Jadelle Implant: Side effects, How to remove and insert Jadelle

Photo of Jadelle Implant: Side effects, How to remove and insert Jadelle

What is Jadelle Implant?

Jadelle is a reversible long acting contraceptive implant that is composed of two flexible silicone-based rod implants, each measuring 43mm long and 2.5mm wide. Each Jadelle implant contains 75mg levonorgestrel as active ingredient. Excipients are: polydimethyl siloxane, anhydrous colloidal silica.

Jadelle is a long acting progestin only contraceptive preparation that can last for up to 5 years. What this means is that, Jadelle can prevent pregnancy for upto 5 years once it has been inserted. Jadelle is normally inserted underneath the skin. Jadelle is manufactured by Bayer Oy Company.

The Jadelle implants comes as two rubber like rods that are thin and flexible and can be inserted in the outpatient clinic by the inner aspect of the arm (the part that touches the skin of the chest). It is normally inserted in the arm that you may do not use often. If you are a right handed woman, then Jadelle will be inserted in the left arm and if you are left handed, then Jadelle is inserted in the right arm. This is to enable you use your most preferred arm very well. It doesnt mean that Jadelle paralyses arms but just for comfort while doing any task.

Mechanism of Action of Jadelle implant

Jadelle contains a chemical substance called a hormone. The name of this hormone is called Levonorgestrel. This hormone is the most active substance in Jadelle, hence it is called the Active ingredient. After insertion of Jadelle implant, the levonorgestrel starts to be released continuously in small amount into the body. The released levonorgestrel causes the mucus of the cervix to become thickened, making it difficult for the spermatozoa to penetrate and get to the ovum. You are to note that it thickens the mucus, on order to make it difficult to penetrate. Sometimes, the mucus can be penetrated and pregnancy may still occur even while using Jadelle (that is why it is always said that there is no contraceptive method that is 100% protective except abstinence). However, the chance of this happening is very rare; hence you should not be worried. Another mechanism through which Jadelle implant works is by inhibition of the release of the ovum (human egg) from the Ovary.

Effectiveness of Jadelle impants

As earlier stated, jadelle can prevent pregnancy for up to 5 years effectively with a failure rate of less than 1% every year. This means that out of 100 women that use jadelle, less than 1 of them may become pregnant. However, it is very effective and can prevent pregnancy to a very large extend. After 5 years, the effectiveness of jadelle implant reduces and pregnancy may occur. It does not mean that once it has been inserted, one cannot remove it again. If you change your mind to become pregnant or may want to change another contraception method, you are free to remove the jadelle any time after without actually waiting for 5 years.

For women weighing greater than 60kg, the effectiveness of the Jadelle may not be up to 5 years because of their body weight; the more the weight, the less the effectiveness of the jadelle implant.

Use of Jadelle Implant

Jadelle is primarily used for prevention of pregnancy and it is a very good method of family planning especially for long term birth control. However, it does not protect from sexually transmitted infections such as Gonorrhea or syphilis, vaginal infections, or even HIV/AIDS.

Before using this contraceptive implant, it is good you discuss with your medical doctor because it has risk and benefits and your doctor would advise you as to whether it is good for you or not.

Jadelle is one among many types of contraceptive methods and can be substituted by others if it is not suitable for use by you.

The insertion of Jadelle is easier than its removal and some medical doctors have more experience in insertion and removal of Jadelle than others.

Removal of Jadelle may be more painful and difficult than the insertion and may leave a scar after removal (a risk that can be avoided by using other contraceptive methods other than impalnts).

Use of Jadelle after giving birth

If Jadelle is inserted within 3 weeks of delivery, then it is unlikely that you may be pregnant; hence there would be no need for other contraceptive precautions. But if you are using it after 3 weeks of delivery, then a pregnancy test would have to be done to confirm you are not pregnant before inserting the implant and after insertion, non-hormonal contraceptive methods such as use of condoms or cervical cap must be done for a minimum of 7 days to allow for adequate distribution and action of Jadelle to occur first before the non-hormonal method is stopped.

Breastfeeding mothers may still use Jadelle but should first discuss with their doctors first. It is excreted in breast milk but there is no evidence of any unwanted effect on breast fed babies.

Using Jadelle implant after Miscarriage or Abortion

Immediately after miscarriage or abortion, the implant can be inserted.

Insertion of Jadelle Implant
Insertion of Jadelle Implant

 

Procedure on Insertion of Jadelle

The insertion of tis implant should be done by a health care professional who knows the procedure. It is implanted within 7 days from the start of the menstrual flow (within the first 7 days when bleeding starts) to ensure the woman is not pregnant.

It is inserted using a local anaesthetic agent such as lidocaine to help reduce the pain during insertion. The implants are inserted just underneath the skin which makes it easier for removal. The deeper it is inserted, the more difficult it is to remove it.

How to insertJadelle

  1. Locate the less dominant arm of the patient
  2. Clean the area you want to insert the implant using methylated spirit and swap
  3. Allow it to dry
  4. Apply local anesthetic agent
  5. Using the Trocar, inject under the skin (in the subcutaneous tissue) up to the level of the mark on the trocar.
  6. Remove the plunger of the Trocar and insert the jadelle implant rod through the trocar.
  7. Remove the trocar.
  8. Repeat the same procedure for the second jadelle rod implant, near the side of the other rod.
  9. Clean the area and cover with a bandage

Do not scratch the area of insertion. The area of insertion may change in color, there may be bruising, itching (do not rub the area) or swelling. An infection may occur, hence, care should be taken to avoid this. Do not overuse the limb after the insertion, wait until after a few days.

Skin reactions following insertion of Jadelle implant

  1. Scarring
  2. Ulceration
  3. Tingling
  4. Numbness

Procedure on removal of Jadelle

  1. Feel for the implant to ascertain the terminal of the rods.
  2. Clean the site of the lower terminal with methylated spirit and swap
  3. Apply your local anesthetic agent
  4. Make a small incision just below the lower terminal end of the implanted rod
  5. Push the upper terminal so that the tip of the lower terminal protrudes through the incision
  6. Use forceps and have a firm grip on the tip and gently pull it out
  7. Repeat the same procedure for the second rod
  8. Clean the site and apply bandage
  9. Allow to heal for few days

Do not remove Jadelle by yourself; it should be done by a health care professional.

Bruising, pain, scarring, numbness and tingling may occur at the site of removal.

After removal of the implant, pregnancy may occur after a month and sometimes may delay for few months.

Contraindications to use of Jadelle implant

  1. Do not use Jadelle if you are allergic to levonorgestrel
  2. Abnormal vaginal bleeding.
  3. Proven or suspected Cancer of the breast or cancer of the endometrium (lining of the uterus womb)
  4. Liver tumors or liver disorders
  5. Blood clotting abnormalities (disorders)

Jadelle contraceptive implant side effects

The side effects of the implant include the common and less common side effects. If you experience any, you may need to see your doctor. The less common side effects do not mean that they are less harmful. Any side effect is important and should be discussed with your doctor.

Common side effects include:

  1. Irregular menstrual bleeding is the most frequent adverse effect with implants. Menstrual period may be prolonged, the bleeding may be heavier or lighter, spotting may occur between periods or periods may even stop. The irregularities in bleeding may stop if the jadelle implant is continued.
  2. Weight gain may also occur.
  3. Visual changes may also occur
  4. Nausea and vomiting
  5. Vaginal discharge
  6. Breast tenderness (pain on touching)
  7. Headache, nervousness (irritability) and dizziness
  8. Increased Bilirubin levels in the blood or yellowing of the eyes
  9. Blood sugar (glucose) and lipid may be altered; hence diabetic individuals should be monitored closely when using Jadelle implant.
  10. Pelvic pain and cervical inflammation

The less common side effects of jadelle contraceptive implant

  1. Weight loss
  2. Migraine headache or persistent headaches or fainting
  3. Acne, rash, itching, hair loss, excessive hair like that of a man (hirsuitism)
  4. Ovarian cyst
  5. Vaginal inflammation
  6. Fatigue
  7. Crushing chest pain
  8. High blood pressure
  9. Feeling of the heart beating (palpitation)
  10. Difficulty in breathing
  11. Breast discharge or benign breast lump
  12. Depression, mood swings and decreased libido
  13. Varicose veins predisposing to thrombus formation. Varicose veins are veins that look tortuous and prominent mostly on the legs.
  14. Abdominal discomfort

Drugs interactions with Jadelle

Some drugs decrease the effectiveness of the implant and these drugs include:

  1. Grapefruit juice
  2. Carbamazepine, phenobarbitone, Phenytoin , primidone ,oxcarbazepine, topiramate, felbamate, lamotrigine for treatment of seizures and psychosis
  3. Rifampicin for treatment of Tuberculosis
  4. St. Johns Wort (Hypericum perforatum)
  5. Medicines used to treat bacterial infections: e.g. clarithromycin or erythromycin
  6. Griseofulvin or itraconazole, voriconazole or fluconazole for treatment of fungal infections
  7. Antiretroviral drugs for HIV or hepatitis C virus (HCV) like efavirenz, nelfinavir, ritonavir, darunavir, amprenavir, lopinavir, nevirapine, indinavir, atazanavir, etravirene or tipranavir
  8. Bosentan for management of hypertension or Verapamil
  9. Cyclosporine

In general, if you are taking other drugs, make sure you let your doctor know before insertion of the implant.