The Contraceptive Implant: Insertion, Periods & Removal

The contraceptive implant is a soft plastic rod about the size of a matchstick — 4 cm long and 2 mm wide — placed just under the skin of the inner upper arm. It releases a hormone called etonogestrel slowly, and it prevents pregnancy for three years.

It is fitted in an outpatient room in a few minutes under local anaesthetic. There is no hospital, no admission, no cut that needs stitching, and nothing goes anywhere near the uterus. For a woman who wants years of reliable contraception without a daily tablet and without a device inside the womb, it is often exactly the right answer.

It also has one real drawback, and it is the reason most women who stop it stop it. This page gives that drawback the space it deserves rather than burying it under the effectiveness figures.

What the implant actually is

One flexible rod, 4 cm by 2 mm, containing 68 mg of etonogestrel — a progestogen, the same family of hormone the body makes in the second half of the cycle. It contains no oestrogen at all, which is what makes it usable by many women who cannot take the combined pill.

The rod is not absorbed and does not dissolve. It sits under the skin, releases hormone at a slow declining rate, and is taken out at the end of its life or whenever you decide, whichever is sooner. The version used in India is Implanon NXT, which is radiopaque — it shows up on an X-ray, which matters in the rare situation where a rod cannot be felt.

You can feel it under your own skin. That is intentional. Being able to run a finger along your arm and confirm it is there is part of how the method is designed to be checked.

How well does it work?

Extremely well. In the original clinical trials no pregnancies occurred while a rod was correctly in place; the manufacturer's pooled figure across the first three years is 0.38 pregnancies per 100 women-years, and the reported first-year failure rate is around 0.05%. However you cut those numbers, the implant sits in the same effectiveness bracket as sterilisation — while being completely reversible.

The important structural point is this: there is nothing to remember. The pill's real-world failure rate is around 7% a year, and essentially all of that gap between the pill's laboratory performance and its actual performance is missed tablets. The implant removes that variable entirely. There is no daily decision, no travel disruption, no forgotten strip.

The part that actually matters: what it does to your periods

This is the section to read twice, because it is the one that decides whether you will still be using the implant in a year.

Etonogestrel thins the lining of the uterus and suppresses the normal cycle. What the lining then does is unpredictable, and it differs between women in a way nobody can forecast in advance. Across large studies, in any given three-month window:

• About 22% of women have no bleeding at all — amenorrhoea.
• About 34% bleed infrequently — fewer than three episodes in three months.
• About 38% bleed roughly normally — three to five episodes in three months.
• About 7% bleed frequently — more than five episodes in three months.
• About 18% have prolonged bleeding — an episode lasting 14 days or longer.

Read those figures together and the honest summary is: roughly one woman in five will love what it does to her periods, roughly one in five will find it genuinely difficult, and the rest sit somewhere in between. The bleeding is not usually heavy — the total blood loss on an implant is typically less than a normal period — but it is unpredictable, and unpredictable is what people cannot live with.

Two further facts belong here, and both are usually left out:

First, the pattern can change at any point during the three years. A woman with a settled pattern at six months can develop a different one at eighteen. Second, and more encouragingly, about half of women who start with an unfavourable pattern see it improve. Stopping at eight weeks, which is when most women want to stop, means abandoning the method before you know what your own pattern will be.

What can be done about troublesome bleeding

Quite a lot, and this is worth knowing before you book a removal appointment.

The first step is not a treatment at all — it is checking that the bleeding is the implant. Bleeding that started with the implant and has a scattered, painless, light character usually is. Bleeding after sex, a foul discharge, pelvic pain, or a pattern that appeared months after a settled phase deserves examination first, including a cervical smear if one is due and testing for infection. The implant is not a reason to skip that; you can read more about the causes of bleeding after sex separately.

Once other causes are excluded, the two options with the best evidence are:

• A course of the combined pill, usually for three months alongside the implant. This is used off-licence for this purpose but is the most commonly effective option, and many women get a durable improvement from a single course.
• Mefenamic acid, an anti-inflammatory tablet, typically 500 mg three times a day for five days during a bleeding episode.

What does not help, despite being frequently prescribed, is adding a progestogen-only pill. There is no evidence supporting it, and it adds side effects without adding benefit.

What insertion is actually like

Shorter and duller than almost everyone expects.

You lie on a couch with your non-dominant arm bent and turned outward, hand near your ear. The site is measured on the inner upper arm — about 8 to 10 cm above the bony point at the inner elbow, and 3 to 5 cm behind the groove between the biceps and triceps muscles. That position was revised a few years ago specifically to keep the rod away from the large nerves and vessels of the arm.

The skin is cleaned and a small injection of local anaesthetic is given. That injection is the only part that stings, and it stings for a few seconds. The applicator, which is preloaded, is then inserted just under the skin and the rod released. In trials the mean insertion time was under 30 seconds.

You then feel for it, and so do we — in trials the rod was palpable in 99.7% of women immediately afterwards. A small pressure dressing goes on for 24 hours and a plaster stays for three to five days. Bruising is common and fades within a week or two. There are no stitches.

You can drive home, go back to work the same day, and shower normally the next day. Heavy lifting or gym work with that arm is best left for a couple of days.

When can it be fitted?

The implant can be fitted at almost any point, but the timing decides whether you need condoms for a week.

• Days 1 to 5 of your period — effective immediately, no extra precautions.
• Within 5 days of a miscarriage or termination — effective immediately.
• Up to day 21 after childbirth — effective immediately. It is safe while breastfeeding, being oestrogen-free.
• Any other time — a pregnancy test first, then the rod, then seven days of condoms.
• Switching from the pill — usually straightforward, and often without any gap in cover.

One specific caution: if you have taken ulipristal acetate as emergency contraception, the implant should not be fitted for five days afterwards, and condoms are needed for those five days and for seven days after insertion. This trips people up regularly.

How long does it last?

Three years is the licensed duration in India, and three years is what we plan for. Put a date in your phone at the time of insertion; it is far easier than trying to remember in 2029.

You may see reports that the implant now lasts five years. In 2025 the US regulator extended the licence for the American version to five years, on the strength of trial data showing no pregnancies in years four and five. That is genuine evidence and it is reassuring — but the Indian licence is three years, and the sensible plan here is a three-year change. The five-year data is useful context if your appointment slips by a few weeks; it is not a reason to leave a rod in for an extra two years.

Taking it out

Removal is also an outpatient procedure and usually takes a few minutes longer than insertion. The rod is felt, the skin numbed, a 2 to 3 mm nick made at one end, and the rod eased out with forceps. The nick is closed with a small dressing rather than stitches.

You can have it removed whenever you want, for any reason, including "I have changed my mind." That is a feature of the method, not an imposition on anybody. A new rod can be placed through the same incision at the same visit if you want to continue.

Return of fertility

Fast, and faster than most women expect. Hormone levels become undetectable within about a week. Ovulation returns within six weeks in almost every woman, and pregnancies have been recorded as early as 7 to 14 days after removal. There is no washout period and no delay of the kind sometimes seen after the contraceptive injection.

If you are planning a pregnancy, this is a good moment to start folic acid rather than waiting for a positive test — our page on folic acid in pregnancy explains why the timing matters.

When a rod cannot be felt

Uncommon, but it happens — usually because the rod was placed too deep at the start, occasionally because it has migrated a short distance. Local migration is typically under 2 cm. Migration into a blood vessel is documented but genuinely rare.

The rule here is firm and worth knowing: an implant that cannot be felt must not be dug for. It has to be located first, by ultrasound or X-ray, and a deeply sited rod should be removed by someone who does that specific procedure. Repeated blind attempts are how small problems become scars and nerve injuries.

At this clinic, routine insertion and routine removal are done here. If a rod is impalpable or lies deep, imaging is arranged by referral and the removal is done in the appropriate setting rather than attempted in the room. Meanwhile you would need another form of contraception, since a rod you cannot confirm is a rod you cannot rely on.

Side effects: what is supported, and what is not

An honest account of this needs to separate three categories, because they are usually presented as one.

Clearly associated with the implant

• Changed bleeding patterns — discussed above, and by far the commonest reason for discontinuation, accounting for around 11% of all users stopping.
• Headache — reported by roughly a quarter of women in trials, though headache is common in any group of adults.
• Acne — roughly 12% report new or worse acne. A smaller number report improvement.
• Breast tenderness and local site reactions in the first weeks.

Genuinely uncertain

• Weight gain. Around 14% of trial participants recorded a weight increase, but the evidence is too limited to say whether the implant causes it. Weight also rises in most adults over three years regardless. This is not the same as saying it never happens — it is saying the studies cannot separate the two.
• Mood and depression. Around 3.5% of users in trials reported depression they felt was related to the implant. The evidence is not strong enough to confirm or exclude a causal link. If your mood changes clearly and persistently after insertion, that is worth taking seriously and worth an appointment.
• Bone density. The data are too limited to draw a conclusion, and there is no recommendation for routine bone monitoring in implant users.

Not what the implant does

• It does not cause infertility. Ovulation returns within weeks.
• It does not travel around the body. Movement is measured in millimetres, not organs.
• It does not protect against sexually transmitted infection. Nothing hormonal does; condoms remain the only method that does.
• It does not need to be removed for surgery, scans or dental work.

Who should not have one

The list is short, which is one of the implant's advantages.

• Current breast cancer — the implant should not be used. A past history of breast cancer is a situation where the risks usually outweigh the benefits, and needs an individual discussion.
• Unexplained vaginal bleeding that has not yet been investigated — investigate first, fit afterwards, because the implant will make the bleeding impossible to interpret.
• Active liver disease or a liver tumour.
• Known or suspected pregnancy — hence the test.

A separate and more practical issue is enzyme-inducing medication — certain anti-epileptics, rifampicin and rifabutin, and St John's wort. These speed up the breakdown of the hormone and reduce the implant's effectiveness both while you take them and for 28 days afterwards. If you are on any of these long term, a different method — the copper device, the hormonal coil or the injection — is a better choice than adding condoms to an implant for years. Bring your medication list to the appointment.

What else the implant does

Two useful side benefits, one of them substantial:

Period pain generally improves. In studies of women who had painful periods before insertion, a large majority saw complete resolution, and only about 5% found their pain worse. For a woman with troublesome dysmenorrhoea who also wants contraception, that is a real double benefit.

Protection of the uterine lining in PCOS. Women with PCOS who ovulate infrequently expose the lining to oestrogen without enough progesterone to balance it, which over years is what drives lining overgrowth. The implant supplies that opposing hormone continuously. Notably, a woman with no bleeding on an implant does not need to be given tablets to induce a withdrawal bleed — the absence of bleeding here reflects a thin lining, not a lining building up. You can read more on PCOS and how it is managed.

Implant, coil, or injection?

All three are long-acting and all three are far more reliable than anything you have to remember. The choice usually comes down to two questions: what do you want your periods to do, and do you want anything inside the uterus?

• The implant — three years, nothing in the uterus, unpredictable bleeding pattern, fitted in the arm in minutes. Best when the uterus is off the table, or an internal examination is not acceptable to you.
• The hormonal coil (Mirena) — planned as five years, dramatically lighter periods for most women, and a genuine treatment for heavy bleeding and for lining overgrowth as well as a contraceptive. Best when heavy periods are also a problem. Our full guide to the Mirena covers this in detail.
• The copper device (Copper-T) — five or ten years, completely hormone-free, but periods are usually heavier and more painful. Best when you want no hormones at all.
• The injection — three-monthly, effective, but the one method with a genuine delay in return of fertility, sometimes up to a year. Worth avoiding if a pregnancy is planned in the near future.

Our contraception page compares all three side by side, including what each does to bleeding and how each is fitted.

Where the implant sits in India

Some context, because it explains why many women here have never heard of it.

India's contraceptive picture is unusually lopsided. Female sterilisation accounts for around 38% of contraceptive use among married women, while intrauterine devices account for about 2%. Reversible long-acting methods have historically barely featured — not because women do not want them, but because they were not on offer. Roughly 9.4% of currently married women of reproductive age have an unmet need for family planning, which is about 21 million women.

The single-rod implant was approved by the Indian regulator in 2017 and launched in the private sector in 2018. It was added to the national family planning programme in July 2023, with a phased rollout across districts in ten states. Only trained allopathic doctors may insert it.

The Indian experience mirrors the international one closely. In the ICMR study, the continuation rate at three years was 66.1 per 100 users — that is, about two-thirds of women were still using it at the end — and the discontinuations were driven overwhelmingly by menstrual irregularity. That is a good continuation figure by the standards of any contraceptive method. It is also a direct argument for counselling women properly about bleeding before insertion rather than after.

What happens at the clinic

Insertion and removal of the contraceptive implant are done here as an outpatient procedure. So is fitting and removal of the Copper-T and the Mirena. There is no admission, no theatre, no general anaesthetic and no fasting.

A typical visit runs like this: a conversation about what you want from a method and what you want your periods to do; a check of your medical history and medications; a pregnancy test where the timing requires it; the procedure itself; and a follow-up plan. You leave with a dated card and the date of removal.

Consultation, blood tests and the procedure itself happen at the clinic. Scans, if any are needed — for example to locate a rod that cannot be felt — are arranged by referral, since we do not run an ultrasound machine here.