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Take a Look | Implanon – In & Out

Important:
This is a topic for open-minded adults who are interested to know about the experiences of having an contraceptive hormonal implant. Adults-to-be and teenagers are welcomed to read but please think 3 times before taking a hormonal contraception as it does impact your developmental growth.

If you are against any of these topics and/or still think of these as taboos, please revert your attention somewhere else. The internet is vast and full of content. Your inputs will not be welcomed here. Please go somewhere else. Thankiew.

Where is Implanon? What is Implanon? Why is Implanon?

It’s basically a plastic rod that’s being chugged into your arm, excreting hormones that thicken the fluid around the cervix to prevent sperm from entering the womb to meet the eggs. Once inserted, it’ll last 3 years and then you’ll need to take it out. You can read more about it here since I’d like this post to be more towards my experience’s side.

I’ve once written a detailed blog post back in 2018 on each and every birth controls that you can find in Malaysia (even price differences). If you want to know more about other birth controls, I’ve got you covered.

Why did I take it?

I don’t like to worry every single second before/during/after the hunka hunka time. For condoms to have a 20% failure rate, it scared me a lot. I wanted a solution that doesn’t need short-term recurring treatment but also doesn’t have a lot of risks putting in and taking it out. I have trouble remembering dates and time so pills are absolutely not my thing. IUD is also not an option for me, especially when I’ve never delivered a child. So, Implanon came into mind and it has an approx 1% failure rate. Why not try it at least once in my life?

Also, prior to that, I tried with the injection (which lasts 3 months) to see what are my possible side effects and nothing much happened. So, I felt that I was alright to take the implant.

Where and how did I do it?

Any gynae clinics should have Implanon in their inventory. (Nexplanon is more popular in the US but not available here.) If they have the stock, they are most likely capable to help you put it into your arm.

I went to a clinic in Serdang to get my Implanon inserted. You need to make sure that you are not pregnant before you are allowed to do the insertion. Firstly, you must be on your period. Then, you need to do a pregnancy test (give them your urine, they test it themselves on the spot). When you’re clear, you’re good to go. (Call your gynae to confirm before this, I might be wrong since it was done 3 years ago in Nov 2018).

The doctor will take out the tools and rod from the Implanon box. Note that everything they used for the insertion should all come from a fresh and new unit. They will apply local anaesthetic onto your upper arm first, then aim the applicator on your skin. The rod will be pushed into your skin (you should not be able to feel pain) and once the doctor confirms that it’s good, congrats, you are now immune to pregnancy.

If I’m not mistaken, you should be using your non-dominant arm as it does affect your daily activities a little, during your healing period.

Assessment of Implanon��� insertion and removal - Contraception
Credit: Sinofsky, Christ, Levine (2008) ORIGINAL RESEARCH ARTICLE| VOLUME 78, ISSUE 5, P409-417, NOVEMBER 01, 2008

Doctor of the day:
The clinic I went to is Specialist Clinic for Women and Children CT with Dr Tan Ee Peng.
I do not recommend this place. 

At this point, I’m not going to be cordial since I had horrible experiences whenever I visited this clinic. I’m most likely not welcomed by the clinic because apparently, they cannot handle it when I confronted them for their bad service and left a bad review on their Google Review. Here’s what went down:

Before I visited, I’ve texted two nurses (who handles Whatsapp inquiries) about the procedure and price. When I asked if I need to be on my period, the nurse said “No, you don’t need to be on your period.” So, I waited until my period was clear, went to the clinic, waited 4 hours over my appointment time, and then when it’s finally my turn, my consultation ended within 3 mins. Why? The doctor now says I must have my period to continue. Great, not only that I missed out on important things I gotta do, I now need to wait for another whole arse period cycle to get my period and fight for another appointment slot. At this point, I’ve already informed the doctor that her two nurses told me I didn’t need to be on the period prior to visitation. She apologized and said I will not need to wait in my next visit, can just jump the queue. (She said she wrote a note down for recording so, in my next visit, the nurse will see it.)

Got my period, booked for a slot, went to the clinic, and did a pregnancy test to confirm that I am not pregnant… then waited another 2 hours over my appointment. When I walked to the counter and asked (nicely) if the doctor still allowed me to jump the queue, the nurses were confused and said they will ask the doctor. Waited for another 1 hour-ish. (At this point, I got really pissed, so I wrote a 3-star bad review lel.) When I walked in, all nurses and the doctor herself were sour-faced. No one smiled or tried to be nice. She didn’t even greet me. She smacked the table as she was getting up, got all her tools, went straight into the insertion. Once she was done, she just said “ok you can go now” without any other words. I was so in-shocked, I really don’t know what to do. All I knew was that I had to pay for the fees and get out of there. No one in the clinic was friendly. When  I got out of that clinic door, I was completely scarred and was at the edge of crying. (For those coming to say “you shouldn’t have written it”, honestly, try being in my position. The whole process took months and it was really frustrating.)

Fast forward to a few months ago, I texted the same nurses to ask about the removal fee and when can I make an appointment. I was left hanging from 12pm to 6pm and was told that “sorry, I cannot help you, I am only taking appointments, we are closed now, sorry for the inconvenient.” Lol. Ok. To be fair, all her nurses can be quite unfriendly (rude, sometimes) during communication, so I guess I shouldn’t be surprised.

Another reason why visiting her isn’t a great idea is because she’s always full-housed. You’ve got an appointment at 1pm? You’ll most likely be seeing her from 3pm-5pm. I would 1000/10 wished I went somewhere else instead. And, no, they pretty much won’t be bothered if I wrote this bad review about them. They have too many patients for them to actually care about me or losing potential patients. I only went to her because my mom loves her. Oh well.

After Insertion

How was the immediate situation after insertion?

My arm was bruised for a few days and it was very weird to use it because it felt so sore and a little numb. My skin felt tender and delicate. I couldn’t bring myself to use my arm for a few weeks. There’s a small and round scar from the insertion but it’s pretty subtle. It doesn’t affect me.

What really affects me is feeling the rod under the skin. It felt so fragile at first. The thought of touching it felt rather painful to think about it. My partner had to try really hard not to grab onto my arm because we were both so worried that it might puncture through my skin or anything inside my arm. Took us a while to get used to it. (He was still very hesitant to touch it at the 3rd year mark lmao.)

His Perspective:
She freaked out about the bruises, it changed colours like most bruises do and lasted for a number of days, from purple to green-ish, though it eventually went away. I still recall that, even after the bruise went away, it still hurt to move the arm here and there. So, yes, do put it in your non-dominant arm to avoid any inconvenience in your day-to-day.

How did I feel on the first year?

I felt amazing, to be honest…. at first. My period stopped. My skin felt clear. I didn’t need to worry about getting pregnant at any point in my life (ok that was not all correct, I still worry but at least it’s not every single second. It’s only when I feel extra bloated and have the need to buy tests and try. They were all negative lel).

My mental state though… a little odd to explain. My mood swings are not as frequent but they swing harder when they do. Feelings are way more dramatic in my head, I had a hard time holding back myself in many situations. My anxiety was amplified a little more. There were days where I got really confused as to why I suddenly feel sad and want to cry out of nowhere (luckily I was always in my room) so it was easier for me to get it out of my system.

I also feel more lethargic a time goes by. I’d say that but at the same time, I was already good at masking so it didn’t look as bad on the outside. I didn’t get any dizziness or feeling nauseous, so that’s really great. I do feel bloated a lot of the times. Water retention got worse with this. My boobies definitely feel a bit tender but they are growing fast. My appetite got a lot bigger too.

Halfway through, I was getting UTI’s quite a few times. I do believe that the spike of progestogen level has caused UTI’s. Good thing they are easy to get rid of, albeit painful to experience. Also, instead of a period, I am spotting on a frequent basis. I spot almost every day of the month, which means I need to wear liners all the time. That contributed to dryness in the southern area.

His Perspective:
The mood swings did swing much harder, for a wider span of reasons. What she may not have taken so seriously in the past now had a chance to swing her into a depressive state and these emotions lasted longer and were a lot more dominant over logical reasons. This continued for pretty much the whole duration of the implant is in. As the boyfriend, it meant that it was about ten times harder to predict what would and wouldn’t send her emotions into another swing, though not impossible, it does take some time and effort to get used to so take note of that. Also, the implant moved from the initial area to further up the arm and maybe deeper too, this matters later on when we came to the time to remove it.

How did I feel on the second year?

Well, here’s where the weight gets a little more out of control. I was having difficulties controlling my cravings so my weight grew kgs easily. I had to snack on things or eat KBBQ meals almost every week. It wasn’t that healthy but I was clearly clouded by the temptations and cravings. 

My mental state got knocked a little harder than before. At this stage, I was stressed with work, family (stupid) issues, and more. The transition from student to adult life really hit me a little harder than I can handle. With the new phase of depression and anxiety, I was having more difficulties in controlling my sobbings and thoughts. 

My bra size went from 70A to 80E lmao. 

How did I feel on the third year?

At this point, my weight has already increased between 6-10kg.

My mental state got worse because not only that I’m constantly getting told that I look superbly fat and that I should take out the implant immediately, I was also under a lot of stress with one of my friends. That friendship caused me to have a mental breakdown, which almost leads to a breakup, and I was sobbing 3-5 times a day, for weeks. (Don’t worry, I know I need professional help at this point.) I couldn’t stop even if I tried and my body was urging me to cry it all out or else I won’t get to sleep. For a few weeks, I was sleeping at 3am or 5am. I knew something was wrong and I needed to do something about it. I couldn’t rely on my own anymore.

I was very conscious about my food intake, tried to avoid food but despite eating smaller portions or lesser meals, nothing really changed. I’ve tried walking more on the treadmills but my backpain (mild scoliosis) and useless ankles (sprained and not properly treated) didn’t really make things easier. 

My bra size went to 85E now. 

His Perspective:
To note this, before the implant, during our days in University she also slept around 2am-3am as well on most days but it didn’t affect her as much as it did now emotionally and mentally. Work was indeed taking a toll on her amongst other things so the lack of sleep definitely added to the growing list of pains for her. 

Overall (while wearing it)

Cons:
1. Emotional wrecking ball appeared
2. Heavy cravings – tough to control
3. Water retention
4. UTI’s
5. Spottings
6. Difficult to lose weight
7. Weakened memory
8. Lot’s of uncontrollable sobbing

Pros:
1. No worries at all
2. No concerns about accidents
3. No need to panic about one-time-hit bingo
4. No need to panic about future
5. No need to worry that I don’t have tens of thousands for dealing with just one baby
6. No mental breakdowns, no financial struggle, no self-torture
7. Boobies

Now that I’m revisiting back the years, the cons do have more quantities than the pros. I guess it really depends on how you see it because, to me, those cons are as equally as the pros, which is essentially not having a baby. Besides, 

The Removal

Where and who did it?

I’m not going to lie, but the process was draggy and tiring. It’s not because I didn’t want to do it, it was mainly because finding the right doctor for anything is tough. Knowing good doctors require word-to-word credit from people you know, for me, I don’t know any good gynes besides the one I mentioned above (I mean she’s good at her job, just not hospitality).

I also tried to do some googling, asking around if anyone has any recommendations, did a lot of calling from here and there. It wasn’t as easy as I thought it could be. I’ve tried asking on IG for any gynae recommendations but there were only a few options available.

Doctor of the day:
One of the gynae recommendation, which is Clinic Christina, popped up and I contacted them to ask for more details. The doctor mentioned that she could do it for RM300-500 depending on what’s required to use, the process, etc. Now, the person who recommended this doctor told me that she was getting hormonal treatments from this doctor but I later found out that she is actually not a gynae through their nurse. 

Basically, the doctor asked her assisting nurse to text me and when I asked “what’s your price for Implanon?” and I got the answer saying (in exact words) “Not sure coz we’re not gynaecology. She is not a gynae but she seen a  lot of women’s problem case”. That surprised me a little but I thought about visiting a gynae for later on. So I told the nurse that I’ll still want to visit Dr Christina and asked if there is any gynae whom she can recommend me to visit afterwards.  The nurse replied (in exact words too), “U can ask the doctor when u come to consult her.” 

At that time, I was losing my patience from asking so many different places. I just decided that I don’t want to visit this doctor anymore, especially when I should’ve visited a proper gynae with actual qualifications to do the minor surgery. (The surgery was not small enough to play around with, even a senior doctor, Dr Lim KB (will talk about him below), does not want to do it because he is not familiar with the process.) 

Also, I made the mistake of going straight to the doctor’s dm without googling on her credentials beforehand because apparently, as I am writing this part, I just realized that she’s more of a medically aesthetic and beauty doctor instead. I will not comment further on this doctor for this topic because she’s not a gynae. It’s up to you if you want to seek medical attention from her. I don’t know much about her credentials but my problem should be solved by a gynae, not a medical aesthetical doctor.

Some of the places that people had recommended were in the hospitals, where asking for pricing gets a little bit tough because you’ll need to see the doctor first. Not only that, if you want to get it removed under insurance coverage, you may not get the claim. I went through dozens of phone calls, back and forth with my insurance company and different hospitals to get more information and set an appointment. It’s not easy but here’s what I did:

Firstly, I called the insurance company to see if it is covered. The general line sent me to Department A, then only get me to Department B (Guarantee Letter department). I asked if the implant removal was covered, they say they don’t know. (Nope, I don’t know why and I am not sure how. It’s supposed to be their job.) They told me to get a referral letter from a general panel and if the service is covered, I’ll get my guarantee letter (GL).

So, that’s what I did. I went to a doctor after work. Waited for about 1-2 hours for a 10min consultation to get the referral letter (assigned me to UMMC without a recommended doctor). Once I got the letter, I needed to wait until the insurance company can issue the GL. When I got the GL, I was confused because the disclaimer said that hormonal replacement therapy, infertility, pregnancy, sexual dysfunction, and contraception FOR WOMEN (the f-king unfairness) are NOT COVERED. So I called the insurance company to check again and guess what, they immediately told me that it was not covered. Apparently, they thought it was because of the side effects (no period, weight gain), so they send me to OBGYN and issued me a GL. Of course, I was furious but I figured that I should visit anyway to see if the doctor can do anything else, such as write it as general surgery, send me to a general surgeon, or give me the price tag to decide if I want to pay myself or not. 

Another problem surfaced, the doctor that the insurance company assigned for my case… had already resigned from the hospital for years. I found this out after calling the hospital to attempt to make an appointment. So, now I need to call the insurance company back and boy, oh, boy… I was told to call the hospital to check which doctor was available. I tried to keep my composure but the person on the other side was a little impatient. Insisted me to call the hospital instead even though I’ve already told her that (a) I’ve called the hospital and they told me to check with the insurance company, and (b) I give them full control on assigning any doctor to me. She went on rambling a bunch of stuff, I didn’t pay much attention to it. Eventually, I just told her to assign me to Dr Lim BK from UMMC. She quiets down immediately, said “Dr Lim BK? OK.” and wanted to end my call immediately. It was really uncalled for but I got my amended GL in the end anyway. (I rated her below average on a survey after the call, another lady called me to ask why and said they will playback the recording to see if there were any actions needed from their side lol.)

With the new GL, I called up the hospital and lucky me, Dr Lim has a slot in less than 7 days away from the day I called the hospital because someone cancelled the appointment. I took it immediately and the next thing left to do was to go and see him.

Doctor of the day:
Dr Lim BK from UMSC has been the highly recommended doctor I’ve heard from someone’s parent who had cervical cancer at the age of 65. Apparently, he is super gentle, sweet, and kind with the old lady. I heard she went through a lot of pain from other doctors but when it’s with Dr Lim BK, everything was more bearable. A lot of good words about him throughout the whole process that lasted 6-12+ months of treatment. I’ve also heard that he is incredibly full-house. If I were to make a new appointment with him, I’ll probably only see him around May or June. He’s also teaching if I’m not mistaken.

My appointment was 4pm and I waited until about 5pm to see him. At first, I was intimidated because he was an old man with grey hair. Normally, older people scare me because you just don’t know what they’re thinking. When I started speaking with him, I realized that I shouldn’t even have to have my guards up. He was very open-minded about what I’m doing. He doesn’t see me as a stupid young adult trying to screw up her life. It was more of a “this is my patient and they are equally important to me” type of energy. 

He asked me what were my concerns and I said that I actually came to see him for removing my implant. He read from the referral note that I haven’t had my period so he asked me when was my last period. I honestly don’t remember when was the last time so I told him the month that I was getting my implant (Oct 19). He got concerned a little and asked me about my weight gain, to which I said below 10kg and above 5kg. He got more concerned and asked me to lay on the bed to do a quick ultrasound check. “Okay, you’re not pregnant, a good thing. So, it was just the side effect of the implant.” He said that in a very light tone and with a slight chuckle to break the tension. 

Then, he informed me that he can’t do the procedure mainly because removing the implant is not part of his speciality/knowledge. He will not do it because it requires a special technique to do so. I thought at that time I would be sent home but he quickly called his colleague and managed to get me a slot right after my session with him. I felt really relieved hearing assurance from him. His nurse asked me to wait outside and sort out my GL on the spot. Once it was sorted out, I waited for another 1 to 2 hours to see his colleague since I’m slotted in last minutely.

Dr Aizura Syafinaz took me under her care and asked me what I needed to do on that day. I stated my concern that the insurance company isn’t going to cover the fees and she said it’s not going to be expensive. Her own charges will be around RM100 and the rest is up to the medical supplies charged by the hospital. She was really nice and straightforward, the no-bullshite type of lady who showed some love and care.  

Once I’ve decided that I wanted her to do it for me, I asked if she wanted me to schedule another time for it since she’s a very busy doctor (I think she’s on par with Dr Lim BK). She was a little surprised because she planned to take it out on the spot. I figured “if not now, when?” I’ve been searching high and low, finally found a doctor, took so much time and energy, and I’m pretty sure her schedule’s going to be tough to get slotted in. So, I said sure, let’s do it.

How was the process?

The doctor ordered some anaesthetics from the hospital before we can start with the procedure. That took a while too, probably 30-60 minutes. Once the medical tools and supplies are ready, it was time to lay on the exam table, with a pillow under my head and shoulder, and have my left arm extended for the doctor. My arm was positioned like a muscle man flexing his muscle with the relaxed- fist facing towards my face. 

Illustration showing insertion of contraceptive implant
Credit: Mayo Foundation for Medical Education and Research

The doctor first injected the anaesthetic into my arm and tested the pain levels. Once I’ve stated that I feel no pain, she begins with the procedure. According to my partner who was witnessing the whole bloody scene, the doctor used the scalpel to cut a hole, about half an inch. The doctor apparently had to extend/stretch my skin with a scissor-like tool to get the cut-hole bigger. The nurse was told to put some pressure on the skin with two fingers to make the implant rod identifiable for the doctor to use a plier to get it out. 

Since the implant had migrated further into the arm, she had some difficulties with catching the rod. I didn’t feel any pain but my anxiety was definitely kicking in at that point because it was very clear to me that she was really having trouble grabbing it. I just remember forcing my arms to relax and keep distracting myself. I also remembered that my brows were frowning really hard. My partner mentioned that the doctor was really trying to “yank” the rod out but there were some complications (I think the rod was latching onto some of the flesh). 

After about 8-10 minutes and a lot of bleeding, the rod was finally pulled out. The doctor had a small celebratory moment and showed me the rod. The first few seconds I was kind of blurred out, not knowing it ended. Took me 1-2 seconds to realize she was trying to show me the rod HAHHAH. In my partner’s words, the rod looked like Yakult straw, which I don’t deny. The doctor wiped off all the blood from my arm (from the size of the area being wiped down, I can tell that there was really a lot of blood) and then put some pressure on my arm to stop the bleeding. Once it’s kind of cleared off, she sewed the wound up, put a patch over the wound, and told me I’m good to go. That was it!

Oh, I also need to go back a week later for follow up but it was just a 3 minutes consultation. Nothing much to check and nothing much to discuss. She was really nice to me and I genuinely felt welcomed and cared for.

There’s a non-gory visual that I found along with a lot more other Implanon insertion and removal information which you can read from here.

How was the billing?

I was hoping that the insurance company could cover most of the medical tools and fees while I pay for the surgery fee. Turns out I didn’t need to pay anything at all because it was ruled as a miscellaneous procedure. I even had the payment counter nurse check with the GL-in-charge nurse from the OBGYN department. The counter nurse checked 3 times with the other nurse just to make sure that I don’t need to pay. The itemized bill totalled at RM460.75. The fees may differ according to everyone’s procedures, needs, complications, assigned doctor’s qualifications, etc. So, the price I’ve stated if purely for references. You should not take the fees I’ve stated and get all up in your doctor’s face if they’ve charged you more. Again, pricing varies accordingly.

As for the follow up, the insurance company made a huge mistake for setting the hospital as a non-panel for my coverage and made me pay RM50 upfront fee. When I checked with 2 cashier counters later on, I ended up paying about RM10+… which should not happen. Technically, I shouldn’t have to pay for anything.

After Removal

Skin Situation

Immediately after the surgery, my arm felt really numb. It took a few hours for it to regain any feelings. My skin felt a little tender, it’s not painful but it gets a couple of single stings here and there. 

The strings do scare me a little. I never had a stitched wound before so I don’t know how to react to it. It didn’t give me any problems tho. There was a few drops of blood leaking out but that’s all.

I was told that I shouldn’t wet the area so I’ll have to put on a waterproof plaster (adhesive dressing) on the wound. There are two options available which are available in the majority of the pharmacies in Malaysia:

  • HANSAPLAST Aqua Protect 20s
    • 25 x 65mm at 12 Strips
      39 x 39mm at 8 Strips
  • Smith & Nephew OPSITE Post-Op Clear Adhesive Waterproof Dressings 8.5cm x 9.5cm 3s

For my wound size, the Hansaplast is enough. My skin couldn’t withstand long hours wearing plasters so I only wear them during shower time. The thread poking out of the wound can be a little irritating so sometimes I’ll use a regular skin-coloured plaster to avoid any friction with the wound and thread. Unfortunately, short-term wearing it also causes irritation to my skin. 

At the same time, since the wound is recovering and regenerating cells, the surrounding area tends to be itchy as well. I tried really hard not to scratch my skin to avoid any breakage. On day 4, my wound practically healed up. The thread was accidentally untied but at this point, it won’t be causing any problems. Later on, I stopped using plasters and the thread fell off eventually.

Body & Mental Situation

On the third day of removal, my stomach felt a lot more bloaty than I’ve ever been. There was a slight cramp and also some feelings of period poop. Spotting became a little heavier. Mental-wise, I feel a lot numb-er than before. It could just be the transition period but I want to wait it out before I make any conclusions.

Day 4 night – the threads fell off. I can confirm that it’s bloody time. It’s either period/shedding of the fluid created by the hormone. I do pee a lot though, for some reasons. Possibly the body trying to adjust to the new hormonal levels.

Day 5 – My head hurts a lot during the evening and I had a deep sleep for solid 2 hours. Felt a little bit too bloated and slight nauseousness. 

Day 20 – My arm feels fine. Mentally-wise, I feel tensed up sometimes but not as blocked as before. Like, the tension gets to be released a lot easier. My body seemed to have released a lot of water retention and I tend to get a lot of gas lately. Not sure how it’s related but I’ve never felt like that before. My front plumpers feel a lot less swollen and I’m kind of worried that I’ll return to flat-chested again 😅 

*I’ll continue to update further as I go
Last update: 5th April 2021

Boyfriend's Critique

Overall, the side effects aside, the implant was what we needed to feel safe and confident to do what we wanted to do at that point in time so I do not have any regrets. The biggest pain was trying to get it removed because that was a wake-up call as she was the one who had to go through the removal process while all I could do was sit there. Even though we split the initial cost of the implant and I did my part to make everything work (well, at least to the extent I knew how), just seeing what it took to remove it, the stitches, the blood, the pain afterwards, it did make me contemplate the benefit of it. So make sure you have someone there to help you through this whole process if you can, even if it’s just being there, I can’t imagine having to do this alone.

Finally, here are the things I’d recommend to keep in stock, no matter what, as long as you have a female organ:

Liner pads: It’s not just for spottings, it’s great for after -seggs-

Towel or waterproof bed pad: Stains are annoying, especially blood. Great for period time and -seggsy- time too.

Urine Alkalizers: Your best friend for when you think/have UTI. Don’t take too many antibiotics though. Abott is a great brand.

Ginger tea or Chamomile tea: Pretty great to warm up the body.

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