Why Don't More Women Use the Birth Control Implant?

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This image shows just how small the implant is within the "inserter," used to place it in the arm.

The intrauterine device (IUD) has been getting more and more attention over the years. After all, it is one of the most effective forms of birth control available and, depending on which one you get, can last more than a decade. But the IUD isn’t the only form of long-acting reversible birth control on the block. In fact, it’s not even the most effective.

We’re talking about the birth control implant: a matchstick-sized flexible rod that sits under the skin of the upper arm. It releases the hormone progestin into the body and protects against pregnancy for three years.

How the Implant is Inserted

Whereas the IUD is placed in the uterus, the implant goes in the arm, which means it can be inserted without having a pelvic exam.

“It’s inserted similarly to when you get a shot. It’s kind of like an injection—there’s a needle that helps place it just underneath the skin,” Kristyn Brandi, M.D., F.A.C.O.G., a family planning specialist at Boston University and Boston Medical Center, told HealthCentral in a phone interview.

Before the insertion, medicine is applied to the arm to numb the area. Compared with inserting an IUD, which can be an uncomfortable experience for some women, the insertion of the implant ends up being painless when the numbing medication is used, Dr. Brandi said.

Like the IUD, the implant can be removed at any time. Removal is a similar process to insertion.

“In the area where [the implant] was inserted, you’ll get the same numbing medicine,” Dr. Brandi said. “We make a small incision—less than a millimeter—and then put gentle pressure on the implant and it slides out.”

Amanda Guiliano, 27, said she felt no pain when she got her implant inserted at her doctor’s office in Arlington, Virginia.

 “I was a little nervous, but since it was going in my arm, I felt a lot more comfortable than knowing that [an IUD] would be going up my cervix,” she said. “I was numbed in advance, then there was some pressure and a little stapler-like sound when it went in, but I didn’t really experience any pain, and there were no sutures.”

Amanda had a full upper arm bandage after the insertion, she said, and her arm was noticeably bruised for several days afterward—but the insertion itself was pain-free.

Overshadowed by the IUD?

According to data from the 2011-2013 National Survey of Family Growth on birth control use among women aged 15-44 in the U.S., the most popular nonpermanent form of birth control was the birth control pill: 16 percent of women used it. Long-acting reversible methods, which include the IUD and implant, trailed behind, garnering 7.2 percent of users in the survey. However, the majority of this percentage is attributed to users of the IUD (6.4 percent). Implant users only accounted for 0.8 percent.

Further, while IUD use increased among birth control users from 2009 to 2012, implant use did not change significantly, remaining low.

While both the IUD and implant are more than 99 percent effective at preventing pregnancy, the implant is actually slightly more effective than the IUD. So why is the IUD so much more popular than the implant?

“I think it depends on [the patient’s] counseling, it depends on what they’re looking for in birth control, and it also may be popularity—that not many people know about the implant,” Dr. Brandi said.

Amanda didn’t know anyone else with an implant when she got hers in November 2015.

“A lot of my friends are pretty old school when it comes to birth control,” she said.

Amanda had been on the pill, but decided to get a long-acting reversible method of birth control because she wanted a method she didn’t have to think about. It was the potential negative complications of the IUD that eventually swayed Amanda to get the implant instead.

“Even though [complications with the IUD] are very rare, I knew I was going to be anxious about it, so I wanted to prevent the anxiety by getting something that wouldn’t have the possibility of perforating anything,” she said.

It’s possible for the IUD to perforate the wall of the uterus during insertion, but it occurs in just 1 out of every 1,000 insertions. Like most birth control methods, the IUD has potential risks and side effects in addition to its benefits. Problems can occur during insertion or removal of the implant as well, but they occur less than 2 percent of the time.

While the implant is not as popular as the IUD overall, Dr. Brandi said, she personally has placed more implants than IUDs—although that may just be her patient population, she said.

“I see a lot of young patients, people that may or may not have had a pelvic exam or are kind of nervous about the placement of an IUD, so implants are a great option for them,” she said.

In fact, Dr. Brandi says, some of the best candidates for the birth control implant may be younger women and teenagers who want to be protected against pregnancy for a longer period of time but don’t necessarily want to go through an IUD insertion.

Other Side Effects of the Implant

Another thing to consider when deciding whether to get an implant is whether you care about your menstrual cycle changing.

“Some people choose different birth controls because it either regulates their cycle or eliminates their menses,” Dr. Brandi said. “With the implant, it’s not really clear what type of bleeding pattern you’ll have.”

Unpredictable bleeding is the main side effect of the implant. When explaining the different ways in which the implant could affect the menstrual cycle, Dr. Brandi breaks it down into thirds for her patients.

“A third of women will have lighter periods than what they had initially, a third of women will have the same period [they had before], and a third of women will have irregular bleeding throughout their menses, meaning that they won’t have a set period but will have intermittent spotting throughout the month,” she said.

Amanda is one of the implant users who experiences some unexpected spotting at times, she said, but she likes that she hasn’t had a regular period in almost a year.

Another tipping point for some patients may be the fact that the implant can be felt in the arm — but it cannot be seen, Dr. Brandi said, nor does it impact your ability to do sports or other physical activities.

“Some patients are a little nervous about [being able to feel it], particularly people that want to hide their birth control,” she said. “However, other people really like it because they’re able to feel it [...] and know that you’re protected because you feel it right there.”

Amanda said she usually forgets her implant is even there.

“Sometimes if I rub my arm I can feel it, but I would call it invisible,” she said. “I don’t think anyone would notice it.”

With all of the media hype surrounding the IUD, it may be easy to overlook the implant as an option. But as another highly effective birth control method that lasts for years, the implant may be a worthy contender for those looking into long-acting methods.

“Like what my OB-GYN told me, if you are going to be anxious about the insertion of the IUD or just having the IUD, this is a less anxiety-inducing option,” Amanda said. “Pretty painless insertion, pretty much no possible complications. I wish it would get more attention because I think it would be a good fit for a lot of people.”