Progestin-only hormonal methods. These methods include pills, the implant such as Nexplanon , and the shot such as Depo-Provera. With the implant, you can get pregnant as soon as it is removed. It may take 3 to 18 months after your last shot to get pregnant. The progestin-only pill, also called the "mini-pill," does not seem to delay fertility. Most women will get pregnant within 6 months after stopping the mini-pill. Intrauterine devices IUDs. Credits Current as of: October 8, Top of the page Next Section: Related Information.
We concluded on a diagnosis of an anembryonic pregnancy of 8 weeks 1 day gestational age based on last menstrual period and our patient was counselled and booked for dilatation and curettage. We performed a dilatation and curettage with suction the following day under local anesthesia, with aid of a manual vacuum aspirator. She was monitored for 6 hours and discharged home. Expelled products were not sent for histopathological analysis because of financial restrictions.
During her follow-up visit 5 days later, she reported a cessation of pelvic pain and vaginal bleeding. A physical examination of her abdomen and speculum vaginal examination were normal Fig. Pelvic ultrasound with arrows pointing to empty intrauterine gestational sac with mean sac diameter of 28 mm. Levonorgestrel is a wholly synthetic and biologically active progestin that exhibits high progestational activity but no significant estrogenic activity.
After insertion, mostly in the non-dominant arm, the implant protects against pregnancy for up to 3 to 5 years [ 2 ]. It is a very effective means of contraception with a Pearl Index pregnancies per women-years as low as 0.
A pelvic ultrasound scan was instrumental for an accurate diagnosis in this case. HCG is secreted by the syncytiotrophoblast cells of the fertilized ova. In anembryonic pregnancy, levels of hCG are significantly lower compared to women with singleton pregnancies which progress until term [ 11 ]. It is therefore common to have a false-negative qualitative urine pregnancy test in anembryonic pregnancy.
We could not clearly establish the cause of contraceptive failure in this case. Reported causes of contraceptive failure associated with POSDIs include poor insertion technique, poorly timed insertion, and drug interactions [ 3 , 4 ]. These were all ruled out in our case after a thorough history, and examination of the implant site.
Out of these three women, one of them had an ectopic pregnancy [ 13 ]. It is likely that synthetic progestins increase the risk of a fertilized ovum implanting out of the uterus by impairing fallopian tube ciliary function [ 14 ].
However, the effect of these synthetic progestins on anembryonic pregnancy has not been clearly elucidated. Out of 27, females with an etonogestrel-releasing subdermal implant reporting adverse reactions to the FDA, 9 0. Synthetic progestins decrease production of natural progesterone from the ovary. Natural progesterone plays a role in oocyte maturity and embryo development [ 16 ]. Although immature oocytes can be normally fertilized, the developmental capability of the resultant embryo is reduced, compared to embryos resulting from mature oocytes [ 17 ].
Also, synthetic progestins create a poor environment for the development of the implanted embryo by suppressing endometrial maturation. More research is required to explicate the influence of synthetic progestins on anembryonic pregnancy. While further research is necessary to explicate the influence of POSDIs on anembryonic pregnancy, proper evaluation of these women in the event of pelvic pain, prolonged menstrual bleeding, and spotting is imperative.
Some but not all studies have found that Jadelle implants became slightly less effective for heavier women after 4 or more years of use. As a precaution, women weighing over 80 kg may want to have their implants replaced after 4 years for greatest effectiveness.
Studies of Implanon have not found that effectiveness decreases for heavier women within the lifespan approved for this type of implant.
What should be done if an implant user has an ovarian cyst? The great majority of cysts are not true cysts but actually fluid-filled structures in the ovary follicles that continue to grow beyond the usual size in a normal menstrual cycle. They may cause some mild abdominal pain, but they only require treatment if they grow abnormally large, twist, or burst. These follicles usually go away without treatment see Severe pain in lower abdomen.
Can a woman work soon after having implants inserted? Yes, a woman can do her usual work immediately after leaving the clinic as long as she does not bump the insertion site or get it wet. Must a woman have a pelvic examination before she can have implants inserted? Instead, asking the right questions can help the provider be reasonably certain she is not pregnant see Pregnancy Checklist. No condition that can be detected by a pelvic examination rules out use of implants.
Can young women, including adolescents, use implants? If a young woman wants to use implants, she can. In fact, implants and IUDs can be good methods for young women who want to be sure to avoid pregnancy for a number of years. They are highly effective and long-lasting methods. In rare cases, implants may start to come out of the skin. When this occurs, it is usually due to improper insertion or infection. A woman can have her implants removed at any time.
Similar to insertion, implant removal is done by a specifically trained provider using local anesthesia and does not require stitches. Removal takes an average of 10 to 15 minutes for Norplant, 5 to 8 minutes for Jadelle, and 3 minutes for Implanon.
Removal can take more or less time, depending on the skill of the provider. Difficulties with removal are rare if the implants were properly inserted and the provider is skilled.
Some women who seek family planning do not want to use implants because they have misconceptions about implants causing illness or problems such as cancer, blindness, or birth defects. In addition to changes in menstrual bleeding, the most common side effects of implants are headaches, abdominal pain, and breast tenderness.
These side effects are not an indication of illness and usually lessen or go away within the first year of use. Studies have not shown increased risk of cancer, blindness or birth defects with the use of implants.
They have been shown to greatly reduce the risk of ectopic pregnancy and protect against symptomatic pelvic inflammatory disease. Implants may also help protect against iron-deficiency anemia. Some women who seek family planning believe that implants can cause complications in the arm in which they are inserted or that they can travel from the insertion site to other parts of the body. They remain where they are inserted until they are removed.
In rare cases, a rod may start to come out of the skin, usually during the first four months since insertion. This typically happens because the implants were not inserted well or because of an infection at the insertion site. If expulsion occurs, the woman should return to the clinic as soon as possible and use a back-up family planning method in the meantime.
Providers can replace the rods. Some women who seek family planning believe that using implants will cause infertility, delay the return of fertility after the implants are removed, or cause ectopic pregnancies pregnancy in which the fertilized egg implants in tissue outside the uterus. Fact: Implant doesn't affect your fertility, and reduces the risk of ectopic pregnancy.
One major study found that women who have had their implants removed can become pregnant as quickly as women who have stopped using nonhormonal methods. Implants substantially reduce the risk of ectopic pregnancy.
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