Letizia is not the only one to not really know what it is. The subdermal implant is one of the latest methods to arrive in Italy, and not everyone is familiar with it yet. It is a soft, flexible rod (4 cm long and 2 mm thick) made of a special plastic (ethinyl-vinyl-acetate) that contains a progestin called etonogestrel inside. The implant is inserted under the skin of the inner part of the arm, and releases a small, constant amount of hormone that provides an effective contraceptive action for 36 months. It works like the progestin-only pill, inhibiting ovulation and creating an unwelcoming environment for the sperm and the egg. Using this method, you are protected from an unwanted pregnancy for up to 3 years. It is therefore considered to be a long-acting contraceptive.

The contraceptive effect begins within 24 hours of insertion, and is immediately reversible after implant removal. It can be removed at any time.

It is good that Maddalena is thinking about this in advance. If you are also thinking about it, prior to giving birth, inform yourself by consulting your gynecologist, who can give you personalized advice regarding your situation. The subdermal implant is a method that is recommended after giving birth. According to several studies, it can be implanted just 48 hours after giving birth, although this may vary from woman to woman. In any case, at the most you will have to wait a few more weeks. The subdermal implant has no contraindications during breastfeeding or for the child's growth. It's good to know that irregular menstruation may occur, and your gynecologist will surely talk to you about this.

This is a good question from Margherita, and one that is asked by many women. The subdermal implant is inserted into the subcutaneous tissue of the arm, between the bicep and tricep muscles, in order to avoid the large blood vessels and nerves that lie deep in the connective tissue. This way, the daily release of small, predetermined quantities of the progestin hormone is guaranteed for the entire 3 year period that is recommended for the method's contraceptive activity.
Studies have documented that this forearm position is optimal.

Martina's question illustrates a maternal concern that has no reason to exist. In reality, there are no contraindications for the implant, even for adolescents. In fact, over the last ten years, there has been a progressive increase in its use by women between the ages of 15 and 44, both for the implant and the IUD that releases the progestin hormone. Both methods are defined as long acting reversible contraceptives (LARCs), and allow you to live your sex life in a completely calm manner, without the daily pressure of taking the pill, and without the need for a good knowledge of your body when you are still young and discovering yourself.

The implant is a method that has recently become available in Italy. This explains why it is not talked about that much, and why it is not used as much as it should be considering the advantages it offers. According to experts, it is an ideal contraceptive for adolescents because of its efficiency and reliability.

Are you also worried about this like Enrica? The subdermal implant does not contain estrogen, but only the progestin etonogestrel. It has the same mechanism of action as the progestin-only pill, but has the advantage of providing long-term contraception for 3 years. Once implanted, there is no need to remember to take a pill every day. It is recommended in all situations where you are not able or willing to use estrogen.

We can respond to Michela that this is, in fact, true. The progestin hormone contained in the subdermal implant (etonogestrel), despite being a different molecule than that found in the progestin-only pill, acts in the same manner for pregnancy prevention. The main mechanism of action is the effective inhibition of ovulation, which is further amplified by the thickening of the cervical mucus, which creates a hostile barrier for the ascension of sperm. The implant, when inserted correctly (only the gynecologist can do this), has a high rate of efficacy that is greater than 99% (99.95% in fact, and it is considered the most effective hormonal contraception) for all three of the years in which it is recommended to keep it in. After this, it can be replaced with a new implant.

We often hear this statement from the women who use it, such as Mimma. The subdermal implant is a long-acting reversible contraceptive that does not require daily, weekly or monthly administration like other contraceptives. Thus, you don't have to remember it. You forget that it's there, but it does its job, leaving you free to safely live your sex life without always having to remember to take something. It has an average duration of three years.

Nives poses an important question that requires good information. The subdermal implant has to be removed by the end of the third year, and can be immediately replaced with a new one. If it is left for a period greater than that indicated, the subdermal implant will have a contraceptive efficacy that is progressively reduced in proportion to the increased amount of time left in, thus increasing the risk of pregnancy. There are not, however, any health risks in general.

Do you have the same fear as Olga? Let's get rid of unjustified fears! The subdermal implant is one of the most effective contraceptive methods available today. It must be inserted by qualified medical personnel, and provides an efficacy greater than 99% of preventing an unwanted pregnancy. It is a discreet and very well tolerated method. You can feel very confident if you decide to use it. For any further questions, talk to your gynecologist.

Pia has arrived with all of her fears (and she is not the only one!). Let’s clarify these aspects well. The subdermal implant is inserted (and removed) in the hospital by a gynecologist, who makes a small incision in the inside of the arm. The insertion time is approximately 28-30 seconds, which is very short, and the woman practically doesn't even realize it. In any case, to reduce any discomfort, a mild local anesthetic is administered. Additionally, the applicator is easily handled and functions well, according to the statements of the women themselves in a study conducted across 23 international centers.
When inserted correctly, the subdermal implant remains in its original position throughout the 3-year period. You shouldn't worry that it will move!

The choice of when to insert the subdermal implant depends on the contraceptive method used up until then.

• If in the last month you have not used any form of hormonal contraception, the implant will be inserted between the 1st and 5th day of the menstrual cycle.
• If you are using a combined hormonal contraceptive (the estrogen-progestin pill, ring or patch), the implant should ideally be inserted the day after the last intake of the previous method, or in any case, by the last day of the interval without the pill (or with the placebo pill), patch or ring.
• If you are using the progestin-only pill, the subdermal implant can be inserted on any day.
• If you are using an injectable contraceptive, the implant should be inserted on the same day that the next injection is scheduled for.

What Patrizia read is true. The subdermal implant (just as the intrauterine device (IUD) that releases progestin) has demonstrated high contraceptive efficacy – higher by 20 times compared to other methods (pill, ring, patch) – as a result of greater adherence to the method of intake, which does not require a precise pattern of use as opposed to the pill, the ring or the patch. The data collected from the scientific literature indicates a high continuity of use for the 1-year and 3-year methods (67% after 3 years of use compared with 31% for other methods).

Numerous studies have also shown the superiority of long-term contraceptive methods like the subdermal implant in preventing repeated miscarriages compared with other methods.
The implant (as well as the IUD) can be inserted at the same time as the interruption of pregnancy, avoiding the necessity to re-intervene immediately in a psychologically delicate moment for the woman.

Renata's question is an entirely valid one. If at any time you change your mind, personal situation or desire for motherhood, the subdermal implant can be removed immediately. It does not affect the existing level of fertility, which will return within a few weeks after correct removal of the implant. The removal, just like the insertion, must always be performed by a gynecologist.

If the subdermal implant has been correctly inserted by the gynecologist, a variation in the menstrual cycle does not mean that the system is not suited to your body, or that it does not ensure contraceptive protection. In general, you shouldn't have to do anything other than inform your gynecologist of the variation in flow.

Scarlett was right to talk to her gynecologist. As happens with the progestin-only pill, even with the use of the subdermal implant, the menstrual cycle may vary both in terms of frequency (absent, less, more or continuous), intensity (reduced or increased) or duration. According to surveys conducted, the absence of bleeding (amenorrhea) was reported by about 1 in 5 women, and 1 in 5 women always report frequent or prolonged vaginal bleeding. The bleeding experienced during the first three months of implantation is considered fairly predictive of the future bleeding to be expected for each woman. Talk with your gynecologist too in order to get all the information you are looking for.

Calm down Rita, you can go to the beach without anybody noticing anything! The subdermal implant is a discrete and personal. It is not noticeable to the naked eye, but the two ends of the implant can be felt if you press your fingers gently at the insertion point. Since it is radio-opaque, it can be viewed using an X-ray or a CT scan. It is also visible through ultrasound and magnetic resonance imaging.