The Implant Game Show Instructions for facilitator: To prepare for this activity, print out the answer key for the Game Show. Review all of the questions and answers. Follow the general instructions included in the session plan to organize the game show activity and explain the rules to the participants. To begin the game show, view the presentation in Slide Show mode and advance to slide 2, which poses the questions and monitors the progress of the show. When a team selects a category and amount, click the corresponding square on the screen to reveal the question. If a team answers correctly, click the green circle at the bottom of the screen. The presentation provides positive feedback and automatically returns to slide 2 to allow selection of the next category and amount. Notice that after a category and amount is selected, it is no longer highlighted as an option. If a team answers incorrectly, click the red circle at the bottom of the screen. The presentation provides negative feedback and stays on the question to allow another team to answer. If no team answers the question correctly, click the blue circle, which provides no audible feedback but returns to slide 2 to allow selection of the next category and amount.

2/17/2019 Characteristics Side Effects & Complications MEC and Initiation Wild Card 100 100 100 100 200 200 200 200 300 300 300 300 400 400 400 400 500 500 500 500 2

What are implants? 2/17/2019 Progestin-only implants are thin flexible rods or capsules, each about the size of a matchstick, that release the hormone progestin, which is similar to the natural progesterone in a woman’s body.

How effective are implants? 2/17/2019 Progestin-only implants are one of the most effective and long-lasting methods, resulting in less than 1 pregnancy per 100 women using implants over the first year. This means that 999 of every 1,000 women using implants will not become pregnant during one year of use.

Name 3 advantages of implant use. 2/17/2019 They do not require the user to do anything once they are inserted. They prevent pregnancy very effectively. They are long lasting. They do not interfere with sexual intercourse.

Name 3 limitations or disadvantages of 2/17/2019 Name 3 limitations or disadvantages of implants. Most women have some side effects—especially changes in menstrual bleeding patterns. Insertion and removal require minor surgery. Progestin-only implants provide no protection against sexually transmitted infections, including HIV.

How do implants prevent pregnancy (mechanism of action)? 2/17/2019 Thickening cervical mucus (blocking sperm from meeting an egg) Disrupting the menstrual cycle, including preventing the release of eggs from the ovaries (ovulation)

side effects associated Name 4 non-menstrual side effects associated with implants. 2/17/2019 Headache Abdominal pain Acne (can improve or worsen) Weight change Breast tenderness Dizziness Mood changes Nausea

What menstrual changes can a new implant user expect? 2/17/2019 What menstrual changes can a new implant user expect? Changes in bleeding patterns in the first several months include: Light bleeding/spotting Irregular bleeding Prolonged bleeding Infrequent bleeding Amenorrhea (no monthly bleeding)

2/17/2019 What menstrual changes can a implant user expect after one year of use? Lighter bleeding and fewer days of bleeding Irregular bleeding Infrequent bleeding

Name two possible complications associated with implants. 2/17/2019 Name two possible complications associated with implants. Infection at insertion site Difficult removal Expulsion of implant

What is the procedure if one or more implants begins to come out of a woman’s arm? 2/17/2019 This rare occurrence; it usually happens within a few months of insertion or with an infection. If no infection is present, replace the expelled implant with a new rod or capsule through a new incision near the original insertion site. If there is an infection, treat prior to reinsertion if using the original insertion site.

Are heavy smokers good candidates for implants? 2/17/2019 Yes, smokers are medically eligible to use progestin-only implants. Smoking is considered a category 1 condition in the medical eligibility criteria.

5 weeks postpartum and breastfeeding eligible to initiate Is a women who 5 weeks postpartum and breastfeeding eligible to initiate implants? 2/17/2019 Yes. Women who are breastfeeding and less than six weeks postpartum are eligible to initiate implants (MEC Category 2). There is no need for a backup method.

To which MEC category does unexplained vaginal bleeding (prior to evaluation) belong? 2/17/2019 Unexplained vaginal bleeding prior to evaluation is a category 3 condition, “usually not recommended.”

According to the MEC, is a client who is HIV positive and on an ARV regimen eligible for progestin-only implants? 2/17/2019 Yes, according to the MEC, HIV-positive women who are on antiretroviral (ARV) therapy can generally use progestin-only implants, but follow-up may be required in some cases. The ARV efavirenz may reduce the effectiveness of implants. Women taking the ARV efavirenz should be encouraged to use condoms along with implants to provide better protection from pregnancy.

criteria for medical eligibility, when can she start using If a woman meets the criteria for medical eligibility, when can she start using contractive implants? 2/17/2019 Anytime a provider is reasonably certain the woman is not pregnant: First seven days of the menstrual cycle, no backup method needed After the seventh day, rule out pregnancy and use a backup method for seven days Postpartum: Immediately (no need to rule out pregnancy until four weeks postpartum) Post-abortion or miscarriage: immediately, without backup Switching from a hormonal method: immediately if that method was used consistently and correctly After taking progestin-only or combined emergency contraceptive pills: immediately, use a backup method for seven days After taking ulipristal acetate ECPs (UPA-ECPs): On 6th day after taking UPA-ECPs, no need to wait for her next monthly bleeding, use a backup method from the time she takes UPA-ECPs until 7 days after implant is inserted

Name 2 different brands of implants. 2/17/2019 Jadelle—two rods, five years Levoplant/Sino-implant (II)—two rods, three years Implanon NXT—one rod, three years (maybe up to 5)

What are 3 key counseling messages to discuss with clients before inserting implants? 2/17/2019 Reproductive health goals Advantages and limitations of implant use Possible side effects Insertion and removal procedures Follow-up procedures and when to return

recommend to a client who returns because of What should a provider recommend to a client who returns because of irregular bleeding? 2/17/2019 Reassure the client that this is a common and expected side effect. It is not harmful and usually lessens or stops after the first year of use. Recommend a five-day course of ibuprofen (up to 800 mg three times per day). If ibuprofen does not help, she can use combined oral contraceptives for 21 days to address irregular bleeding. If bleeding is heavy, iron tablets may prevent anemia. If irregular or heavy bleeding continues to bother the client, or starts after several months of normal monthly bleeding or amenorrhea, rule out a possible underlying condition unrelated to method use, such as uterine fibroids, a sexually transmitted infection, genital cancer, or pregnancy.

associated with progestin-only implants. Name 3 known health benefits associated with progestin-only implants. 2/17/2019 Reduced risk of symptomatic PID Reduced risk of iron-deficiency anemia Reduced risk of ectopic pregnancy rate in implant users: 6 per 100,000 rate in women using no contraception: 650 per 100,000

Name two conditions that are MEC category 2 for initiating implants and category 3 for continuation. 2/17/2019   Current or history of ischemic heart disease History of stroke Migraines with aura, at any age

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