When it comes to hormonal birth control, is a contraceptive implant (rod) or injection any better than the Pill?
Pharmaceutical companies would like you to think an implant is better because they want you to choose it as your alternative birth control. But let’s be honest. A true alternative would be a non-hormonal method such as fertility awareness or the copper IUD. Implants or rods are basically “business as usual” and here’s why.
Just like the Pill, implants and injections work by shutting down ovulation. So just like the Pill, they switch off hormones and induce a kind of chemical menopause. That’s a pretty significant downside.
Depo-Provera injection completely suppresses both estrogen and progesterone, which is why it has the scariest side effects of any birth control (see below).
Implants are a bit gentler because they permit some estrogen. Their downside is that they annihilate all progesterone and therefore rob you of progesterone’s many benefits for mood, hair, thyroid, bones, and skin. Please read the 7 Superpowers of Progesterone.
But wait, don’t those little rods you put in your arm contain progesterone? Nope. There’s no progesterone in any type of hormonal birth control. Injections and contraceptive implants contain the progestin steroid drugs medroxyprogesterone acetate, levonorgestrel, and etonogestrel. Progestin drugs don’t give the same benefits as progesterone for hair or mood or skin. Instead, they give side effects which are the opposite of progesterone. Please read The Crucial Difference Between Progesterone and Progestins.
Medroxyprogesterone acetate is the progestin in the Depo-Provera injection. The drug is also used orally as Provera to treat abnormal uterine bleeding and other conditions. By severely suppressing both estrogen and progesterone, Depo-Provera damages bones and so earned its “black box” warning from the FDA. It also causes the troubling side effect of unstoppable weight gain and can set women up for some distressing withdrawal symptoms called an “estrogen storm.“
Levonorgestrel is the progestin in the implants Norplant and Jadelle. The drug is also used in many oral contraceptives, hormone replacement, Plan B morning-after pill, and the hormonal IUDs Mirena and Skyla. Because levonorgestrel is derived from testosterone, it causes androgenic (male hormone) side effects such as acne, hair loss, and weight gain. Levonorgestrel and other progestins were linked with anxiety and depression in the 2016 Danish study of 1.1 million women.
Etonogestrel is the progestin in the implants Nexplanon or Implanon. The drug is also used in Nuvaring and the progestin-only Pill Cerazette. Like levonorgestrel, etonogestrel can cause mood problems, but it is less androgenic (testosterone-like) than levonorgestrel and so slightly less likely to cause acne, hair loss, and weight gain. Like all progestins, etonogestrel can cause insulin resistance.
Both levonorgestrel and etonogestrel implants can cause ovarian cysts, which makes sense when you consider that their main action is to disturb and suppress ovarian activity. And all types of contraceptive implants can cause erratic bleeding.
What’s with all the crazy bleeding on contraceptive implants and injections?
The side effect of erratic bleeding is referred to as “irregular menstruation,” which I would argue is a misnomer. The random bleeds that occur on implants are not real periods or menstruation. Instead, they’re random bleeds or “anovulatory cycles.”
What’s the difference between a real period, a Pill-bleed, and an anovulatory cycle?
A real period is the final event in a menstrual cycle in which ovulation occurred and progesterone was made. In other words, a real period is a withdrawal bleed from natural progesterone. The timing of a real period is about the healthy functioning of your ovaries.
⚠️ Tip: Ovulation is the primary hormonal event of a healthy menstrual cycle.
A Pill-bleed is a withdrawal bleed from a pharmaceutical progestin such as levonorgestrel. The timing of Pill-bleed is about the dosing of the drug. There is no reason to bleed monthly when on hormonal birth control. For more information about Pill-bleeds, please watch the short animation Why Hormonal Birth Control Can Never Regulate Periods.
An anovulatory cycle or “breakthrough bleed” is a bleed that occurs when the uterine lining has been exposed to estrogen, but not progesterone. Estrogen causes the uterine lining to build up until it cannot hold any longer and at which point it sheds. Anovulatory bleeds also occur with conditions such as polycystic ovarian syndrome (PCOS).
⚠️ Tip: Hormonal IUDs permit little or no bleeding, but they do permit some ovulation and some progesterone, which is better than none. In that sense, Mirena gives a more “natural cycle” than does the Pill. Read The Pros and Cons of Mirena.
If we agree that progesterone is important and that ovulation is the only way to make it, it changes the entire conversation about birth control.
Non-hormonal birth control
The main advantage of non-hormonal birth control is that it permits ovulation and the production of progesterone.
The best types of non-hormonal birth control are:
- Fertility awareness method (FAM), which is highly reliable contraception, even for women with irregular cycles. You can do it on your own after receiving online training or reading Taking Charge of Your Fertility. Or you can do it with the assistance of technology such as Daysy Fertility Calculator or Natural Cycles (the first phone app to be certified as contraception).
- Condoms, which are one of the oldest methods of birth control and still one of the best. Check out new brands such as the crowd-sourced unbreakable condom Hex.
- The cervical cap (Femcap) and diaphragm (Caya), which are effective female barrier methods.
- The copper IUD, which is highly effective and non-hormonal and nothing whatsoever like a contraceptive implant. It should not be lumped together with implants into the category of ‘Long-Acting Reversible Contraception’ (LARC).
- Vasalgel, which is a non-hormonal method coming soon for men.
What about implants and injections for endometriosis?
Endometriosis is a serious inflammatory disease. In addition to surgery and natural immune-modulating treatment, endometriosis does sometimes require hormonal suppression with birth control. But even then, I think that Mirena IUD can be a better option than implants. Please read Endometriosis: 5 Natural Treatments that Really Work.
What’s your experience with contraceptive implants? Please comment.
Yours in health,