Definition and Overview

Nexplanon, developed by Merck, is a progestin-only birth control implant, which is ideal for people who are estrogen-intolerant. Matchstick sized, the implant is embedded underneath the skin. It is preferred by many women as it is very convenient and effective. Nexplanon can be removed through a minor surgical procedure.

Who should undergo and expected results

Nexplanon removal may be performed if:

  • The implant has already reached three years – Nexplanon is only effective for three years. If the patient decides to continue with this birth control method, the old one will have to be removed and a new implant will be placed.
  • The woman wants to get pregnant – The implant can be removed earlier than three years, especially if the woman wishes to get pregnant. It may take a few weeks after removal before the likelihood of pregnancy becomes high.
  • The woman doesn't like the side effects – The side effects of the implant can significantly vary among women, but some of the reported ones are vaginal inflammation (vaginitis), weight gain, flu-like symptoms, and change in menstrual bleeding pattern. The last one is due to the progestin being regulated. Nexplanon continuously releases progestin to prevent the ovaries from releasing eggs and for sperm to fertilize them. This changes the menstrual process and women may have light, heavy, or no bleeding.
  • The woman is diagnosed with a certain condition – The implant is not recommended for women who suffer from heart or liver disease, are currently pregnant, or have blood clots. It is also not recommended for patients with breast cancer or any cancer that is sensitive to progestin.
  • The woman is overweight – There's no clear evidence that the birth control implant is effective for women who are overweight or obese. If they desire to wear one, the implant may have to be removed earlier than three years.


The removal process doesn't take more than an hour to complete. Discomfort is also minimized with the administration of local anesthetic.

How the procedure works

Only a health care provider trained to remove the implant can perform the procedure.

Three years after the Nexplanon is implanted, the woman is directed to proceed to the clinic or hospital for the removal. Prior to the procedure, an allergy test is performed to ensure that the patient is not allergic to antiseptic and anesthetic that will be used later on.

The provider then locates the implant by using the details found on the user card, which includes the place of implantation and palpation. An antiseptic solution is then applied followed by the administration of local anesthesia such as the lidocaine. It can be injected underneath the implant to bring the device much closer to the upper layer of the skin.

An incision of about 2mm is then made in the uppermost layer of the skin; from the tip of the implant toward the elbow. The implant is gently pushed toward the incision and then pulled using forceps. The implant usually has a capsule, so forceps may be used to pull the implant from its capsule.

The incision is then closed and a pressure bandage is placed.

Possible risks and complications

There may be some minor bleeding and bruising in the area, especially a few hours following the procedure. There's also the risk of the rod being left behind during the first pull of the implant. If this happens, the health provider needs to insert the forceps into the incision to pull the rod out.

In some cases, the implant will move elsewhere. The provider may use X-ray to locate it, and if necessary, minor surgery is performed to pull it out.

References:

  • American Journal of Obstetrics & Gynecology
  • Planned Parenthood: "Birth Control Implant (Implanon and Nexplanon)."
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