Aunt Vadge: I got Implanon, and now I’m feeling crappy

Hey Aunt Vadge,

I decided to get the Implanon contraception about 4 or 5 months ago and had been getting about 2 periods a month and a lot of spotting in between since then as my body got used to it being there.

It’s started to settle down now and I think that means my body’s getting used to the implant. Annoyingly, in the last week I’ve been feeling quite down and I’m not interested in sex with my partner as much as I was previously.

I’m worried that the Implanon is the reason I’ve been feeling sad and less interested, but honestly, I don’t want to go through the trouble of finding another contraception option.

Is it likely that the implant is the cause of these feelings or is it me? Will it settle down or is this what I’ll feel like until I get it removed? Is there any way for me to improve my mood without getting it removed?

Thanks,
Concerned
Age: 17
Country: Australia

_____

Dear Concerned,

The Implanon contraceptive implant is a type of contraception that secretes a small amount of one specific type of synthetic hormone (progestin) into your bloodstream over a three-year period.

Progestin acts like your natural progesterone in your body, but it’s synthetic, which means the molecule is slightly different to natural progesterone.

The role of progesterone

Progesterone is produced in the second half of your menstrual cycle, after ovulation, and is the hormone that keeps the foetus fed and clothed until it can set up its own blood supply in the uterus.

So, progesterone production ramps up after you ovulate, in case you get pregnant. Then, when your body realises you are not pregnant, all your hormones drop off and you get your period.

Having a dose of progestin in your blood all the time prevents ovulation, since your body already ‘thinks’ its pregnant, in a sense. You are put into a state of temporary infertility, like what happens between when you would normally ovulate and when you would get your next period (the one to two weeks before your period).

Implanon works in this way by suppressing ovulation, since none of the normal cycles are able to fulfill themselves to release an egg. It also thickens the mucous in your cervix, which is what normally happens when you’re pregnant (the ‘plug’), physically blocking sperm entry.

Progestin also causes changes to the endometrial lining, which is your ‘period’, or the cause of spotting or bleeding on the implant. This bleeding is called breakthrough bleeding.

How the implant affects you

This is how Implanon protects you from pregnancy, but there are secondary effects that this artificial state causes in your body. This is also why you get spotting/irregular bleeding patterns, since your normal cycles that build and dump your endometrial lining are not occurring.

Implanon is not for everyone, and mood changes and other unpleasant side-effects do occur. Some women find it absolutely fine and love it, while others turn into a monster!

Because you are 17, and your normal menstrual cycles are important for your body to grow properly, it may be worth talking to your doctor about alternatives.

I know it’s annoying – you just want to not get pregnant – but there are more important considerations, like do you feel ok? There are lots of reasons why you may have mood changes, but it is smart to consider the implant as one of them.

Feeling crappy and not wanting to have sex do have many causes, and because it’s only been a week, I’d probably keep going and see how you go. If the sad feelings and low libido continue, then it might be wise to consider taking the implant out and seeing if it improves things.

You don’t want to go on too long feeling bad, if the solution is a quick doctor’s visit away. But, you also need to think about contraception, since getting up the duff is not a great alternative.

We tend to think that contraception is our lifesaver and we’ll be just fine, but for many women, hormonal contraception just doesn’t work well at all. There is a percentage of women who don’t relate their mood, weight or other changes to their hormonal contraception, and therefore miss out on feeling great.

The hormones in the implant are out of your body quickly once it’s out, so if the implant was inexpensive for you in Australia on Medicare, then you could do a little experiment getting it out (in a few weeks if your symptoms don’t improve) and then getting another one put in later if you want.

Research into side-effects of Implanon

Two studies have looked at the tolerability of the contraceptive implant, and you are certainly not alone in your experience according to these studies. I’ve highlighted the side-effects you talked about.

Study #1:

Eighty women were followed after Implanon implantation to see what side-effects they experienced

1. Twenty women had the Implanon removed prematurely due to side-effects or family planning reasons
2. Loss of periods (41 per cent)
3. Spotting (24 per cent)
4. Frequent bleeding (17 per cent)
5. Breast tenderness (19 per cent)
6. Acne (10 per cent)
7. Headache and dizziness (4 per cent)
8. Depressive mood disorders, pelvic pain, loss of libido (2.5 per cent)

Study #2:

Over 1,000 women women in Switzerland with the implant were studied

1. Implanon was removed prematurely in 24 per cent of the women in the study due to side effects (20 per cent) or family planning reasons (4 per cent)
2. Bleeding disturbances (45 per cent)
3. Infrequent bleeding (28 per cent)
4. Periods stopped (33 per cent)
5. Prolonged bleeding (15 per cent)
6. Frequent and heavy bleeding (16 per cent)
7. Acne (12 per cent)
8. Dizziness (12 per cent)
9. Mood swings (8 per cent)
10. Headache (5 per cent)

Consider the pill

You’ll need to think of contraception in the meantime, with the pill another option that includes oestrogen as well as progestin. Each brand of hormonal contraceptive uses a slightly different molecule, for patenting reasons, which means another type of hormonal contraception may work very well for you instead of the implant.

A type that contains more than just one hormone, so your body is less starved of a vaguely normal hormonal profile. The pill is not a drama if you just remember to take it each day, which becomes a habit rather than a hindrance.

It might pay to avoid the injection for now, as it works in the same way as the implant, but you can’t undo the injection – you’re stuck with it for three months!

Considering the future

A healthy menstrual cycle has many beneficial effects on how your body works – your reproductive system is not isolated, and functions in concert with every other part of you. This means that the ultimate goal besides not getting pregnant should be to have a healthy menstrual cycle, without hormonal interruptions, at some point.

At 17, you are wise to be on contraception, but don’t forget to take breaks and see what a healthy, normal menstrual cycle feels like. Ovulating is the best and your most sexually receptive time.

But, a dodgy time for getting it on without protection of some kind. Give it a little time, and see how you go.

Best,
Aunt Vadge

References

• Eur J Contracept Reprod Health Care. 2007 Dec;12(4):362-5. Contraceptive efficacy and side effects of Implanon. Gezginc K¹, Balci O, Karatayli R, Colakoglu MC. [PubMed]
• Eur J Contracept Reprod Health Care. 2004 Dec;9(4):278-84. Acceptability and side-effects of Implanon in Switzerland: a retrospective study by the Implanon Swiss Study Group. Bitzer J, Tschudin S, Alder J; Swiss Implanon Study Group. [PubMed]