The implant, also known by it’s brand name Nexplanon, is a long-active reversible contraceptive (LARC). The implant releases progestin, a hormone that keeps ovaries from releasing eggs and thickens cervical mucus (which blocks sperm from getting to the egg in the first place!). The implant was introduced to me by my primary care doctor when I was getting my Master of Public Health at Brown University. I had used combination birth control pills (pills containing both estrogen and progestin) for years, and when the doctor saw I reported having migraines on my chart at one of my annual visits, she suggested I switch to a progestin-only birth control method. She explained that progestin-only contraception is considered a safer option for people with migraines. Birth control containing both progestin and estrogen can lead to an increase in the frequency of migraines, thus an increased risk of stroke.
I scheduled a visit at Planned Parenthood that day and got an implant inserted weeks later. Having a birth control method resembling a toothpick implanted into my arm became my favorite party trick. I told my friends, people I met on dating apps, and even my thesis advisor, “look at this” and then proceed to poke the implant with my finger until it stuck out a little. People would then put their finger over my skin. When they felt the hard, round, tiny rod they would say things like “wow”, “cool”, “does it hurt?”. The answer to the latter was “no”.
Some people continue to get their periods while on the implant, others have spotting, and others, like me, don’t get their period at all. I loved not getting my period when using the implant. I was concerned about not getting my period as a signal that I was pregnant, but after I was over the spotting phase of the first few months, I never thought about that again and trusted fully in it’s efficacy. I never truly thought about this benefit until a classmate, during a group project session said, “does anyone have a tampon?”. I didn’t have one because I hadn’t needed to use even a pantiliner to manage my period or discharge in a year. This made me feel alienated to the experiences of people who have the capacity to get periods. While I felt grateful for all the money I had saved over those months on menstrual hygiene products, reduction in waste into the planet, not having days where I could function due to cramping and fatigue, and lack of fluctuations in my physical and mental states— I felt a longing to be connected with my body that I had never felt before. And had forgotten what that connection to my body was like. I want to acknowledge that during this time I held privilege in being able to make the decision to get a period or not, had the resources to purchase pads and tampons if I wanted to, and did not encounter dysphoria or unwanted gendered experiences as some trans or non-binary people do with menstruation.
I removed my implant in early March 2020 — days before restrictions to travel, movement, and healthcare due to the COVID-19 pandemic were put in place across the world. My implant was about to expire (they last up to 4 years) and I was dating women at that time. If I had sex with men at all, I would use external condoms. I was engaging sexually with people who identified within one of the gender binaries during that time — I acknowledge that not everyone identifies with the terms “woman” and “men”. Little did I know I wouldn’t be sexually active for a while due to a deadly virus that was spreading over the world and restricting our ability to have sex. Especially for people like me, who were not cohabiting with sexual partners or in a steady relationship that involved sex.
During endless weeks of isolation, I was on a journey to get to know my body without hormonal birth control. This exploration made me feel like a teenager again. I had the privacy, time, and space within my home to delve into new pain, messiness, and emotions. I experimented with menstrual cups and period underwear. I started wearing pads more instead of tampons, and admired the blood clots that would pass each month as they left my body with each cycle. I talked about my bleeding and period symptoms with everyone. I even felt more connected with my feminism.
When my sex life picked back up, I used external and internal condoms as my birth control method when needed, and I continued using them for two years. I eventually grew into a steady romantic and sexual relationship with someone with a penis. We were not being consistent with condom use, and we didn’t want to experience an unplanned pregnancy. Going over the different contraceptive options I have memorized in my mind from years of studying sexual and reproductive health and my personal experiences, I decided to transition into using a LARC method again. This time, a non-hormonal IUD, also known as a copper IUD or by its brandname ParaGuard. My partner came with me to the doctor’s office the day of the insertion and drove me back home. They took care of me that day by helping me change into comfortable clothes, making me herbal tea, bringing me hearty Thai food to bed, and making sure my heating pad kept me warm.
During the first three months post non-hormonal IUD insertion, I bled and experienced cramping so much more compared to any other method of birth control. Though I knew these were common side effects, I did not expect them to be as painful and as debilitating as they were. When I disclosed this to my gynecologist during my Pap smear days before my 30th birthday, she suggested I consider transitioning to another method. She expressed that the IUD may be negatively impacting my quality of life. However, she said the symptoms usually go away on their own after three months post insertion.
The unbearable symptoms did indeed go away after the third month and now I forget my IUD is even in my uterus. I like to joke that during my Pap smear visit my gynecologist flipped the pain switch in my vagina to“off”. Real talk, though, I know that post my IUD insertion my body was left tense, weak, shocked, and traumatized. I believe that revisiting the scene where I had my IUD inserted, speaking to my kind doctor, and feeling cared for by her helped me gain closure and heal.
Today, I still have a non-hormonal IUD (it lasts up to 12 years!). I love continuing to experience most of the emotional and physical feelings I felt when using other non-hormonal contraception methods. I think at this point in my life, hormonal birth control is not for me, and I am grateful to be able to make the autonomous and informed choice to use whatever method feels safe, effective, pleasurable, and connected with myself and my partner. Some people may feel that a hormonal method or no method at all is best for their lives — and that is okay, as long as whatever they choose meets their current needs and priorities. Others may feel forced by partners, friends, family members, or health care providers to use contraception. This is called reproductive coercion, and it is not okay.
Everyone deserves to be able to make their own decisions about their sexual and reproductive health lives. If you or someone you know wants to learn more about contraception, download the Euki app. Euki doesn’t store any of the information you enter into the app in the cloud or anywhere else. You can even set up a personal pin that is not tied to your email or phone number as an additional level of security. If you or someone you know is experiencing reproductive coercion or just needs someone to talk to, the All-Options Talkline offers free and copassionate support. Dial 1–888–493–0092 from anywhere in the United States or Canada.
