Health

Health Canada Just Approved the Birth Control Arm Implant

We talked to one of Canada’s leading contraception experts about Nexplanon and what this means for Canadian birth control options

People around the world have been raving about their birth control implants for years—and by the end of this year Canadians will no longer need to miss out. The popular contraceptive Nexplanon has finally officially been approved by Health Canada.

“[Nexplanon] is available in more than 100 countries worldwide and has been for many years,” says Dr. Amanda Black, the chair of the Society of Obstetricians and Gynaecolgosists of Canada’s contraceptive awareness program. “It’s exciting that we will finally have this available to [people] in Canada. The more options you have, the more likely you are to find a method of contraception that works for you.”

Nexplanon is a three-year contraceptive implant that is inserted into the upper arm via a small puncture, which can be done in your doctor’s office or by a trained practitioner at a clinic—and (typically) can be removed just as easily with a small incision. The flexible plastic rod—about the size of a matchstick—releases a low dose of etonogestrel, a form of progestin or synthetic progesterone. The medication works by stopping an egg from being released by your ovary and preventing sperm from reaching the egg. It also changes the lining of your uterus to help prevent implantation.

Here’s what else you need to know about this new-to-Canada birth control.

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Why wasn’t Nexplanon approved in Canada until now?

In the past, Merck—the drug company that produces Nexplanon—did not have recent enough clinical trial research to satisfy Health Canada’s requirements, but mounting public pressure for the implant, and persistence from the manufacturer, played a part in reversing that decision. “At the end of the day, it’s been well studied in other countries, certainly post-approval,” says Black. “And [people] in Canada should have access to similar contraceptive methods that are available in other countries.”

When will Nexlpanon be available in Canada?

Even though it’s received the green light by Health Canada, the birth control implant likely won’t be readily available for several months. “Health care providers need to be trained on insertion and removal,” explains Black. It’s also unclear how the COVID-19 pandemic will affect supply.

How much will Nexplanon cost?

The cost of Nexplanon in Canada hasn’t yet been released. And drug prices in Canada can vary greatly compared with other countries, so there’s no point in searching how much it costs in the U.S., TBH. (For example, a hormonal IUD costs between $395 to $500 in Canada, while in the U.S. getting one can cost anywhere between $0 to $1,300 USD.)

What’s the difference between the birth control implant and an IUD?

The discreet arm implant doesn’t replace the need for IUDs, it just gives women another option, Black says. Nexplanon lasts for three years and potentially longer, as opposed to five years for a hormonal IUD. “If someone, for whatever reason, prefers not to  have an IUD inserted [vaginally] or if they don’t want a pelvic exam, this provides another option for those who still want a long-acting method of contraception,” she adds.

Is Nexplanon safe?

Implants are safer for people who can’t otherwise take estrogen for a number of health reasons, including being at higher risk of stroke and blood clots. “One of the nice things about it is that we have not just the clinical trials data but we have real-world data at this point, so we can say it appears to be a safe and effective method of contraception,” Black says.

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How effective is Nexplanon?

The implant is more than 99% effective. According to the American College of Obstetricians and Gynecologists, long-acting reversible contraceptives like IUDs and implants are up to 20 times more effective at preventing pregnancy than birth control pills, the patch or the vaginal ring because you don’t have the daily, weekly or monthly hassle of remembering to do something. “It’s a ‘forgettable’ type of contraceptive,” Dr. Black says.

How long does it take for Nexplanon to start working?

If it’s inserted within the first five days of your period, it’s effective immediately, explains Black. “If it’s inserted at another time, you just have to make sure that you’re using a backup method of contraception for a week afterwards.”

Can you feel the implant once it’s in?

Yes, you can feel the little rod in the upper inner arm. But Black says that’s a good thing: “We want you to feel it, because then you know you have to take it out as well,” she says. That said, the Nexplanon device is only about 4 cm long and very thin, so it shouldn’t be overly noticeable or uncomfortable.

Is the birth control implant reversible?

When it comes to removal of the implant, Black explains, “It’s done under a local anaesthetic, a tiny incision…and we dissect it out. Most of the time we don’t need to put a stitch in after, we can just put tape over it.” It can be removed at any time, and is completely reversible. You can get pregnant as soon as it’s removed.

What are the potential side effects associated with Nexplanon?

The side effects of Nexplanon are similar to what you would see with other hormonal contraceptives, says Black. The top reasons why some people may avoid or discontinue the implant are irregular periods, mood changes, headaches and acne. Depression and weight gain have also been reported but those numbers are low.

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Does Nexplanon protect against STIs?

Nope. Non-barrier birth control methods such as the implant or IUDs do not protect against sexually transmitted infections or diseases, so it’s always recommended to use condoms for STI protection.

Do you still get your period with the birth control implant?

“The best answer is that it’s known to be associated with changes in bleeding,” says Black. “Those changes can be very dependent on the woman.” Overall, Black says more than half of women do not get their periods with the implant. If they do have bleeding, it’s usually infrequent.