth control, such as a condom or diaphragm, until your healthcare provider confirms that the implant is secure and effective.

You should not use Implanon if you:

  • Have allergies to Implanon or any other ingredients found in the implant
  • Are pregnant or may be pregnant
  • Are bleeding from the vagina without known cause
  • Have a history of blood clots
  • Have breast cancer now or in the past or have a history of any cancer that progestin stimulates
  • Have liver disease or tumors
  • Had a baby within three weeks

Talk to your doctor before Implanon insertion if you:

  • Have high blood pressure
  • Have high cholesterol
  • Smoke
  • Have heart disease, diminished blood flow to the heart, or blood clots
  • Have or are at risk for having diabetes
  • Have a family history of angioedema
  • Are depressed or have been in the past
  • Have lupus
  • Had a baby within six weeks
  • Are breastfeeding

Pregnancy and Implanon

Implanon can cause birth defects and miscarriage.

A small amount of etonogestrel passes into breast milk, so ask your doctor if Implanon’s right for you if you’re breastfeeding.

Talk to your doctor about all of your medications if you’re pregnant, planning a pregnancy, or are breastfeeding.

The following adverse reactions reported with the use of hormonal contraception are discussed elsewhere in the labeling:

  • Changes in Menstrual Bleeding Patterns
  • Ectopic Pregnancies
  • Thrombotic and Other Vascular Events
  • Liver Disease

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In clinical trials including 942 women who were evaluated for safety, change in menstrual bleeding patterns (irregular menses) was the most common adverse reaction causing discontinuation of use of IMPLANON (11.1% of women).

Adverse reactions that resulted in a rate of discontinuation of ≥ 1% are shown in Table 3.

Table 3: Adverse Reactions Leading to Discontinuation of Treatment in 1% or More of Subjects in Clinical Trials of IMPLANON

Adverse Reactions All Studies
N = 942
Bleeding Irregularities* 11.1%
Emotional Lability† 2.3%
Weight Increase 2.3%
Headache 1.6%
Acne 1.3%
Depression‡ 1.0%
*Includes “frequent”, “heavy”, “prolonged”, “spotting”, and other patterns of bleeding irregularity.
†Among US subjects (N=330), 6.1% experienced emotional lability that led to discontinuation.
‡Among US subjects (N=330), 2.4 % experienced depression that led to discontinuation.

Other adverse reactions that were reported by at least 5% of subjects in clinical trials of IMPLANON are listed in Table 4.

Table 4: Common Adverse Reactions Reported by ≥ 5% of Subjects in Clinical Trials with IMPLANON

Implant site complications were reported by 3.6% of subjects during any of the assessments in clinical trials. Pain was the most frequent implant site complication, reported during and/or after insertion, occurring in 2.9% of subjects. Additionally, hematoma, redness, and swelling were reported by 0.1%, 0.3%, and 0.3% of patients, respectively .

The following additional adverse reactions have been identified during post-approval use of IMPLANON. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Gastrointestinal disorders: constipation, diarrhea, flatulence, vomiting.

General disorders and administration site conditions: edema, fatigue, implant site reaction, pyrexia.

Immune system disorders: anaphylactic reactions

Infections and infestations: rhinitis, urinary tract infection.

Investigations: clinically relevant rise in blood pressure, weight decreased.

Metabolism and nutrition disorders: increased appetite.

Musculoskeletal and connective tissue disorders: arthralgia, musculoskeletal pain, myalgia.

Nervous system disorders: convulsions, migraine, somnolence.

Pregnancy, puerperium and perinatal conditions: ectopic pregnancy.

Psychiatric disorders: anxiety, insomnia, libido decreased.

Renal and urinary disorders: dysuria.

Reproductive system and breast disorders: breast discharge, breast enlargement, ovarian cyst, pruritus genital, vulvovaginal discomfort.

Skin and subcutaneous tissue disorders: angioedema, aggravation of angioedema and/or aggravation of hereditary angioedema, alopecia, chloasma, hypertrichosis, pruritus, rash, seborrhea, urticaria.

Vascular disorders: hot flush.

Complications related to insertion or removal of the implant reported include: bruising, slight local irritation, pain or itching, fibrosis at the implant site, paresthesia or paresthesia-like events, scarring and abscess. Expulsion or migration of the implant, have been reported, including to the chest wall. In some cases implants have been found within the vasculature including the pulmonary artery. Some cases of implants found within the pulmonary artery reported chest pain and/or dyspnea; others have been reported as asymptomatic . Surgical intervention might be necessary when removing the implant.

Read the entire FDA prescribing information for Implanon (Etonogestrel Implant)

  1. What is Nexplanon?
  2. How does Nexplanon work?
  3. Key facts
  4. Who can and can’t have the Nexplanon implant?
  5. How and when is Nexplanon inserted?
  6. How and when is Nexplanon removed?
  7. What are the side effects of Nexplanon?
  8. Can I take other medicines while I’m on Nexplanon?

What is Nexplanon?

Nexplanon is a small, flexible, plastic contraceptive implant that provides contraception for three years. The implant is 4cm long and 2mm in diameter. It’s inserted under the skin of your upper arm by a doctor or nurse. You can have it removed at any time.

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How does Nexplanon work?

Nexplanon contains the active ingredient etonogestrel, which is a synthetic form of the naturally occurring female sex hormone, progesterone. Etonogestrel is released continuously into your bloodstream from the implant.

Etonogestrel prevents pregnancy mainly by stopping your ovaries from releasing an egg each month (ovulation). It also increases the thickness of the natural mucus at the neck of the womb, making it more difficult for sperm to cross from the vagina into the womb.

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💡Key facts

  • Nexplanon is more than 99% effective and lasts for three years.
  • You can have it removed earlier if you want to have a baby or get unacceptable side effects.
  • It’s suitable for most women and can be a good option if you don’t want to remember to take a pill every day or use contraception each time you have sex.
  • Nexplanon is not affected by vomiting or diarrhoea, but can be affected by some medicines.
  • Nexplanon will not protect you against sexually transmitted infections; you’ll still need to use condoms for this.
  • Nexplanon can disrupt your periods, causing irregular, lighter, heavier or longer bleeding. Women commonly find that their periods stop while on Nexplanon.
  • Other common side effects include feeling sick, acne and breast tenderness.

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Who can and can’t have the Nexplanon implant?

Most women can have the Nexplanon implant, including breastfeeding mothers and women who can’t take oestrogen-containing contraceptives. However, it may not be suitable for:

  • Women with abnormal vaginal bleeding that hasn’t been investigated by a doctor.
  • Women with breast cancer or a history of breast cancer. (But, your doctor may say you can use Nexplanon if you have been free of cancer for five years and you don’t want to use non-hormonal methods of contraception.)
  • Women with serious arterial disease, eg that has caused a stroke, angina or heart attack.
  • Women with severe liver cirrhosis or liver cancer.
  • Women with rare hereditary blood disorders called acute porphyrias.

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How and when is Nexplanon inserted?

Having the implant inserted is a minor procedure that can usually be done at your GP surgery or sexual health clinic, by a doctor or family planning nurse who has been trained in the procedure. It feels a bit like having an injection.

When you can have it inserted depends on personal circumstances, such as if you’re changing from another form of contraception, or if you’re having the implant after having a baby or following a miscarriage or abortion. Your doctor will advise. They’ll also advise on how soon you’ll be protected against pregnancy. For most women this will be as soon as the implant is inserted, but some women need to use an extra method of contraception such as condoms (or not have sex) for seven days after having it inserted.

The skin inside your upper arm will be numbed first with a local anaesthetic and the implant is then inserted under your skin. You won’t need to have any stitches – the skin will heal like it usually does after a cut. The area might feel a bit sore or bruised for a few days.

After your implant is inserted, your doctor or nurse should, together with you, feel for the implant in your arm. Get familiar with how it feels and check it regularly. If at any point you can’t feel the implant or it seems to have changed shape you should go back to your doctor. Use condoms until your doctor confirms that the implant is still protecting you.

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How and when is Nexplanon removed?

Nexplanon will provide contraception for three years if left in place, but you can have it removed at any time before that if you want. After the implant is removed you are no longer protected against pregnancy and your fertility will rapidly return.

The implant doesn’t dissolve in the body and shouldn’t be left in place any longer than three years. If you want to keep using Nexplanon you can have it removed and replaced with a new one in the same visit. You won’t need to use any extra contraception.

Before removal the skin is numbed with a local anaesthetic, a small cut is made in the skin and the implant is gently pulled out.

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What are the side effects of Nexplanon?

Medicines and their possible side effects can affect people in different ways. The following are some of the side effects that are may be associated with the Nexplanon implant. Just because a side effect is stated here doesn’t mean that all women having the implant will experience that or any side effect.

Very common side effects (affect more than 1 in 10 people)

  • Changes in your period, eg irregular, lighter, heavier or prolonged bleeding, or periods stopped altogether.
  • Breast tenderness or pain.
  • Acne.
  • Headache.
  • Vaginal infections.
  • Weight gain.

Common side effects (affect between 1 in 10 and 1 in 100 people)

  • Irritation, bruising, pain or itching at site of implant.
  • Fatigue.
  • Increased appetite.
  • Mood swings or feeling depressed.
  • Reduced sex drive.
  • Dizziness.
  • Hot flushes.
  • Feeling sick.
  • Stomach ache or wind (flatulence).
  • Hair loss.

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Rare side effects (affect between 1 in 1000 and 1 in 10,000 people)

  • Rise in blood pressure.
  • Scarring or abscess at site of implant.
  • On rare occasions the implant may move from the insertion site. You need to see your doctor if you can’t feel your implant, if it appears to have changed shape, or if you get any pain or skin changes around the site of the implant.

Women using all hormonal contraceptives appear to have a slightly increased risk of being diagnosed with breast cancer, compared with women who do not use these contraceptives. The risk is very small and goes back to normal with time after you stop using the contraceptive.

Talk to your doctor, nurse or pharmacist if you want any more information about the possible side effects of Nexplanon. If you think you have experienced a side effect, did you know you can report this using the yellow card website?

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Can I take other medicines while I’m on Nexplanon?

Before you have the Nexplanon implant inserted, make sure you tell your doctor or pharmacist if you’re already taking any other medicines, because some medicines can make it less effective at preventing pregnancy. For instance, if you regularly take any of the medicines below Nexplanon probably won’t work for you, so you’ll usually need to use a different form of contraception:

  • certain antiepileptic medicines, such as carbamazepine, oxcarbazepine, perampanel, phenobarbital, primidone, phenytoin or topiramate
  • some medicines for HIV, such as cobicistat, efavirenz, nevirapine or ritonavir
  • the antifungal griseofulvin
  • modafinil for narcolepsy
  • the antibiotics rifabutin or rifampicin for tuberculosis
  • the herbal remedy St John’s wort (Hypericum perforatum).

If you’re prescribed a short course (up to two months) of any of these medicines they will also make Nexplanon less effective. You’ll need to use an extra method of contraception (eg condoms) for as long as you take the extra medicine and for at least four weeks after stopping it.

The emergency contraceptive ulipristal (Ellaone) has the potential to make Nexplanon less effective. If you take Ellaone as an emergency contraceptive either just before having the implant, or while it is in place, you should use extra contraception such as condoms for 14 days after you take it.

While you’re using Nexplanon it’s a good idea to check with your doctor or pharmacist before you take any other new medicines.

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Womens health: Essential information and advice on matters affecting women

Last updated 04.10.2018

Helen Marshall, BPharm, MRPharmS Helen Marshall, BPharm, MRPharmS A UK registered pharmacist with a background in hospital pharmacy.

Contraceptive implant Implanon: Your experiences

Image copyright bbc Image caption The Department of Health says around 1.4 million women have used Implanon since 1999

Nearly 600 women have become pregnant despite using a popular contraceptive implant, a health watchdog has said.

There have also been more than 1,600 reports of adverse reactions to the Implanon device, which is designed to prevent pregnancy for three years. The NHS has been forced to pay compensation to several women because of the failures, Channel 4 News reported.

The implant maker, MSD, said no contraceptive was 100% effective.

BBC News website readers have been sharing their experiences with the contraceptive device:

Jennifer, County Durham

I had the implant put in December 2009. The pain was intense and the bruising covered my whole upper arm.

When I pointed this out to the professionals they told me this was perfectly normal and the bruising would go down in a few days. It took two weeks.

It felt too close to the surface of the skin and itched a lot so I finally decided I wasn’t going to be fobbed off anymore and wanted it to be reinserted. I had used it before in 2000, just after the device came out, and had absolutely no problems with it.

Before I got the chance to make the appointment I found out I was pregnant.

Every professional I spoke to kept telling me and convinced me that I must have been pregnant before it was put in and some were even quite defensive and abrupt.

I had just started a relationship which was the reason for getting the implant to begin with. I am now a very proud mother of a beautiful little girl and me and her dad are enjoying every minute.

We are lucky to have accepted this and seen the good that has come out of this but there are many that clearly haven’t. I think it is only right that compensation was paid out and don’t always listen to what you are told. You know your own body and if it doesn’t feel right persevere until you sort it. I would like to say I wish I had sooner but I may not have my little girl.

Kimberly, Devon

I was fitted with the Implanon back in August 2008 and fell pregnant with my daughter in early May, so it failed me after only seven months.

My periods had stopped after only two months of having it fitted so I had no idea I was pregnant until I was 31 weeks – it was a massive shock!

The doctors then tried to remove the implant but they couldn’t find it. I was sent for an ultrasound to try and locate it with no success.

To this day its still “floating” around in my body. I was told it wouldn’t do any harm to my daughter.

She is a very healthy one-year-old, but I did worry a lot at the time. Having only nine weeks to prepare for a baby I thought I couldn’t have was a big worry, let alone the added stress of wondering what the Implanon was doing to my body – and if it had effects on my unborn child.

It was worrying how little the doctors knew about people who had conceived on the Implanon.

Just crossing my fingers for the best was all I could do. I didn’t ask for compensation as I my main worry at the time was the baby.

Emily, Wiltshire

I became pregnant two months after the Implanon wasn’t inserted properly. I told the doctor I couldn’t feel it in my arm but the doctor said it was okay.

I believe this isn’t an effective form of contraception as human error is too high and it devastated me – I was about to go to university.

I was told I wouldn’t get periods, so didn’t realise I was pregnant until I got morning sickness.

I was panicky and couldn’t understand how I could be pregnant.

I successfully claimed compensation. I had an ultrasound and they found out it wasn’t in my arm at all, but it was a lengthy process as the procedure wasn’t properly documented.

And compensation may not be the case for everyone. Also, the issue is so much bigger than money and one of painful decisions that shouldn’t need to be made.

Gemma Byrne, Liverpool, Merseyside

I am an Implanon user and feel slightly cheated that I was expressly told that this device is 99.9% successful in preventing pregnancy.

However, there are certain requirements to a successful insertion and I feel my local student health care provider met those, such as insertion on the correct day and teaching me to make sure that the device is in and how to check it hasn’t moved around.

She made sure I had it fit correctly and then taught me how to find it – it took me around five minutes to find it and from there I knew where to look for it.

I know that this device is having an effect on my cycle and I am happy to continue using it.

In some ways I feel that these unfortunate women who resulted in unwanted pregnancies should have taken it upon themselves to find out all the facts prior to insertion.

I was expressly recommended to read up on the device and speak to other users.

I was also told that I had to have it on the first day of my cycle and continuing taking the contraceptive pill for some time.

This was to help me feel comfortable with what I was doing and to understand that I had a responsibility to make sure that the device was in fact there and having some effect.

Katherine, Surrey

I strongly feel that the success relies upon the doctors and nurses fitting it.

In my case, I had a fantastic doctor who checked the device was in my arm, and made me check too, bandaged me up so well that I had no scarring or bruising, and prepared me for what the implant would do to my body.

While women have become pregnant, I think the issue we should focus on here is that, firstly, they are difficult to put in so you need to check yourself if it has been inserted, and that in the first month or two of it being fitted, it is advised to use other non-hormonal contraception, such as condoms, while your body is adapting to the new hormones.

This is obviously not advised strongly enough and, until further research has continued and my own personal experience changes, I stand by that Implanon is an effective contraception.

Other comments:

I had one in following the birth of my second son. Worst mistake I’ve made! It was incredibly painful to get it in my arm, no one seemed to have a clue about them either besides one trained person at my surgery. I never lost the sensation of it being there in my arm and so every time I used the muscle (as when picking up my children) I could feel it there and it was very uncomfortable. After a year I was fed up and wanted to have it taken out but no one at my surgery was able to do it (I had moved to a new area) and I had to organise it somewhere else and travel to have it done. Surprisingly only one person here knew how to do it as well, so my appointment was turned into a training session for several nurses. The stitches were put on wrong amongst all the gossiping/”training” so the wound was painful and never healed properly and I have a scar. Besides a complete takeover of my hormones and a dramatic weight gain (which I’m afraid to say a lot of women expect from contraceptives in general anyway) the lack of training, awareness and experience that medical professionals have for this method was ridiculous. I will never use it again and have already recommended my girlfriends do the same. Jenny Knight

I have had the implant for seven years with no problems. How can someone not realise the implant is not in their arm? It’s like a large match stick under your skin! My GP made sure I could feel it and showed me the correct position for it. And as for damages money? Nothing is ever 100%. You wouldn’t sue a condom factory if one split. Too much of a compensation society. Katy Tyler, Brotton, North Yorkshire

My implant lasted a year then I began to have awful “spotting” periods and bleeding during and after intercourse. I had it removed and then heard that with people I knew it only lasted a year for them as well. I really don’t recommend it at all as removal and insertion can be quite traumatic. Vikki Pullen, Lincoln

I find it very difficult to believe that people didn’t realise it wasn’t in their arm, or for the doctor/nurse who inserted it, as I remember distinctively the doctor showing me where it was under my skin and suggested for me to feel it. I have had a few issues with the implant but these have been addressed by doctors I have seen and I am confident that it is one of the better forms of contraception on the market. Alex Theaker, Shillington, Herts

Although I did not fall pregnant, I did have the Implanon removed after a year of near constant periods. Ann Archer, Pencaitland, East Lothian

I had the implant put in and had a severe reaction, my arm became inflamed and itchy and sore. I now have a scar from the implant being inserted and removed. Also my doctors surgery effectively refused to take it out when I requested not only that but I was not happy with having it done in the first place I felt their tactics were forceful and unnecessary. They gave limited information with regards to possible side effects and talking me through the procedure. I was also told I was not allowed to stay on the pill I was on as it was dangerous but immediately after the implant was removed I was put back on the same pill! They have wasted my time and I have also had to take unpaid time off work as a result. Katy Lee, Bradford

I am now using my third Implanon device,the first having been inserted soon after the birth of my third child in December 2002. The only issue I have ever had was the removal of the second implant early in 2006 – it was in my arm at an odd angle and difficult for the doctor to retrieve. Twenty minutes and a small scar later and all was fine. I can feel the implant safely in my arm so I know it is there. I think it is a great thing! Joanne, Dartford, Kent

Explore Methods

It’s a very common story. A woman starts using hormonal birth control, finds herself gaining weight, and assumes the birth control is to blame. The tricky thing is that lots of research about hormonal birth control shows that, with one important exception, it’s probably not the birth control.

A note on personal experiences vs. the big picture

Before we lay out the evidence, we want to acknowledge the difference between looking at lots of women on average versus an individual woman. Research tells us about women on average, but not about specific women’s experiences. When we describe what happens for women on average, we are not dissing personal stories. (Bedsider has big love for personal stories!)

Here’s why the big picture is important: it sets our expectations. Being influenced by our expectations is a basic part of human nature. That’s why the placebo effect exists.

The big picture

Researchers have looked at whether hormonal birth control makes it more likely to get bloated or hungry. They’ve also looked at women’s weight changes over time when using specific birth control methods and compared them with women using methods with no hormones. With one exception, they’ve found no direct link between using hormonal birth control and gaining weight. Here are the details.

IUDs. There are two kinds of IUDs. One kind releases a low dose of progestin hormone (Mirena and Skyla) and the other kind has no hormones (ParaGard). Both kinds of IUDs mainly work inside the uterus, so there are minimal effects on the rest of the body. Studies show no difference in weight changes between women using hormonal IUDs and women using birth control without hormones.

The implant. The implant also releases a low dose of progestin hormone. Because the implant is relatively new, there are fewer studies about it. Early studies showed that about 5% of women using the implant got them removed due to concerns about weight gain. However, the weight changes don’t appear to be different between women using the implant and women using birth control without hormones.

The pill, the patch, and the ring. Birth control pills contain both an estrogen and progestin hormone, and are probably one of the most studied medicines on Earth. Many studies show that the pill does not cause weight gain, yet concern about weight gain is the main reason why women quit taking it. The ring and the patch are similar to the pill in terms of their ingredients and dose, so are not likely to cause weight gain, either.

That important exception

The shot. Most women don’t gain weight because of the shot, but some do. Interestingly, weight gain on the shot seems to be more common in young women who are already considered overweight. Additionally, the women prone to gaining weight because of the shot will usually notice a change within the first six months. If weight gain is absolutely not okay for you, the shot may not be the best choice.

The takeaway

Understanding all of the details that can affect weight—like diet, exercise, and genetics—can feel overwhelming. The tendency is for people to gain weight throughout their lives, so being a year older is more likely to cause weight gain than birth control. But like we said—this is on average and doesn’t take into account women’s personal experiences. If you think your birth control is affecting your weight in a way you don’t like, talk to your health care provider to find another effective method that works for you.

No matter what birth control you’re using, it’s important to get a daily cardiovascular workout. And no one says you have to leave the bedroom for that.

Jessica Morse is an ob/gyn at UNC where she works with residents providing a full spectrum of reproductive health care. Her main research interest is making sure women get the birth control they want, when they want it. She lives in Durham, NC, with her husband and silly 5-year-old son, where they spend weekends hiking, hanging out at playgrounds, and exploring the Bull City.

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