Evolution of available contraceptive implants in the US

Dear Reader,

It’s great that you had an enjoyable experience with Norplant. The story of the contraceptive implant involves multiple iterations since its creation, but that specific device is currently no longer available. As for what’s currently available in the United States currently, that would be Nexplanon. Keep reading for more on the history of this type of contraceptive device and the details on the current version on the market.

This story begins with Norplant’s introduction as a progestin-only contraceptive method that was implanted into the arm. The birth control pill and intrauterine devices (IUDs) had recently been introduced, and the adverse health effects of these methods had not yet been observed or reported. Seeking to continue this momentum, reproductive scientists were eager to expand on the repertoire of contraception methods for people who had trouble remembering to take a pill, didn’t want to be permanently sterilized, who weren’t eligible to use IUDs, or who simply wanted another option, among other reasons. Norplant was novel, as many users of this device valued the long-term (five years) pregnancy protection that it provided. Yet, amidst this innovation, ethical concerns arose. Marginalized communities, such as communities of color and low-income communities, felt unnecessarily targeted to utilize Norplant. Many state government and public programs sought to provide benefits in return for agreeing to use it. This heavy pressure by institutions coupled with adverse health effects, such as scarring, headaches, bleeding irregularities, and mood alterations, resulted in a number of lawsuits. About 50,000 lawsuits were filed against the company that marketed Norplant, and in 2002, it was taken off the market in the United States.

With the fall of Norplant, a gap was left for contraceptive implants. An updated version of the device, Jadelle, has only two rods compared to the previous six, but it wasn't approved for use in the US. This remains true even today, though it remains available internationally. However, another company came forward with another implantable device in 1998 with Implanon, which soon rose in popularity as an alternative due to the controversy surrounding Norplant. It consisted of only one tiny (about 1.5 inches by 0.08 inches) rod. This rod slowly released the hormone etonogestrel, providing long-term (three years) pregnancy prevention. While Implanon wasn’t associated with the same adverse effects as Norplant, there were still some concerns. Specifically, issues arose regarding the insertion and removal process of the device. In response to this, Implanon was discontinued in 2014 and replaced with its current version, Nexplanon.

This story now brings us to Nexplanon as the only contraceptive implant available for use in the US. It utilizes the same mechanism as Implanon with the key difference being that it contains barium sulfate. The presence of this allows for the implant to be easily detected by an X-ray. This feature remedied some of the issues in removal and insertion that were present in Implanon. Other advantages of this implant are that it provides pregnancy prevention for up to three years and doesn’t require any action by the user to maintain its maximum effectiveness for that time period. However, it doesn’t prevent against sexually transmitted infections (STIs), and some side effects that may occur are mood swings, weight gain, headache, acne, and depressed mood.

Hopefully, this journey through history has provided some clarity to where the implant has been and how the current version came to be. If you’d like to go deeper into how they work, what to expect, or other options, consider checking out the Contraception category in the Go Ask Alice! Sexual & Reproductive Health archives. A health care provider or health promotion specialist may also provide further consultation.

Best of luck in finding what works best for you,