Implanon experiences depend almost entirely on one thing: your bleeding pattern. Roughly one in five users loses her period completely and is glad of it. A similar group bleeds for long stretches or unpredictably, and that is the main reason implants get removed early.
What strikes me is that this is presented everywhere as bad luck. Research from 2019 shows there is more to it, and that it relates to how much hormone is actually in your blood.
What is the implant and how does it work?
The contraceptive implant is a flexible rod about 4 centimetres long, placed by your GP under the skin of your upper arm, on the inner side. It slowly releases etonogestrel, a progestogen, which switches off ovulation and thickens cervical mucus. It works for three years and contains no oestrogen.
Insertion takes a few minutes under local anaesthetic. You can feel the rod afterwards if you run your fingers over your arm, but you cannot see it.
On reliability the implant is among the very best methods according to Thuisarts.nl, because no user error is possible. You cannot forget it and there is nothing to do on time.
Implanon experiences: the bleeding pattern
Expect irregular bleeding in the first months. After that it settles for most women into one of three patterns: no period at all, occasional spotting, or frequent and prolonged bleeding. The pattern in the first three months predicts the later pattern reasonably well.
| Pattern | How common | How women rate it |
|---|---|---|
| No periods at all | About 1 in 5 | Usually seen as a benefit |
| Rare or light bleeding | Largest group | Manageable |
| Frequent or prolonged bleeding | About 1 in 5 | Main reason for removal |
| Unchanged pattern | Small group | Cycle simply carries on |
Here is the interesting part. Research in Obstetrics and Gynecology in 2019 measured etonogestrel concentrations in the blood of implant users and set them alongside their bleeding patterns. A relationship emerged between the measured level and how often someone bled.
Picture two women fitted on the same day, both with 68 milligrams of etonogestrel. One has no period at all after four months. The other bleeds on roughly half the days across those same four months. Same rod, same dose, and still a different blood level.
That changes the conversation. Your bleeding pattern is not a punishment and not a coin toss, but pharmacology. For anyone who cannot live with unpredictable bleeding, that is at least reassuring: it was not you.
What is the difference between Implanon and Nexplanon?
Same hormone, same dose, same duration. The difference is that Nexplanon contains barium sulfate, which makes the rod visible on an X-ray. The insertion device was redesigned too. In the Netherlands the successor is now standard.
That sounds like a detail, but it solves a real problem. With the old Implanon a rod could occasionally not be located, and removal then became complicated.
Does the implant make you gain weight?
Weight gain is reported, but a clear causal link has not been convincingly shown in research. A review in Seminars in Reproductive Medicine in 2001 already described weight as one of the most reported and simultaneously hardest to prove side effects of implants. What you notice may simply be age and lifestyle.
Alongside weight, women report acne, headache, tender breasts and mood changes. Acne can increase with a progestogen-only method, because the suppressing effect of oestrogen on your sebaceous glands is missing here.
If you notice a mood change that shapes your day, do not wait three years with it. That is worth a conversation with your GP.
What does an implant cost?
In the Netherlands contraception is reimbursed from basic insurance up to age 21, including insertion. Older than that and you pay for the implant yourself or through supplementary insurance. Spread over three years it is one of the cheapest methods per month.
Separately, count on two appointments in three years: one to insert, one to remove. Compare that with four injection appointments a year and the difference is substantial.
Implanon removal: how does it work?
Removal is done under local anaesthetic through an incision of a few millimetres, and usually takes less time than insertion. If the rod sits clearly palpable just under the skin, it is routine. If it sits deeper, your GP sometimes refers you on.
Your fertility returns quickly afterwards. Etonogestrel clears your blood within roughly a week and ovulation can happen within the first weeks. That is a large difference from the contraceptive injection, where you can wait months.
If your period stays away for a long time after removal, blood testing can help your GP. The progesterone test from Lunara shows whether ovulation has happened, with an assessment by a BIG-registered doctor. What an absent period can otherwise mean is covered in irregular periods.
Which is better, an implant or an IUD?
Both are highly reliable and long acting, so the choice is about your period and about where you want something placed. The implant sits in your arm and makes your bleeding pattern unpredictable. A hormonal IUD sits in your uterus and usually makes your period lighter.
If you want no hormones at all, the implant is out and you end up at the copper IUD. If your main goal is ending heavy bleeding, the hormonal IUD is more logical. The wider overview is in birth control and your hormones.
Frequently asked questions
How expensive is an implant?
Reimbursed from basic insurance under 21. Above that, self-funded or through a supplementary policy, spread across three years.
Does insertion hurt?
You get a local anaesthetic, so you mostly feel pressure. A bruise and some tenderness in the following days are normal.
Can you feel the rod?
Yes, as a thin line just under the skin of your inner upper arm. That is intended, and it makes checking easy.
Is an implant free?
Only if you are under 21. After that it falls outside basic insurance.
The implant asks little of you and gives three years of highly reliable protection in return, with your bleeding pattern as the great unknown. If that pattern still does not suit you after six months, removal is a normal and quick step. Discuss it with your GP rather than sitting it out until year three.
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
References
- Thuisarts.nl. Choosing the contraceptive implant. Accessed 2026.
- NHG Guideline on Contraception. Dutch College of General Practitioners. Accessed 2026.
- Lazorwitz A, Aquilante CL, Dindinger E, Harrison M, Sheeder J, Teal S. Relationship between etonogestrel concentrations and bleeding patterns in contraceptive implant users. Obstetrics and Gynecology, 2019. PMID 31503152.
- Meckstroth KR, Darney PD. Implant contraception. Seminars in Reproductive Medicine, 2001. PMID 11727176.
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