Is the implant still right for me?

[Kela]

Hi all,

So I’ve decided to go back on the implant after 5 years.

In the past, both times I was on it I got weird pregnancy test results that I interpreted as positive - first one was in hospital when I went for a UTI (looking back, they didn’t ask or explain doing one to me, just did it which now I think was wrong, but this was over 10 years ago now) and the second one there was no reason, but I had a pregnancy test done by a dr the same day that was negative, and all other tests I ever did were negative.

I accept I’ll never know if it was a real positive or just misinterpreted tests, but now I’m going back on the implant, if I was happy with the side effects last time etc, is it wise to go back on the implant? I mean, if they were real positive results, then that means for whatever reason the implant just doesn’t work for me, right?

Been reasearching the implant and effectiveness etc, and everywhere says it’s super high effectiveness, I’m just convinced I’m the 0.05% it’ll fail for

[CaitlinEve]

Hi Kela!

Contraceptive anxiety is common; there are much more than 0.05% of people who are convinced they're part of that 0.05% statistic. Do you like using the implant? Are you still using other methods of protection (ie. condoms) while on it as well? From what you've described, I think that it's safe to say that your previous positives were false positives or misinterpreted.

Ultimately, this is your body and your health! We can't tell you definitively whether or not to get the implant again. I can say that from what you've described here, I don't think that it's a bad idea to get it again and I don't think that the implant doesn't work for you.

I'll link this article for you as well, just in case you wanted more specific information on the implant that you may not have received before!
Birth Control Bingo: The Contraceptive Implant

[Kela]

Yes I didn’t mind the bleeding etc, I didn’t have much libido on it but I also had to deal with anxiety, and now I’m on citalopram so I’m hoping I’m just in a better space mentally anyway, meaning it’ll be all round a better experience.

Thanks for the link!

I’m happy to go without condoms at this point from a trust POV, as we have been together 9 years and STI tested, it’s just the pregnancy prevention buddying up angle I’m still questioning…might ask at the appt about the diaphragm and spermicide

[Andy]

Hi there Kela!

It really sounds like a good choice of contraception for you! (And glad to hear you’ve got treatment for your anxiety)
While false positive test are quite rare, they can still happen sometimes, so that certainly might be what happened here. It can be for a bunch of reasons like not doing the test right, certain medication or conditions. Along with asking about the other methods, this is certainly something you could bring up with your healthcare provider, who will probably be able to explain it all way better than us. And they will also be able to help you decide if the implant is the best method for you taking your medical history into account! Do you need any help preparing for the conversation?

[Kela]

Hi Andy,

Thanks for your reply!

Hmm no I think I’m okay with the conversation, I just hope I’m taken seriously when I ask about the implant with the diaphragm/spermicide. Don’t want to come across as demanding

Hopefully they’ll be nice to me about it

[Jacob]

Hi Kela!

Totally feel you on wanting to be taken seriously. I've had incredible doctors on the NHS that do, and experiences with NHS doctors that definitely don't! So I'd recommend writing down what treatment you want and be prepared for either possibility.

From what I know of medicine in the UK, the bias is very much towards people using long-acting methods, which when you get a doctor or health worker who is pushy or a poor communicator, it is usually most annoying for people wanting to stick with the birth control pill, or just use condoms - so my hope is that even if they're a bit crappy, they're probably going to support your decision to get the implant!

If you're just asking for advice on using the diaphragm and/or spermicide they might struggle to give you an answer for that when the failure rate for the implant is so close to zero. The most they can give you in answer to your question (if they're properly clued up) is the same as we can tell you here - that every method you use is going to lower the theoretical risk, but also that if the risk hovers closer to zero, it's a benefit which is harder and harder to measure.

Whether they'll agree to prescribe it, if that's what you're asking them, is harder to know. However, it's also worth knowing that you can get [some birth control] without prescription in the UK, so if they rebuff your request for a prescription for a diaphragm, or you want to avoid a conversation which it doesn't feel like is going to go your way, you can still talk to your pharmacist about your other options.

It can't really hurt to try though! So if this is what you're feeling I'd say make an appointment, ask them and see how it goes.

Edited to avoid misleading anyone who reads this in future regarding the availability of diaphragms!

[Kela]

Aah okay I didn’t realise I could get a diaphragm without a prescription! I was under the impression they were made in different sizes.

Where can I get one? Do UK pharmacies offer them?

[Jacob]

Gosh, thanks so much for double-checking: I think I misread the sentence "You can also buy it without a prescription from pharmacies." from the NHS' website, as referring to the diaphragm where on closer inspection they were very likely talking about spermicide(!) as they are spoken about together: Where to get diaphragms or caps

They do come in different sizes - and sizing is important, which you'll need some kind of help to establish - and I can't see how they'd be able to do the sizing part without someone qualified to do that with you? So I'm very sorry it seems that I got that one wrong, and that's a big facepalm for me!

Pharmacies are doing a lot more in-house in the UK around sexual health, prescribing and contraception, as it's been a big policy to move more contraception out of GPs and Sexual Health clinics to pharmacies. It varies from pharmacy to pharmacy, which will be why I had to look it up but then unfortunately misread the answer. It might be worth checking with your usual pharmacy what they do offer in terms of contraception methods without prescription but the diaphragm seems less likely, given the sizing thing.

Apologies again, for the detour and for my brainfart here!

Do you think you'll be okay to bring that up in your appointment about the implant, and see how it goes - as that does seem like the best way?

[Kela]

No worries, Thankyou so much! Yes I will

[Jacob]

Awesome, and best of luck. It'd be great to hear how it went.

[Kela]

If…I still had contraceptive anxiety, and took vitamins, specifically folic acid just in case there was a pregnancy (irrational fear of spina bifida), is that okay? I can’t see any data on interactions between vitamins and nexplanon, but do you have any further knowledge?

Also…I’ve been reading lately about a gene that can make birth control less effective, and obviously that is a whole other nightmare unlocked- any advice for that?

[Jacob]

By the looks of the genetic research, none of it is definitive enough to have any real-world applications, maybe with future research. So there isn't really anything special to advise!

I'd also say that adverse interactions data for drugs that are already in-use comes from people reporting adverse reactions, so if there's no data on it, there are therefore no known reports/cases and so there's no evidence of a negative reaction. We do know that a lot of people use the implant successfully so the medications it clashes with are very very likely to have already caused a problem and be well known (e.g. treatments for TB) and we know that the way they fail is stuff like someone already being pregnant when they get it inserted poor insertion of the implant (if it looks wrong after insertion, tell your doctor asap).

I think it's worth saying that regardless of what you choose, and how well you research the underlying factors that might affect a method's efficacy, and while there are things you can do to make pregnancy even less likely (like adding a second method: The Buddy System: Effectiveness Rates for Backing Up Your Birth Control With a Second Method) you you can't scrub the feeling of risk, with research or takng extra precautions.

That emotional side of it is better faced head on - at some point you will need to be able to say "I chose this and I take responsibility for whatever happens next".

Trusting yourself around your choices isn't about having 100% certainty in your correctness but giving yourself the kindness of allowing the work you've already done and the preferences you already have, to be enough, and trusting that future you can handle the unexpected when it arises.

[Kela]

I hear you.

The worst thing that can happen is that I fall pregnant, but I can deal with that, either by having the baby or I live in the U.K. so there are choices available to me.

Doesn’t stop the worry though but I will defo buddy up with something else!

[Kela]

I have technical question, just curious..

What is the process for trials for contraceptives? I understand they can’t test every drug in the world for interactions, but how do they go about checking what interacts with a hormonal method? Do they do deliberate research or is it a case of trial and error and see what people fall pregnant on and then figure out what caused it?

Cosmetics, moisturisers, oils on the skin etc wouldn’t affect BC would they? I feel like given they are a female specific thing, we’d know if something like rosehip oil interacted because it would become obvious pretty soon.

[Heather]

Hey, Kela. Contraceptives and lab testing and trials are all so diverse, but interaction testing is, as I understand it, usually something that happens in the first phase of testing medications of any kind.

Because no one here works in this arena (clinical trials for medications), though I can't answer more than this for you in any kind of expert way, but if I wanted to know about this, I'd start my research with a web search, maybe using search phrases like "drug interaction" and "clinical trials." It's not going to go one way for hormonal methods of contraception and different for all other kinds of medications, so there's no reason to focus specifically on hormonal meds. When it comes to interactions, drugs are drugs.

There's also no one way lab tests and trials go for contraceptive methods versus other medications. An efficacy study is an efficacy study, you know? In this case, though, yes, efficacy is measured for contraceptives by how many people become pregnant in one year of a given method (save for emergency contraception, which is measured by incident of pregnancy or not).

You can also look up and find what may or does interact with a given contraceptive online very easily. Here's a page for that for the implant: https://www.nexplanon.com/medicine-interactions/ Your pharmacist is also someone who can always look this up: they have access to databases with all this information.

I will say, it is sounding like you're pretty locked into worry about this, and so I'd suggest maybe stepping away from so much focus on it, at least for a bit. It feels a little to me like your anxious mid might kind of be trying to trick your rational one into thinking questions like these are about curiosity when they may instead be based in anxiety?

[Kela]

Re your last point - oh yeah for sure, but I do actually find the science behind birth control interesting too have read quite a few studies now on nexplanon/the implant in general, fascinating stuff!

[Heather]

I get it. It's not an either/or.