When to Start
Important: a woman can start using implants any time she wants if it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist .
| Woman’s situation |
When to start |
Having menstrual
cycles or
switching from
a nonhormonal
method |
Any time of the month
- If she is starting within 7 days after the start of her monthly bleeding (5 days for Implanon), no need for a backup method. Backup methods include abstinence, male and female condoms, spermicides, and
withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive
methods. If possible, give her condoms.
- If it is more than 7 days after the start of her monthly bleeding (more than 5 days for Implanon), she can have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after insertion.
- If she is switching from an IUD, she can have implants inserted immediately (see Copper- Bearing IUD, Switching From an IUD to Another Method)
|
Switching from
a hormonal
method |
- Immediately, if she has been using the hormonal method consistently and correctly or if it is otherwise reasonably certain she is not pregnant. No need to wait for her next monthly bleeding. No need for a backup method.
- If she is switching from injectables, she can have implants inserted when the repeat injection would have been given. No need for a backup method.
|
| Woman’s situation |
When to start |
Fully or nearly fully
breastfeeding
Less than 6 months
after giving birth |
- If she gave birth less than 6 weeks ago, delay insertion until at least 6 weeks after giving
birth.
- If her monthly bleeding has not returned, she can have implants inserted any time between
6 weeks and 6 months. No need for a backup method.
- If her monthly bleeding has returned, she can have implants inserted as advised for women
having menstrual cycles (see above). |
More than 6 months
after giving birth |
If her monthly bleeding has not returned, she can have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion.
If her monthly bleeding has returned, she can have implants inserted as advised for women
having menstrual cycles (see above). |
Partially breastfeeding
Less than 6 weeks
after giving birth |
Delay inserting implants until at least 6 weeks after giving birth. |
More than 6 weeks
after giving birth |
- If her monthly bleeding has not returned, she can have implants inserted any time it is reasonably certain she is not pregnant. Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to
obtain contraception limited, some providers and programs may insert implants at the 6-week
visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not
yet returned. She will need a backup method for the first 7 days after insertion.
- If her monthly bleeding has returned, she can have implants inserted as advised for women
having menstrual cycles (see above). |
| Woman’s situation |
When to start |
Not breastfeeding
(continued)
More than 4 weeks
after giving birth |
- If her monthly bleeding has not returned, she can have implants inserted any time it is reasonably certain she is not pregnant. Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to obtain contraception limited, some providers and programs may insert implants at the 6-week visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not yet returned. She will need a backup method for the first 7 days after insertion.
- If her monthly bleeding has returned, she can have implants inserted as advised for women
having menstrual cycles (see above). |
No monthly
bleeding (not related to childbirth or
breastfeeding) |
She can have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion. |
After
miscarriage or
abortion |
- Immediately. If implants are inserted within 7 days after first- or second-trimester
miscarriage or abortion, no need for a backup method.
- If it is more than 7 days after first- or second-trimester miscarriage or abortion, she can have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion.
|
After taking
emergency
contraceptive
pills (ECPs) |
Implants can be inserted within 7 days after the start of her next monthly bleeding (within 5 days for Implanon) or any other time it is reasonably certain she is not pregnant. Give her a backup method, or oral contraceptives to start the day after she finishes taking the
ECPs, to use until the implants are inserted. |
Giving Advice on Side Effects
Important: thorough counselling about bleeding changes and other side effects must come before inserting implants. Counseling about bleeding changes may be the most important help a woman needs to keep using the method.
Describe the most common side effects
Changes in her bleeding pattern:
− Irregular bleeding that lasts more than 8 days at a time over the first year.
− Regular, infrequent, or no bleeding at all later.
Headaches, abdominal pain, breast tenderness, and possibly other side effects.
Explain about these side effects
-
Side effects are not signs of illness.
-
Most side effects usually become less or stop within the first year.
-
Common, but some women do not have them.
-
Client can come back for help if side effects bother her.
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