Ask the client the questions below about known medical conditions. Examinations and tests are not necessary. If she answers “no” to all of the questions, then she can have implants inserted if she wants. If she answers “yes” to a question, follow the instructions. In some cases she can still start using implants.
1. Are you breastfeeding a baby less than 6 weeks old?
No
Yes - She can start using implants as soon as 6 weeks after childbirth (see Fully or nearly fully breastfeeding or Partially breastfeeding).
2. Do you have severe cirrhosis of the liver, a liver infection, or liver tumor? (Are her eyes or skin unusually yellow? [signs of jaundice])
No
Yes - If she reports serious active liver disease (jaundice, active hepatitis, severe cirrhosis, liver tumor), do not provide implants. Help her choose a method without hormones.
3. Do you have a serious problem now with a blood clot in your legs or lungs?
No
Yes - If she reports a current blood clot (not superficial clots), do not provide implants. Help her choose a method without hormones.
4. Do you have vaginal bleeding that is unusual for you?
No
Yes - If she has unexplained vaginal bleeding that suggests pregnancy or an underlying medical condition, implants could make diagnosis and monitoring of any treatment more difficult. Help her choose a method to use while being evaluated and treated (not progestin-only injectables, or a copper-bearing or hormonal IUD). After treatment, re-evaluate for use of implants.
5. Are you taking medication for seizures? Are you taking rifampicin for tuberculosis or other illness?
No
Yes - If she is taking barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, or rifampicin, do not provide implants. They can make implants less effective. Help her choose another method but not combined oral contraceptives or progestin-only pills.
6. Do you have or have you ever had breast cancer?
No
Yes - Do not provide implants. Help her choose a method without hormones.
Be sure to explain the health benefits and risks and the side effects of the method that the client will use. Also, point out any conditions that would make the method inadvisable, when relevant to the client.
Using Clinical Judgment in Special Cases
Usually, a woman with any of the conditions listed below should not use implants. In special circumstances, however, when other, more appropriate methods are not available or acceptable to her, a qualified provider who can carefully assess a specific woman’s condition and situation may decide that she can use implants. The provider needs to consider the severity of her condition and, for most conditions, whether she will have access to follow-up.
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Breastfeeding and less than 6 weeks since giving birth
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Current blood clot in deep veins of legs or lungs
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Unexplained vaginal bleeding before evaluation for possible serious underlying condition
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Had breast cancer more than 5 years ago, and it has not returned
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Severe liver disease, infection, or tumor
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Taking barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, or rifampicin. A backup method should also be used because these drugs reduce the effectiveness of implants.
Implants for Women With HIV
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Women who are infected with
HIV, have
AIDS, or are on antiretroviral (ARV) therapy can safely use implants.
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Urge these women to use condoms along with implants. Used consistently and correctly, condoms help prevent transmission of
HIV and other STIs. Condoms also provide extra contraceptive protection for women on ARV therapy. It is not certain whether ARV medications reduce the effectiveness of implants.
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