Finding her nightly Pill increasingly hard to swallow – literally – our reporter had a matchstick-sized contraceptive implant inserted into her arm instead. Here’s exactly what happened
I’ve been taking the contraceptive Pill for six years, but recently, despite having a relatively normal experience on it, I felt like I needed a change. I didn’t know at first know why I felt so strongly about it, but part of it may have been to do with not really knowing my options before.
When I was younger, the Pill seemed like the easiest and most obvious method of contraception for me to choose, and it remains so for around 3.5 million women in the UK alone (that’s roughly 1 in 3 females of reproductive age). After visiting my doctor in 2007, I was first put on to Yasmin, then Marvellon a few years later and then for about two years ago, Cerazette. Cerazette is a progesterone-only Pill, which is usually prescribed to women who have particularly bad PMS, unusually heavy periods, or issues with their weight. I had the latter, though I have a friend who was prescribed Cerazette because she was fainting due to her painful periods. She is much happier now, but if I’m honest, I didn’t experience much of a change from one brand to the other.
When I first had my doubts about the Pill and began to analyze why, I realized a few things. Firstly, I’m pretty forgetful when it comes to taking it. I rarely go as far as to miss one but, taking my pill at night, I’m usually in bed and about to fall asleep before I remember it. You think it would come naturally after six years, but still, my boyfriend has to check with me and more often than not I have to shamefully get up and go find it.
Although most women would think me strange for saying it, I don’t like not having my period every month. Unlike the other two previous brands, Cerazette is taken every day without a week’s break, and my periods stopped as soon as I switched (however this does differ from woman to woman). There’s something oddly reassuring about having monthly bleeds, whether they’re natural or not, which I previously never thought I’d be saying.
I guess what I hated most about taking the Pill was going to my doctor for the prescription. It never seemed to be an easy process; I’d either not realize I was running low until I was nearly out, or I’d remember to put my prescription request in early but then get a call saying they wanted me to have a check-up before they could fill it in. When I went for an appointment (usually every six months), I’d always get a nurse I hadn’t seen before, and they’d all ask the same questions over and over; How long have you been on the Pill? What type are you on? Any problems? Step on the scales please. Let’s take your blood pressure. Hmm, bit high. Let’s take it again. Do you have a history of heart disease in your family? (That was always a great one for calming the nerves…) It sounds crazy, but I always felt a bit guilty and embarrassed talking to my doctor about the contraceptive Pill; it was like admitting to your house mistress that you’re sexually active. The easiest appointment I ever had was with a male nurse, probably because he wanted to get it over with as quickly as I did!
All of these factors added up to a terribly anxious feeling that would come over me whenever I had to take my Pill. Every night it became increasingly hard to swallow, or I’d feel like it was stuck in my throat. I knew at this point that I had to look for an alternative method.
For a few years now I’ve heard friends rave about the contraceptive implant. ‘It’s amazing!’ they’d say, ‘I don’t have to think about it at all! Look!’, and then they’d stretch back the skin on their arm to make the implant visible. That always left me feeling a little queazy, but when I started to consider it for myself, I thought of the millions of people who live with things in them to keep them going, and really, is an implant any more invasive to your system than ingesting a pill every day? When it was again brought to my attention when reading an article about LARCS (long-acting reversible contraception), I remembered what my friends; care-free and hassle-free contraception really did sound good. I decided to consult the NHS website.
The implant itself is small and thin, similar in size to a hair-slide (4cm x 2mm). It contains etonogestrel, a synthetic progestogen, of which a small amount is continuously released into the bloodstream. This prevents the release of an egg from the ovaries and causes changes in the cervix (like thickening of the cervical mucus) that make it difficult for sperm to enter. It lasts for three years, with no checks after the initial three months, and if you decide that you want to have it taken out, because you want to get pregnant or otherwise, your fertility will revert back to normal instantly. The stats on the NHS website also said that of those using the implant, fewer than 1 in 1,000 women become pregnant each year.
Straight away I thought it sounded appealing. I went ahead and booked an appointment at my local family planning clinic, so as to find out more about it. Despite never having been there before, I imaged that they would be more knowledgeable about the implant that my local surgery, and more qualified to insert it if I decided to see it through.
Even when sitting in the waiting room, hearing everyone talk openly about their periods, I knew I had come to the right place. I tried my best to explain to the nurse my recent doubts concerning the pill. Although she was confused as to why I wanted to change from one hormone contraceptive to another, when I explained that it was more the pill and the taking it that I didn’t like anymore, she agreed that the implant would be a good alternative. She did tell me that as I hadn’t had periods with Cerazette, I may not get them with the implant, but that certainly wasn’t enough for me to want change my mind. She also took me through my other options, like the coil, the injection and the diaphragm, but as I’ve heard bad things from both family and friends about all of these, I chose against them. My nurse then looked at the clock and said ‘Well, should we do it now then?’, which took me completely by surprise! I was feeling slightly lightheaded after a long day at work, so thought it best to go home with a leaflet and think it over a bit more before returning a week later. ‘That’s just as well,’ she said, ‘as the receptionist gets a bit snippy past seven o’clock.’
The implant only had one downside for me, and that was the procedure itself. On my way to the clinic the following week, I started to get myself really worked up about the whole thing. Even though I knew I would be given a local anaesthetic, I was worried that it would still be painful. Not knowing the exact logistics (Would I be sitting or lying down? How long would it take? How much of the procedure would I have to see?), I was also a bit anxious that something might take me by surprise and I might do something stupid like faint or feel queazy again. I don’t think I’m bad with needles or blood, but I wasn’t too keen on that being tested again on my own arm. When I got into the nurse’s room I decided that the best thing to do was to confess all and tell her exactly how I was feeling. Hopefully if she knew, she’d be a bit gentler with me, and certainly not make any jokes that would turn my stomach! “I have to admit,” I said to her, “I’m feeling a bit nervous about all of this.” She smiled, which made it clear to me that I was obviously not the first person to have these kind of doubts. She was so kind and sweet, and when I lay down on the bed with my arm bent upwards next to me on the pillow, I decided to just turn my head, close my eyes, and not open them again until she told me to get up.
After the area was disinfected and anesthetised, the implant was inserted underneath the skin using a special needle. She kept me talking all the way through, apologising profusely, and although her “Does that hurt?”s worried me slightly, I couldn’t feel anything, other than a bit of a pain when its pushed through.
The nurse showed me where she had inserted it, which was covered by a butterfly stitch, and then made me feel for it so I knew how to check it to make sure nothing was wrong. Once I was upright again, she checked my blood pressure, gave me my Nexplanon card, which has information, emergency contacts, and the date in three years time when I should have it removed. Nexplanon is the name on the implant, which is the only one currently prescribed in the UK.
The nurse also gave me a calendar so I could mark my days of bleeding and spotting. She said I should see her for a check-up in three months time, but if anything seemed peculiar (like feeling ill or irregular bleeding) I should come back as soon as possible. She told me to expect a bruise, and that I had a few little spots where my body had reacted to the anaesthetic (she had therefore given me a smaller dose), but that all of this would go down in a week or so.
It’s advised to carry on taking the pill for a week after the insertion, so as to make sure you are fully protected. I carried on for an extra week though, because I had an event that really didn’t want to have a bleed during. I was warned to look after my diet for this time, as the double amount of hormone in my system may lead to increased hunger, but as I’m careful with what I eat anyway, this didn’t affect me much.
For the first few days after the insertion I was very sore, and the area of my arm was quite swollen. I took painkillers, which helped, and a week later I had no pain at all. I took the plasters off when the pain had stopped (although three days would have apparently been fine), and I was left with a small mark where the incision was made, a few blood blisters and one horrific rectangular shaped bruise. It went through a rainbow of colour changes, but after another week the bruise and the blood blisters were practically gone.
I took my last Pill on the Friday night and on Monday I was an emotional wreck. At first, I didn’t connect the two, but then a familiar pain came and when I went to check, my period had just started. The strange thing was though, it never full developed, and two days later it had stopped completely. It may come back again as my periods regulate (apparently they can take up to a year to settle), but I’m pretty sure this means I won’t be having them at all, like the nurse had suggested. Looking at the wider picture, I guess this doesn’t really bother me as much as I thought, and to be honest, if they had started up, I would probably have been wishing them away again!
It’s now three weeks after I had the implant inserted and all is well. I have no pain or discomfort, the tiny scab is nearly gone, and if I’m honest, I very rarely need to think about it. The funny thing is that for the first time ever, I always think about my Pill just before bed! Typical. It is such a relief to know that I am protected, without the hassle of prescriptions or trips to the doctor. The anxious feeling in my throat has gone, and will stay gone for at least another three years – I really feel that the implant was the right choice for me.
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