Hormone Implants for Teen Girls, How They Work
The new guidelines issued by the American Congress of Obstetricians and Gynecologists (ACOG) encourage healthcare providers to offer intrauterine devices (IUDs) and hormone implants for teen girls as their first choice for birth control. Yet much of the media discussion has focused on IUDs rather than hormone implants, so this discussion focuses on the latter and how they work.
What teenage girls should know about hormone implants
Hormone implants are a contraception option for females that are highly effective at preventing pregnancy. Compared with other birth control methods, hormone implants are greater than 99% effective compared with birth control pills (95-99%, depending on which pills a woman takes), IUDs (about 99%), male condoms (87-98%), and diaphragms with contraceptive jelly (80-94%).
A hormone implant looks like a tiny plastic straw that measures about 4 cm long and 2 mm in diameter. Inside the implant is 68 mg of a synthetic hormone called estonogestrel, which is slowly released into the bloodstream over a three-year period. In the United States, the available hormone implant is Implanon®.
Teenage girls must see a physician to have the implant inserted. This procedure takes only about 5 minutes. First a local anesthetic is administered to the implant area, which is the inside of the upper non-dominant arm (the left if you are right-handed, and vice versa). Then the implant is inserted just under the skin using a special applicator.
Girls may feel some mild pain or itching at the insertion site, and some bruising may occur as well. Infrequently there is scarring or numbness where the implant has been placed, and rarely infections occur. The implant is usually not visible, but in thin teens an outline of the device may be detectable.
Anyone who is considering a hormone implant should have it performed by a healthcare provider who had performed many such procedures, as improper insertion of the implant can cause nerve or blood vessel damage. There is also a slight chance an implant can move (migrate) from its original implant site because of physical contact at the impact site, which might occur during participation in contact sports.
A hormone implant is effective at preventing pregnancy for about three years, but overweight or obese females may need to have a new implant inserted sooner. The cost of a hormone implant ranges from about $400 to $800, and it is covered by some insurance plans.
The main advantage of a hormone implant is that it eliminates the necessity of taking a daily pill. It also offers peace of mind: less than one per 1,000 women get pregnant during the first year of having a hormone implant.
However, as with all types of birth control, a hormone implant does not prevent the spread of sexually transmitted diseases (STDs). Therefore, females who are not in an exclusive relationship with a disease-free partner need to use a condom to protect against STDs.
Although hormone implants are highly effective at preventing pregnancy, use of certain medications can reduce the contraceptive's effectiveness. Some of those medications include drugs for epilepsy (e.g., barbiturates, felbamate, phenytoin, primidone), tuberculosis (e.g., rifampicin), infectious diseases (e.g., griseofulvin), and HIV (e.g., nelfinavir, nevirapine, ritonavir).
Very common side effects (affecting more than 10% of females) associated with hormone implants include acne, breast tenderness, headache, vaginal pain and/or infection, and weight gain. About 20% of females experience frequent or longer lasting bleeding during their periods while about 20% stop menstruating.
Some of the less common side effects impacting more than 1% of females include abdominal pain, depressive mood, dizziness, gas, fatigue, flu-like symptoms, nausea, nervousness, and painful menstruation, among others.
Any teenage girl who has any of the following conditions may not be a candidate for a hormone implant. That decision can be made by her healthcare provider. Those conditions include tuberculosis, diabetes, liver disease, being overweight, epilepsy, high blood pressure, and breast cancer.
When it's time to remove the hormone implant, whether it is time to replace it or a woman wants to get pregnant, the implant should be removed by a trained healthcare professional. A local anesthetic is injected into the site of the implant, and a small incision is made to remove the implant with forceps. A dressing is applied and recovery is within 3 to 5 days.
When women who have a hormone implant want to get pregnant, their fertility is restored immediately after the implant is removed. Similarly, when a hormone implant is replaced, protection against pregnancy begins within 24 hours of implantation if it is placed within the first 7 days of the menstrual cycle.
A hormone implant is being recommended as a contraceptive option for teenage girls by the ACOG. Teenage girls, their parents, and their healthcare providers need to explore all the options, risks, and benefits before choosing a form of contraception.
American Congress of Obstetricians and Gynecologists