STEAM Project Essay:
15 April, 2023
How The Nexplanon Birth Control Implant Hormonally Regulates Ovulation and Menses
Out of the 72.2 million women in the United States 46.9 million of them are on some sort of contraceptive birth control. The conversation of beginning a course of contraception is one that just about every, if not all women will have with their providers at some point in their lifetime. When we think of contraceptives our mind immediately takes us to the daily oral contraceptive pill. However, there are multiple other contraceptive options that are not as commonly talked about. The birth control patch, hormonal IUD, copper IUD, Depo shot, and Nexplanon arm implant are all other forms of contraception. Most of them are in fact more accurate at preventing pregnancy than the everyday oral pill. For my STEAM project I will be using objective nine under the reproductive category by targeting the Nexplanon arm implant. So, how does this contraceptive work, and what is it doing to your body?
The Nexplanon became available on the market in 2010. This device was marketed as a contraceptive that is inserted directly into your arm, FDA approved for up to three years, has a 99% effectiveness rate in pregnancy protection, and is designed to be radiopaque (visible in x-rays). The Nexplanon device releases the hormone gonane progestin etonogestrel continuously throughout its three year cycle. This type of hormone is called progestogen which is a synthetic version of the hormone progesterone. The amount of progestogen released can be measured to about 68mcg daily according to Williams Textbook of Endocrinology (Thirteenth Edition). This release of progestogen into the body allows for thickening of the cervical mucus, altering of the lining of your cervix, and prevention of ovulation.
Progesterone inhibits follicular development ultimately leading to the prevention of ovulation. When the Nexplanon device releases progesterone it starts a negative feedback loop that works at the hypothalamus to decrease the pulse frequency of gonadotropin-releasing hormone (GnRH). GnRH is the hormone that is responsible for releasing follicle stimulating hormone (FSH) and luteinizing hormone (LH). By decreasing the pulse frequency of GnRH, FSH and LH can never be released meaning that there is no development of a follicle. This negative feedback loop causes the secretion of LH to be stopped in the middle of the LH surge cycle. Now that follicle development and LH surge has been completely stopped there is no follicle to be fertilized. Therefore, ovulation has been completely prevented, ultimately preventing the risk of pregnancy.
As with any medical device, Nexplanon does not come without its side effects. One of the most common side effects to the implant is changes in menstrual pain caused by dysmenorrhea (abdominal and uterine cramping), and bleeding. According to Nexplanon.com 1 in 10 women who get the implant will stop their menstrual cycles altogether, this is also known as amenorrhea. Others may experience longer or shorter bleeding cycles, lighter or heavier bleeding, and/or irregular time in between cycles. This happens due to the fact that Nexplanon is a progestin only contraceptive. While your body is adjusting to the newly introduced extra progesterone menstrual cycle patterns will change. Any changes that are made to your menstrual cycle may disappear once your body has become used to the implant (usually between 6-9 months post insertion), or may remain permanent until implant is removed.
Other side effects that do not include menstruation are headaches, weight gain, breast pain, ovarian cysts, and persistent nausea. However, these side effects are never guaranteed. Most women go the entire three years, and get a new device inserted without ever experiencing major side effects due to Nexplanon. This is because every woman’s body will react differently to the hormones being introduced.
For my STEAM Project abstract I chose to design and draw a poster using cartoon-like characters to describe what is happening within the female body with the Nexplanon implant. At the very top of my poster is a cartoon illustration of an egg follicle, the Nexplanon, and a sperm cell. This illustration shows the Nexplanon rod chasing away the sperm cell from the egg follicle. The rod is seen yelling “GET OUT!!” while the sperm cell yells back “but why can’t I get in?” Below this image is a drawing of a girl who displays the proper insertion point for the Nexplanon rod (the bicep). She then responds to the sperm cell by saying she is protected from pregnancy because of the Nexplanon implant.