Photo credit: YouTube/7NewsAustralia
There are few scenarios more cringe-inducing than the thought of having a foreign object accidentally lodged in a major organ – but having to undergo open heart surgery to remove that object might be one of them. That’s exactly what happened to Australian Cloe Westerway in 2021 when she went to the doctor for what was supposed to be a routine contraception procedure. The experience ended up taking a chilling turn – and may even result in open-heart surgery.
Here’s how the birth control implant works to prevent pregnancy
Cloe, 22, had an Implanon rod inserted into her arm as a method of contraception. The device is a common form of birth control that thousands of women use every year. It prevents pregnancy by slowly releasing synthetic progesterone, which does three things. First, it prevents the release of an egg from the ovaries (ovulation). Secondarily, it thickens the body’s cervical mucus to trap sperm and prevent conception (should ovulation still occur). Lastly, it thins out the uterine lining or endometrium to prevent implantation of a blastocyst (the stage of human development before embryo), just in case the first two mechanisms fail to prevent conception [1].
Cloe was no stranger to the Implanon rod. In fact, she previously had an Implanon device in her arm when she was fifteen years old and had no complications. Because of her prior unproblematic experience with the device, she figured she’d do it again. What she wasn’t expecting, however, was to face years of medical interventions in the aftermath of an erroneous implantation procedure.
Westerway experienced strange symptoms after her Implanon insertion
After getting the new Implanon rod in her arm, Cloe began experiencing several alarming medical symptoms including vomiting, heavy bleeding, and nerve pain. Additionally, Cloe began having heart complications such as palpitations and heartburn. She consulted her doctor, and they decided the best course of action would be to remove the Implanon rod and see if Cloe’s symptoms cleared up. But when they went in to retrieve the rod, they were horrified to discover that the device was no longer there.
After several tests and scans, doctors found the birth control rod lodged in Cloe’s pulmonary arteries. The device, which measures approximately 4 cm, traveled up her right arm and eventually made its way to her heart’s left chamber. The Implanon migration likely resulted from an error during the insertion procedure, where the device was inserted either directly into a vein, or close enough to it to cause damage to the vein. This enabled it to enter into and migrate through her circulatory system.
How common is birth control implant migration?
Unfortunately, Cloe is not the only woman to experience implant migration when using the birth control rod. In 2019, a 31-year old woman in Portugal had a similar nightmarish experience with the Implanon, which came to light after she experienced three months of abnormal vaginal bleeding [2]. Just like in Cloe’s situation, doctors went in to retrieve the rod, only to discover that it had migrated to the patient’s lung. The patient had to undergo surgery to extract the device, and has reportedly experienced no further complication since.
According to a 2017 study, birth control implant migration happens in approximately one out of every one million procedures [3]. However, this is likely an underestimation, given that not every instance of implant migration is reported to the FDA. In most cases of birth control rod migration, the device travels down the arm and into the hands, resulting in carpal tunnel-like symptoms
Implanon is no longer sold in most countries, but migration is still possible with its replacement
Implanon is no longer sold in the U.S. or the United Kingdom. As of 2010, it was replaced by Nexplanon, which acts to prevent pregnancy in the same way but has several features intended to improve safety It comes in a preloaded applicator intended to reduce insertion errors. Nexplanon also contains a tiny amount of barium in order to make it show up on imaging like CAT scan or X-ray in case of device migration due to improper insertion. But migration can still happen.
In 2021, a South Carolina woman won a $600k settlement from the state’s insurance fund after experiencing complications from her Nexplanon implant. The patient experienced permanent nerve damage after an improper placement. And back in 2017, a 37-year-old American woman suffered Nexplanon migration to her left lung [4]. She required hospitalization and lung surgery to remove the rod.
Insertion errors are the main— but not the only— reason for birth control implant migration
Insertion errors are not the only reason for birth control implant migration. In fact, vigorous physical activity can increase the risk of migration, even after proper insertion [1]. So even if a patient has the device in her arm for months or even years without any issues, there’s a possibility that it could still migrate.
Birth control implant migration is an uncommon but very serious problem
The infrequency of birth control implant migration doesn’t make it any less concerning. In Cloe’s case, the doctors were eventually able to locate the device, but getting it out will be no small task. It will likely take multiple surgeries to finally retrieve the rod. Initially, Cloe will undergo lung surgery to remove the Implanon rod out, as it’s less invasive than open-heart surgery. However, the rod’s tricky location means that open-heart surgery will likely be unavoidable. Cloe’s recovery will take months, but her story could have had a much darker outcome – if the rod had traveled much farther, Cloe could have died.
Birth control implants are marketed as hassle-free contraception, but they’re not without risks
Women are drawn to the birth control implant rod because of its ease and convenience. In fact, Nexplanon’s website boasts that the device is “just as effective as the pill, without the daily hassle.” Whereas oral contraception is generally taken daily, using the rod device for birth control is supposedly as simple as getting it implanted. In theory, after the implantation procedure you’re good to go, family planning-wise: maintenance- and pill-free for up to three years.
But as with any medical intervention, the risks associated with the birth control implant should not be ignored. In addition to migration, the rod poses other risks to users, including headaches, vaginitis, weight gain, acne, painful periods, breast pain, and mood swings, among others. Coming on the heels of British teen Layla Khan’s death of a blood clot in the brain just weeks after starting oral contraception, Cloe’s story is a cautionary tale of just how risky hormonal birth control can be.
The bottom line
The only surefire way to avoid complications associated with birth control is to stay off contraception altogether. If you’re looking for a risk-free way to avoid pregnancy, look to an evidence-based Fertility Awareness Method (FAM). Tracking your body’s unique cycle in accordance with your chosen FAM not only helps in family planning, but also provides valuable insight to your overall health as a woman–something no pill or device could ever do.
This article was updated on April 17, 2024 to add links to Nexplanon FDA label and reference citation on its mechanism of action (how it works to prevent pregnancy).
References:
[1] Gilbert, Bernadatte G. “Contraceptive Implant Insertion and Removal.” Primary care vol. 48,4 (2021): 545-554. doi:10.1016/j.pop.2021.07.002 [2] Carlos-Alves M, Gomes M, Abreu R, et alLung migration of contraceptive Implanon NXTBMJ Case Reports CP 2019;12:e230987 [3] Kang, Sarah et al. “Etonogestrel implant migration to the vasculature, chest wall, and distant body sites: cases from a pharmacovigilance database.” Contraception vol. 96,6 (2017): 439-445. doi:10.1016/j.contraception.2017.08.009 [4] Choi JH, Kim HY, Lee SS, Cho S. Migration of a contraceptive subdermal device into the lung. Obstet Gynecol Sci. 2017 May;60(3):314-317. doi: 10.5468/ogs.2017.60.3.314. Epub 2017 May 15. PMID: 28534019; PMCID: PMC5439282Additional Reading:
How the IUD, implant, pill, and other birth control methods work
16-year-old dies of blood clot just days after starting birth control
