Birth control implant: What you should know before getting it inserted

When it comes to birth control, there’s no such thing as one size fits all. Something that might work perfectly for your friend might not be ideal for you. That’s why it’s so important to know your options. 

One method of contraception that’s worth considering is the birth control implant. Inserted under the skin in your upper arm, the birth control implant is the size of a matchstick and is incredibly effective. How effective, you might ask? There’s less than one pregnancy per 100 people who use the implant per year (around 0.05%). So essentially, you can think of it as over 99% effective in protecting you against unplanned pregnancy. 

Those statistics might have gotten you interested. So how does the birth control implant work, and (perhaps more importantly) does it hurt when you have it inserted in your arm? We’ve pulled together an expert guide with the help of Lee P. Shulman, a professor of obstetrics and gynecology in Illinois, US, to fill you in on everything you need to know … 

What is the birth control arm implant? 

First things first, if you’re reading this, you’ll likely be curious as to what the implant actually is. The birth control implant is a small, flexible plastic rod that looks a bit like a matchstick. It’s around 4 cm (1.57 inches) long and 2 mm (0.078 inches) thick — so tiny you could hold it in your palm. 

You might have heard your doctor refer to the implant as the “subdermal implant.” This is because it’s inserted under the skin in your upper arm —“sub” meaning “under” and “dermal” meaning “skin.”

Once in place, the implant continuously releases a synthetic (meaning made in a lab) version of the hormone progesterone, which your ovaries usually release each month after you ovulate. This hormone (called etonogestrel, for the fact fans out there) enters your bloodstream, thickens up your cervical mucus to keep sperm out,  and prevents your ovaries from releasing an egg during ovulation. You can read more on the ins and outs of how the implant works below. 

How long does the birth control implant last?

One of the main perks of the birth control implant is that it’s very effective and very easy to use. It’s approved to work for up to three years (but sometimes it lasts even longer), and as we now know, it’s more than 99% effective in preventing pregnancy.

Simply put, the birth control implant is a “get-it-and-forget-it” birth control option — like the IUD. It’s classed as a long-acting reversible contraceptive (or LARC), meaning that once you’ve had it placed, you don’t have to do anything else with it. If you feel it’s worked well for you when the time is up, you can get the old one removed and a new one placed at the same time. Super straightforward.  

Many people choose the implant for this reason. Stats published by the Centers for Disease Control and Prevention highlight that around 10.4% of the women they spoke to choose to have an implant or an IUD (coil). If you don’t want to have to think about your birth control regularly (like the daily pill, weekly patch, or monthly contraceptive ring), then a LARC could be a great fit. Similarly, you might have a very hectic routine, travel a lot, or just aren’t comfortable with having to remember to take contraceptives regularly. 

Saying that, if you feel like the implant isn’t right for you, for example, if you experienced any side effects from it that you find unmanageable (more on those later), you can always have it removed before its scheduled time is up. All you need to do is reach out to your doctor. But here’s an important heads up: Make sure you have a plan for which birth control method you’re going to switch to afterward, as your fertility can return very quickly.

Something else to keep at the front of your mind is that hormonal contraceptives don’t protect you from sexually transmitted infections. You’ll still want to use barrier protection, like a condom. 

How does the birth control arm implant work?

Many of us are used to taking tablets, so understanding how the contraceptive pill works can feel a little bit more straightforward. However, the birth control implant works in a very similar way. You just don’t need to remember to take it every day. 

As we’ve mentioned, it contains progestin, a synthetic (or artificial) version of the sex hormone progesterone. Progestin has two main jobs: 

• It thickens your cervical mucus, making it much harder for the sperm to wriggle up and fertilize your egg.
• It stops you from ovulating, which means your ovaries won’t prepare or release another egg, and you can’t get pregnant. 

Where can I get the birth control implant?

As with any new birth control method, if you’re interested in the implant, the best thing to do is reach out to your health care provider. They will be able to walk you through what the implant is in even more detail. 

At your appointment, your health care provider might ask you about your general health, any other birth control methods you’ve used, and why you think the implant could be a good choice for you. They will also ask you about any medication you’re currently taking. This might feel irrelevant, but it’s important because some medications can make the implant less effective. They include (among others):

• Some medications that are used to treat migraines or seizures
• Some antifungal medications
• Some medicines to treat or prevent tuberculosis
• Some HIV treatments

This isn’t an exhaustive list, so to ensure you’re getting the most out of your birth control implant, make sure your doctor knows all the medication that you’re taking. Oh, and don’t worry about preparing before your appointment. You don’t need to be a birth control implant expert. Your health care provider will be able to answer any of your questions. 

How is the birth control implant placed? 

It might sound a little bit daunting, but the procedure of having your implant placed is very quick. It’s like getting a shot. Here’s what generally happens:

• Your health care provider will ask you to lie on your back, bend your arm at the elbow, and they’ll point out where they’re going to insert the implant. This will be just below the groove you can feel in between your bicep and tricep muscles on your inner upper arm. It’s usually placed in your nondominant arm. So if you’re a leftie, it usually goes in the right arm and vice versa. 
• Then they’ll numb the area with a local anesthetic. This will feel like a little bit of a sharp scratch but will stop the rest of the procedure from feeling too painful. 
• The implant will then be inserted into your arm with an applicator that looks a little bit like a needle.

Your health care provider will usually recommend that you wear a bandage over your implant for the first 24 hours, and they’ll give you any other aftercare instructions you need to know about. Then you’re good to go. 

How painful is the birth control implant?

“How painful is the birth control implant?” is one of the most asked questions about the implant. And that’s not particularly surprising, considering nobody likes the idea of pain. So, how does it feel when you have an implant placed? The short answer is everyone’s pain tolerance is different, so you might feel a little bit more uncomfortable than a friend. However, the anesthetic should help so it won’t be severely painful. 

“I have never had anybody, in the course of inserting the implant, experience any kind of severe pain,” says Shulman. “It’s a little uncomfortable, but that’s it.”

The area where your implant has been inserted might be a little sore for a couple of days, but nothing that could potentially outweigh the benefits of having it in, says Shulman. 

How to remove the birth control implant

When it comes time to have your birth control implant removed, you’ll need to see your health care provider again. “It’s very easy to take out,” says Shulman.

Removing the birth control implant is quick and straightforward, and the procedure takes around 5 minutes from start to finish. Again, they’ll numb the area with an anesthetic before making a small cut and gently pulling the implant out of your arm. 

You might be curious as to whether you can still get pregnant with an implant and how quickly you’ll be able to get pregnant once it’s removed. While it’s extremely unlikely that you’ll get pregnant while you have a birth control implant in, it stops working as soon as it’s removed. That means there’s a possibility you could get pregnant right away. So if you aren’t planning on having a baby, you should consider switching to another type of birth control. Your health care provider will be able to talk to you about this at your removal appointment. 

When should you have a birth control implant placed?

One of the pro points of the implant is that you can have it placed at any point during your cycle. There’s no perfect time. 

However, it might be helpful to track your cycle (you can do this using an app like Flo) and plan your insertion during the first five days of it. If you do this, you’ll be protected against unplanned pregnancy immediately from the day you get your implant placed. 

If you have your implant inserted at any other time in your cycle, you’ll need to use another form of protection for seven days to make sure it has enough time to start working. You could use barrier protection (such as condoms), for example. 

And, of course, you want to make sure there’s no way you could be in the very early stages of pregnancy at the time the implant is placed. For this reason, it’s best to make sure you don’t have unprotected sex for at least two weeks prior to having the implant placed. It’s also wise to do a pregnancy test just before your appointment.

You can have an implant placed at pretty much any point in your life. If you’ve just given birth, then the implant is a safe form of contraception to use while you’re breastfeeding. If you have it placed within 21 days of giving birth, you’ll be protected from unplanned pregnancy immediately. 

Similarly, if you don’t want to have a baby right now but want a birth control method that you don’t need to think about too much, it could be a great option for you. 

How much does a birth control implant cost?

Another factor you might consider when deciding if the birth control implant is right for you is how much it costs. This is a question that’s a little bit trickier to answer, as it can differ depending on where you live. 

If you’re in the UK, the implant is free through the National Health Service. If you live in the US, most insurance programs will cover the implant as well as other forms of contraception. Wherever you are in the world, the best thing to do if you’re curious about how much an implant might cost is to check with your insurance or speak to your doctor. 

What are the side effects of the birth control implant? 

If you were to draw up a list of advantages for the birth control implant, it’d be pretty long. It’s very effective, convenient, and doesn’t contain estrogen. That can be helpful because some people can’t use estrogen due to medical problems or risk factors, while others find that hormonal birth control containing estrogen causes nausea for them. 

`However, like any medication, you might also experience some side effects linked to the birth control implant. These can include: 

• Changes to your monthly bleeding. As the implant puts a pause on ovulation, it can impact your menstrual cycle and bleeding. This might mean your periods stop altogether (this is totally safe and is seen by some people as a bonus). Alternatively, you might experience light and infrequent spotting or bleeding, or you might have heavier, irregular bleeding. Some people find that their period becomes more regular again after they’ve used the implant for about two years. Don’t worry if this happens to you — it’s still very effective in preventing pregnancy.
• Headaches 
• Changes in your mood
• Sore boobs
• A lower sex drive 

If you’re worried about the side effects associated with the birth control implant before you decide to have it inserted, don’t be afraid to speak to your doctor. They’ll be able to outline why some of these changes might happen and how long side effects can last. 

If you’ve had the implant placed and you’re experiencing side effects that are really impacting your way of life, then reach out to your health care provider for support. They should be able to talk through your symptoms. If the implant isn’t working for you, they’ll be able to explain your other options to you. 

Birth control implant: The takeaway

Schulman says “the best way to describe” the birth control implant is “highly effective, safe, and reversible.” A pretty glowing review.

The tiny, flexible rod is inserted into your arm for up to three years. Many people choose the implant because you don’t have to think about it, and it’s really effective (over 99% effective, remember.) 

As always, it’s really important to remember that you have lots of birth control options, and you don’t have to stick with the same one for your entire life. 

“What may be the best method for your sister or your girlfriend or your daughter or your mother does not necessarily mean that method is best for you,” says Shulman. Talk to your doctor and walk through your options so you can make the best choice for you.