Following a spring approval by Health Canada and training for health-care providersthis fall, Nova Scotians now have access to another form of birth control.
Nexplanon is a small plastic rod that's implanted in the upper arm and slowly releases a synthetic hormone that prevents pregnancy.
Since the late 1990s, millions of women around the world have used it, but Health Canada just approved it in May 2020.
Falling under the same umbrella category as an IUD, or intrauterine device, Nexplanon is a long-acting reversible contraceptive, or LARC. It's effective for up to three years and it stops working as soon as it's removed.
Dr. Hali Bauld was one of the first doctors in Nova Scotia to be trained on implanting Nexplanon, and earlier this month she started training other physicians and nurse practitioners in the province and across the country.
Bauld said she counts any new contraceptive option as a win, but LARCs especially so.
"Medical research, as well as the guidelines from the Society of Obstetricians and Gynaecologists of Canada, would indicate that [LARCs] should be first-line options for all women, including adolescents and adults," Bauld said.
Bauld said Nexplanon is a good alternative to an IUD "especially for younger women who maybe aren't as comfortable having the intrauterine devices placed."
But, as with all forms of birth control, she said it's important for people to explore all the details before choosing what to use.
How does it work?
Nexplanon is made by a U.S. pharmaceutical company, Merck, which describes it as "the size of a matchstick." After making a small incision on the inside of the upper arm, a physician uses a special insertion device to implant the rod just under the skin.
One rod contains 68 milligrams of etonogestrel (synthetic progesterone), and about 70 micrograms are released into the body each day.
The hormone prevents ovulation and thickens the cervical mucus, which makes it difficult for sperm to reach the uterus.
According to Merck's clinical trials, Nexplanon is more than 99 per cent effective.
Who is it for?
Generally, Nexplanon is meant for teenage and adult women, before or after pregnancy.
Merck's clinical trials were done on women between the ages of 18 and 40, but the company says safety and efficacy are "expected" to be the same for any woman who's past puberty and under the age of 65.
Where is it available?
Nexplanon can be purchased at a pharmacy with a prescription. It can then be taken to a trained health-care provider to be inserted.
It takes two separate appointments to get Nexplanon — one for the assessment and prescription, and one for implantation.
Bauld practises out of the Halifax Sexual Health Centre and the Truro Sexual Health Centre, but she said there are at least a few other physicians in the Halifax area who are trained to work with the device, including one at the IWK Health Centre.
What are the downsides?
There's a comprehensive list of possible risks and side-effects on Nexplanon's website.
The most common side-effect is a change in menstrual bleeding, which could mean longer or shorter periods, an irregular cycle, spotting in between periods, or having no period at all.
In order for Nexplanon to work, it has to implant properly. Once the wound has healed, the implant should be visible (with a bit of pressure on the skin) and tangible under the skin. If it isn't, it could have moved to another part of the body and may need to be surgically removed.
What does it cost?
Up front, Nexplanon could cost a purchaser $350. Some private health insurance policies may cover all or part of that cost.
Nexplanon is not currently covered under Nova Scotia's pharmacare program — something Bauld said she hopes will change soon.
"In order for any contraceptive method to be successful and widely utilized, it needs to be publicly funded. So I would strongly suggest that this device be quickly expedited for public coverage," she said.
A spokesperson for Nova Scotia's Department of Health and Wellness told CBC News that Nexplanon will be considered for pharmacare, but not until the pan-Canadian Pharmaceutical Alliance negotiates its price. The alliance currently has Nexplanon listed as "under consideration for negotiation."
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