Among the contraceptive methods available in Canada, the subcutaneous contraceptive implant - marketed under the brand name Nexplanon - represents one of the most effective and discreet options. With a failure rate of less than 0.1 % over three years - i.e., an efficacy of over 99 % - it surpasses even the daily contraceptive pill, whose theoretical efficacy deteriorates significantly in everyday use due to forgetfulness. Yet the implant remains under-utilized in Quebec, partly due to a lack of information and sometimes lengthy access times in the public network.
Clinique Omicron offers insertion and removal of the Nexplanon contraceptive implant in several of its Quebec branches, with access times significantly shorter than those observed in the public network. This guide tells you everything you need to know about this implant - its mechanism of action, patient profiles, insertion procedure, expected effects on menstruation, and removal procedures - so you can make an informed contraceptive decision with your healthcare professional.
What is Nexplanon and how does it work?
Nexplanon is a small subcutaneous contraceptive implant - around 4 centimeters long and 2 millimeters in diameter - containing 68 mg etonogestrel, a third-generation progestin. The implant is inserted under the skin of the inner side of the non-dominant arm, usually around 8 to 10 centimetres from the elbow crease, using a dedicated applicator during an outpatient procedure lasting just a few minutes and performed under local anaesthetic. Once in place, it releases a low dose of etonogestrel continuously and progressively over a three-year period.
The main contraceptive mechanism is the inhibition of ovulation - etonogestrel blocks the secretion of LH by the pituitary gland, thus preventing the release of the ovum. This action is complemented by two side-effects that reinforce its efficacy: thickening of the cervical mucus, which constitutes a physical barrier to spermatozoa, and modification of the uterine endometrium, making it less conducive to possible implantation. The combination of these three mechanisms explains the method's exceptional efficacy. Unlike estrogen-containing combined oral contraceptives, Nexplanon is purely progestin-only - an advantage for women with contraindications to estrogen.
Who can benefit from the Nexplanon implant?
Nexplanon is suitable for most women of childbearing age who want reliable, discreet, long-term contraception without daily constraints. It is particularly suitable for women who frequently forget to take the pill, those who wish to space their pregnancies over several years without actively thinking about it, teenagers - it is approved for pubescent teenagers -, post-partum women - including those who are breast-feeding, as it is purely progestin-only and does not affect lactation -, and women with contraindications to estrogens - migraines with aura, thromboembolic history, smoking after age 35, uncontrolled hypertension.
Contraindications to Nexplanon are relatively few. They include malignant liver tumors and severe liver disease, undiagnosed vaginal bleeding, known or suspected pregnancy, and known hypersensitivity to any of the components. A history of breast cancer or hormone-dependent tumors is assessed on an individual basis, depending on the context and the length of treatment. A medical consultation prior to implantation ensures that there are no contraindications and that the implant is the most appropriate method for the patient's individual situation.
Installation procedure: quick, ambulatory, painless
Nexplanon insertion is an outpatient procedure that takes just a few minutes. The patient lies down, with the non-dominant arm slightly flexed and in external rotation. After disinfecting the insertion zone, a small amount of local anesthetic - lidocaine - is injected under the skin to numb the area. The implant is then inserted using the dedicated single-use applicator supplied with Nexplanon, which deposits the implant in the correct subcutaneous position without the need for incisions or stitches.
The entire procedure generally takes five to ten minutes. The only uncomfortable sensation is a slight pain when the local anesthetic is injected - the insertion itself is painless. A compression bandage is applied to the insertion area and maintained for 24 hours. Local bruising and slight swelling are common in the first few days and resolve spontaneously. The implant is palpable under the skin, but invisible. It is advisable to check its presence by palpation after insertion and at regular intervals. Contraception is effective immediately if the implant is inserted within the first five days of the menstrual cycle, or after seven days in other situations.
Effects on menstruation: what to expect
Altered bleeding patterns are the most frequently reported side effect of the Nexplanon implant, and the main reason for early withdrawal. It is important to inform patients of this before insertion to avoid premature discontinuation of an otherwise highly effective method. Around a third of users develop amenorrhea - absence of menstruation - with Nexplanon, which is medically harmless and often perceived as an advantage after the initial adaptation phase. Another third experience irregular but light bleeding. The final third maintain a relatively predictable bleeding pattern.
Prolonged or frequent bleeding - defined as more than five bleeding episodes over 90 days - affects around 17 % of users and represents the main difficulty in accepting the method. These cycle disturbances are usually more marked in the first few months of use, and tend to stabilize over time. Occasional medical treatments - non-steroidal anti-inflammatory drugs, short courses of estrogen under certain conditions - may be suggested in the event of persistent, troublesome bleeding. A medical check-up is indicated if bleeding is very abundant or accompanied by significant pain, to rule out another cause.
Frequently asked questions about the Nexplanon contraceptive implant
Is the Nexplanon implant covered by RAMQ or insurance?
In Quebec, Nexplanon is included in the RAMQ's list of drugs covered by the general drug insurance plan - people insured by the public plan are therefore covered for the cost of the implant itself, subject to the usual deductible and co-insurance. The medical procedure of insertion and removal is covered by RAMQ when performed by a participating physician. Private group insurance plans generally cover Nexplanon as part of their drug coverage. It is advisable to check the specific terms of your plan before your consultation to avoid billing surprises.
Can I get pregnant quickly after implant removal?
Yes, the return to fertility after Nexplanon removal is rapid - in the majority of cases, ovulation resumes within three to six weeks of implant removal. Recovered fertility is comparable to that of a woman who has never used this method. Contrary to popular belief, there is no recommended waiting period before seeking pregnancy after removal. If contraception is still desired after withdrawal, it should be initiated immediately to avoid an unplanned pregnancy during the fertility recovery period.
Can the implant move or migrate within the body?
Cases of implant migration have been reported in the medical literature - the implant may sometimes move slightly from its initial insertion site. In rare cases, migration to deeper structures in the arm has been documented, requiring a more complex removal procedure guided by imaging - ultrasound or CT scan. To minimize this risk, placement should be carried out by a healthcare professional trained in the correct insertion technique for Nexplanon, who ensures proper superficial subcutaneous positioning and verifies the correct location of the implant immediately after placement. Regular palpation of the implant by the patient herself enables early detection of any unusual displacement.
How does the Nexplanon removal work and is it painful?
Nexplanon removal is also performed as an outpatient procedure under local anaesthetic. After disinfection and injection of lidocaine at the implant site, a small incision of a few millimeters is made in the skin, and the implant is extracted using fine forceps. The wound is closed with a steristrip or a small adhesive dressing - rarely with a stitch. If there are no complications, the procedure takes around ten minutes. If a new implant is desired immediately after removal, it can be inserted during the same consultation via the same incision or via a new, slightly different site, for an uninterrupted contraceptive transition.
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