The role of Implanon in a woman's body
Implanon, also known by its newer name Nexplanon, is a type of long-acting reversible contraception (LARC). It is a small, flexible rod inserted under the skin of the upper arm that releases a synthetic progestin hormone called etonogestrel. This hormone works to prevent pregnancy mainly by stopping ovulation, but it also thickens cervical mucus and thins the uterine lining.
One of the most common side effects of the Implanon implant is a change in menstrual bleeding patterns. For some, this means lighter, less frequent periods or no periods at all (amenorrhea), while others experience irregular spotting. This effect on bleeding is a major reason why the implant can complicate the diagnosis of menopause.
Masking the signs of menopause
The perimenopausal phase is defined by the body's natural hormonal fluctuations as it approaches menopause, typically beginning in a woman's 40s. A key indicator of perimenopause is a change in menstrual bleeding, with periods becoming shorter, longer, lighter, or heavier. Since Implanon already affects menstrual bleeding patterns, this crucial sign of the menopausal transition is often obscured for women with the implant.
The progestin in Implanon does not contain estrogen, so while it can manage some symptoms like heavy bleeding, it does not prevent or mask the symptoms caused by declining estrogen levels. This distinction is critical for identifying perimenopause while on the implant.
Distinguishing Implanon side effects from menopause symptoms
With overlapping symptoms like mood changes and headaches, it can be challenging to determine the cause of your discomfort. Focusing on symptoms driven by estrogen decline is the most reliable strategy for tracking your menopausal transition while on Implanon.
Perimenopausal symptoms unaffected by Implanon
- Hot flashes and night sweats: These are classic signs of fluctuating estrogen levels and are not caused by Implanon. If you experience sudden feelings of heat, flushing, or excessive sweating, it is a strong indicator of perimenopause.
- Vaginal dryness and atrophy: Declining estrogen can lead to vaginal dryness, itching, and discomfort during sex. This symptom is not a side effect of the implant.
- Urinary changes: Frequent or urgent urination can be a symptom of perimenopause, often resulting from weakened pelvic floor muscles and vaginal atrophy.
- Sleep disturbances: While hormonal changes from the implant can affect sleep, perimenopausal insomnia often occurs independently of night sweats.
- Skin and hair changes: Thinning hair, dry, itchy skin, and changes in skin elasticity are often linked to declining estrogen and can suggest the onset of menopause.
- Joint and muscle aches: Some women experience new or worsening joint and muscle pain during perimenopause, a symptom not associated with Implanon.
Perimenopausal symptoms masked by Implanon
- Changes in bleeding patterns: As mentioned, the implant significantly alters menstrual bleeding, making it impossible to use your cycle as a guide for when your periods are becoming irregular due to perimenopause.
- Mood changes: While both the implant and perimenopause can cause mood shifts, the implant's hormonal effects can make it difficult to determine the root cause of symptoms like anxiety or irritability.
Confirming menopause while on Implanon
For women over 50, a healthcare provider may suggest specific tests to confirm menopausal status while on progestogen-only contraception like Implanon.
Follicle-Stimulating Hormone (FSH) test
When you are amenorrhoeic (have no periods) while on Implanon, your doctor can measure your FSH levels via a blood test. Menopause is associated with significantly elevated FSH levels. If two FSH tests, taken at least six weeks apart, show levels above 30 IU/L, it indicates ovarian insufficiency. Based on these results, your provider can advise you on when it is safe to stop contraception.
Continuing until age 55
Many women choose to continue using Implanon until age 55, at which point spontaneous conception is exceptionally rare, and menopause can be assumed to have occurred. This avoids the need for hormone testing and ensures reliable contraception throughout the transition.
Implanon vs. other perimenopausal contraceptive options
If you are looking for an alternative to Implanon during perimenopause, consider this comparison table with other methods.
| Contraceptive Method | How it Works | Key Pros during Perimenopause | Key Cons during Perimenopause | Role in Symptom Management |
|---|---|---|---|---|
| Implanon Implant (Etonogestrel) | Progestin suppresses ovulation; thickens cervical mucus. | Highly effective, long-lasting (3–5 years). Good for women sensitive to estrogen. Reduces or eliminates periods. | Masks period changes, complicating menopause diagnosis. Some may experience irregular bleeding. | Manages heavy bleeding; does not address hot flashes or vaginal dryness. |
| Hormonal IUD (Levonorgestrel) | Local progestin thickens cervical mucus; thins uterine lining. | Long-lasting (5+ years). Reduces heavy periods. Can provide endometrial protection with HRT. | Masks period changes; can cause irregular bleeding initially. | Manages heavy bleeding and provides endometrial protection with estrogen HRT. |
| Combined Pill, Patch, or Ring | Estrogen and Progestin prevent ovulation. | Provides regular, predictable "withdrawal" bleeding. Helps manage hot flashes and other symptoms. | Increased risk of blood clots over age 50. Masks virtually all menopausal symptoms. | Manages both bleeding and vasomotor symptoms effectively until age 50. |
| Non-Hormonal (Copper IUD) | Copper prevents sperm from fertilizing the egg. | Long-lasting (up to 10 years). No hormonal side effects. Does not mask any menopausal symptoms. | Can increase menstrual bleeding and cramping, which may worsen perimenopausal symptoms. | Does not provide any hormonal benefits for managing symptoms. |
Conclusion
Navigating menopause while using the Implanon implant requires a different approach than relying on menstrual cycle changes alone. While the implant is a safe and effective contraceptive during this time, it is crucial to pay attention to non-bleeding symptoms like hot flashes and vaginal dryness, which are more reliable indicators of your menopausal transition. Regular communication with your healthcare provider is key to understanding your body's changes and determining when contraception is no longer necessary. You can explore options like an FSH test or simply continue the implant until age 55 for simplicity. For trusted and comprehensive women's health resources, you can visit the American College of Obstetricians and Gynecologists website to make informed decisions about your health.
