Implanon (Norplant)

   

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    Implanon is a single-rod contraceptive implant (40 mm by 2 mm), which contains 68 mg of etonogestrel (ENG) dispersed in a membrane of ethylene vinyl acetate. Implanon delivers ENG at a dose sufficient to suppress ovulation in every cycle throughout the 3 years of use.

     

    Benefits                                                                                                                                                                

             Very effective, even in overweight women.

             Long-term pregnancy protection, but reversible. A single decision can lead to

             very effective contraception for up to 37 years.

              No need to do anything at the time of sexual intercourse.

              Increased sexual enjoyment because no need to worry about pregnancy.

              One-time activity.                                                                                          

              Effective within 24 hours after insertion.

              Fertility returns almost immediately after implants are removed.

              They do not affect the quantity and quality of breast milk.

              No estrogen side effects.

              Help prevent iron deficiency anemia.

              Help prevent ectopic pregnancies.

              May help prevent endometrial cancer.

              May make sickle cell crises less frequent and less painful.

              May reduce the risk of PID.

     

    Limitations

             The client cannot start or stop use on her own. Capsules must be inserted and

             removed by a specially trained health care provider.

             Minor surgical procedures are required to insert and remove capsules. Some

             women may not want anything inserted in their arms or may be bothered

             that implants may be seen or felt under the skin.

             Discomfort for several hours to 1 day after insertion for some women.

             Removal is sometimes painful and often more difficult than insertion.

             In very rare instances when pregnancy occurs, as many as one in every six

             pregnancies is ectopic.

             Do not protect against sexually transmitted infection (STIs), including HIV/

             AIDS.

     

    Sides effects & management

    Most women using implants have some changes in their menstrual pattern such as spotting or irregular bleeding in between periods. Some may have scanty menses or amenorrhoea after about a year of use. Assure the client that these menstrual changes will not harm her and will settle in a few months.

     

    Sides effects

    Management

    Pain in the arm for 12 days

    Reassure client.

    Give her tab paracetamol.

    Pain continues after 23 days with swelling of the insertion site

    Give her appropriate antibiotic and

    analgesic and follow her.

    Menstrual changes:

          spotting/slight bleeding between period

    Reassure the client that it will be resolved on its own.

    advise ibuprofen up to 800 mg (max) or ponstan 500 mg three times daily after meal for 5 days.

    Give iron tab 1x3 for 1 month, or

    Give COC pills 1 daily for 21 days.

    If this does not help, provide:

              − 50 mcg of ethinyl estradiol daily for 21 days.

    If bleeding continues to be heavy and the client is worried, remove the implants.

    Amenorrhoea after scanty menses

    Reassure the client that it will not harm her (as it does not harm her when she is pregnant).

    Amenorrhoea after regular cycles

    Do a pregnancy test.

    If not pregnant, reassure the client.

    If pregnant, remove the implants.

    Rare side effects

     

    Weight gain less than 2 kg in 3 months

     

    Reassure the client.

    ask her to reduce food intake, especially fats and sweets.

     

    Weight gain more than 2 kg in 3 months

    Watch her weight for another 23 months on a reduced diet.

    If client continues to gain weight 

    Remove the implants.

    Depression or other mood changes

    Refer client to a doctor.

    Infection at the insertion site (pain,

    heat, and redness) but no abscess

    Do not remove the implants.

    Clean the infected area with soap and water or antiseptic.

    Give an oral antibiotic for 7 days and

    ask the client to return in 1 week. If

    still not better, remove the implants

    or refer for removal.

    Infection with abscess 

    If significant skin infection is involved,

    give oral antibiotic for 7 days.

    prepare the infected area with

    antiseptic, make an incision, and

    drain the pus.

    Remove the implants or refer for

    removal.

    treat the wound.

     

     

     

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