What Happens During and After Nexplanon Removal?

Nexplanon removal is a brief in-office procedure that usually takes under five minutes. A trained clinician numbs the skin over the implant with local anesthetic, makes a small incision, and pulls the rod out with forceps. Most people describe the experience as less uncomfortable than insertion. The straightforward cases far outnumber the complicated ones, but when an implant has shifted position or settled deep into tissue, removal can become significantly more involved.

What Happens During the Procedure

The removal process relies on the implant being palpable, meaning you or your clinician can feel it as a thin rod just beneath the skin on the inner side of your upper arm. Before anything starts, the clinician cleans the area and injects a small amount of local anesthetic, similar to what a dentist uses, around the tip of the implant closest to your elbow. Once the area is numb, a small incision (a few millimeters) is made at that tip. The clinician then pushes the implant toward the incision until the end is visible, grabs it with forceps, and slides it out. The incision is closed with adhesive strips or a pressure bandage rather than stitches.

You can expect some bruising, mild soreness, and possibly a small amount of bleeding at the incision site for a few days afterward. A bandage is typically worn for 24 to 48 hours. Most people return to normal activities the same day. If you want to continue using the implant for contraception, a new one can be inserted through the same incision immediately after the old one comes out, so you stay protected without a gap.

When Removal Is Scheduled

Nexplanon is approved to provide contraception for three years, and most people schedule removal around that mark. But removal can happen at any point before then. The most common reasons fall into three broad categories: the implant is reaching the end of its labeled duration, you want to become pregnant, or side effects have become intolerable.

There has been some research into whether the implant remains effective beyond three years. One study following over 200 women who kept their etonogestrel implant in for a full five years found no pregnancies during years four and five, with a cumulative pregnancy rate of 0.6 per 100 women-years over the entire five-year span.¹ That sounds promising, but a systematic review of all available studies on extended implant use found the overall evidence base to be limited and of poor to fair quality, with issues around generalizability.² The current guidance remains to replace the implant at three years, though some clinicians discuss extended use with patients on a case-by-case basis.

Why People Choose Early Removal

Side effects are the dominant reason people have the implant taken out before the three-year mark. Across multiple studies, bleeding irregularities consistently top the list. Some people experience prolonged or frequent bleeding, while others have unpredictable spotting that never settles into a pattern. These changes are driven by the implant’s steady release of the hormone etonogestrel, which thins the uterine lining but can cause it to shed erratically.

In a qualitative study of young women who had their implants removed, participants described reaching a “tipping point” where the negative experiences outweighed the convenience of not having to think about contraception. Beyond bleeding, commonly mentioned side effects included mood swings, headaches, and weight gain, and it was often a combination of these factors rather than any single issue that drove the decision.³ A separate qualitative study from Ethiopia echoed these findings, identifying heavy and irregular bleeding as the most frequently cited side effect behind early removal, alongside partner opposition and desire for pregnancy.⁴

A cohort study of adolescents found that about 80% reported abnormal uterine bleeding, roughly 10% reported mood changes, and 9% perceived weight gain. Adolescents who experienced frequent or prolonged bleeding were more likely to have the implant removed before 12 months. Early removal was also more common among those reporting weight or mood concerns.⁵ Still, three-quarters of the teens in that study kept their implant for at least a year, with the average time to removal being about 22 months.

Does Counseling Reduce Early Removal

One consistent finding across the research is that what happens before insertion significantly shapes whether someone ends up requesting early removal. Women who were not counseled about potential side effects before their implant was placed were roughly twice as likely to discontinue early compared to those who received thorough counseling.⁶ That same study found that women who did not choose the method themselves, who were not given follow-up appointments, or who were dissatisfied with the service during insertion were all more likely to have the implant removed ahead of schedule.

An evidence-based educational program for providers found that standardizing the counseling patients received about common side effects, especially bleeding changes, led to a measurable reduction in early removal rates.⁷ The takeaway is practical: if you are considering an implant, ask your provider to walk you through exactly what bleeding patterns to expect in the first several months. If you already have one and are frustrated by irregular bleeding, it is worth a conversation about whether the pattern is likely to settle before making the removal appointment. Many people find that bleeding irregularities diminish after the first six to twelve months.

What Happens When the Implant Cannot Be Felt

The vast majority of removals are straightforward because the rod sits just under the skin and is easy to locate by touch. Problems arise when the implant is non-palpable, meaning neither you nor your clinician can feel it in the expected position. This can happen when the implant was inserted too deeply, when it has shifted within the arm tissue, or in rare cases when it has migrated to a distant location in the body.

When an implant cannot be felt, ultrasound is the first step. It is quick, non-invasive, and can locate the rod in the soft tissue of the arm in the vast majority of cases. If ultrasound fails, the next options include X-ray (since Nexplanon contains barium sulfate, making it visible on standard imaging) or MRI for implants that have settled deep or migrated away from the original insertion site.⁸ In suspected cases of distant migration, CT scanning may be needed.

The critical point is that a non-palpable implant should not be removed by trial and error. Clinicians probing blindly in the arm risk damaging surrounding structures. One case report described a 21-year-old woman who suffered ulnar nerve injury during an attempted in-office removal of a deeply placed implant. The injury resulted in nerve palsy that required surgical exploration, excision of a nerve tumor that formed at the injury site, and nerve grafting to restore function.⁹ Devices that are non-palpable, deep, or suspected of having migrated should always be imaged before any surgical exploration is attempted. If your provider cannot feel the implant during a removal visit, imaging is the appropriate next step, not repeated attempts to locate it manually.

Implant Migration

Migration is the most dramatic complication associated with the implant, though it remains rare relative to the millions of devices placed worldwide. A 2024 systematic review identified 148 independent cases of etonogestrel implant migration reported in the medical literature: 74 involved migration into pulmonary (lung) blood vessels, 16 into other blood vessels, and 58 involved extravascular migration where the implant moved through tissue but stayed outside the bloodstream.¹⁰

The leading theory is that during insertion, the implant is inadvertently placed into or too close to a vein in the arm. From there, it can travel through the venous system to the right side of the heart and lodge in a branch of the pulmonary artery. Low body weight or thin subcutaneous tissue may increase the risk, because there is less of a buffer between the skin surface and the deeper vascular structures.¹¹ One reported case involved a 17-year-old whose implant was found by CT scan in a branch of the pulmonary artery in the left lower lobe of her lung, after she presented simply because the implant could no longer be felt in her arm.¹²

Many people with migrated implants are asymptomatic, and the migration is only discovered when removal is attempted and the rod is not where it should be.¹³ Retrieval of a migrated implant typically requires interventional radiology or surgery rather than a simple office visit. If you cannot feel your implant at any point during the three years, mention it to your clinician. Confirming its position early with imaging can prevent a more complicated situation at removal time.

How Quickly Fertility Returns After Removal

Fertility rebounds rapidly after the implant comes out. The hormone etonogestrel clears the body within days, and its contraceptive effects do not linger the way many people assume. A narrative review of the evidence found that over 90% of former implant users resumed ovulation within three weeks of removal in one study, and 86% had their period return within three months in another.¹⁴ Pregnancy rates after removal were similarly brisk: roughly 12% became pregnant within two weeks, about 14% to 29% within three months, about two-thirds by nine months, and nearly 96% within a year.

These numbers compare favorably to general population conception timelines. There is no evidence that the implant causes lasting changes to fertility or that longer use (closer to the full three years versus shorter durations) delays the return to fertility. If you are having your implant removed specifically because you want to get pregnant, you should assume that pregnancy is possible almost immediately and plan accordingly. If you are switching to another method and want no gap in protection, that transition should happen at the removal appointment, either by having a new implant placed, an IUD inserted, or starting a new hormonal method the same day.

Provider Training and Who Can Remove It

Removal is typically performed by the same types of providers who insert the device: family medicine physicians, obstetrician-gynecologists, nurse practitioners, and physician assistants. In some countries, trained nurses also perform removals. A study evaluating a nurse training program in Australia found that after training, all nurses reported feeling very confident in insertion, and the vast majority reported confidence in removal, with file audits confirming successful outcomes.¹⁵ Similarly, a study of healthcare providers trained at two Brazilian centers found that nearly 88% felt very confident performing removals after practical training.¹⁶

For routine, palpable implants, the procedure is within the scope of any trained clinician. Complicated cases, those involving non-palpable or migrated implants, should be referred to a specialist, typically a surgeon experienced in soft-tissue procedures or, in the case of intravascular migration, an interventional radiologist. If you go to a clinic for removal and the provider cannot easily feel the implant, expect a referral and imaging rather than an extended attempt to extract it on the spot.

Barriers to Getting the Implant Removed

An underappreciated issue in reproductive health is that getting an implant removed is not always as straightforward from a logistical standpoint as having it placed. For adolescents and young adults in the United States, barriers include limited access to the healthcare system, concerns about confidentiality (especially for minors who may not want a parent to know about their contraceptive use), and provider bias, where a clinician may discourage removal because they believe the patient should continue using the method.¹⁷

Cost can also be a factor. While most insurance plans in the U.S. cover both insertion and removal, gaps in coverage exist. Someone who was insured when the implant was placed may have lost coverage by the time removal is needed, and paying out of pocket for an office visit and a minor procedure can be a real barrier. Federally qualified health centers and Title X-funded clinics can sometimes provide removal at reduced or no cost.

Advocacy groups and reproductive health organizations emphasize that the right to have an implant removed on request is a fundamental aspect of informed consent. If you feel that a provider is pressuring you to keep the device or creating unnecessary obstacles to removal, you are well within your rights to seek care from another clinician. No one should have to justify their reason for wanting a contraceptive device taken out.

What to Expect in the Days After

Post-removal recovery is minimal for uncomplicated procedures. The incision site may be tender for a day or two, and bruising around the area is common and resolves within a week. You will typically leave the office with a small adhesive bandage and a pressure wrap. Keeping the area dry for 24 hours and avoiding heavy lifting with that arm for a couple of days is standard advice.

Hormonally, changes can begin quickly. Some people notice a shift in mood, appetite, or energy levels within the first week as etonogestrel clears the system. If irregular bleeding was a problem while the implant was in place, you can expect your cycle to begin resettling over the next one to three months, though some people see a period return within a few weeks. The timeline varies considerably from person to person.

If you had the implant removed and a new one placed simultaneously, the transition is generally seamless. You will not experience a hormonal gap or a return of your natural cycle since the new device begins releasing etonogestrel right away. The arm may be a bit more sore than with a standalone removal because two procedures happened at the same site, but the recovery timeline is essentially the same.

For anyone experiencing persistent numbness, tingling, or weakness in the hand or fingers after removal, prompt follow-up is important. While nerve injury during removal is rare, it requires early diagnosis and potentially referral to a specialist for the best outcome.¹⁸ Ordinary soreness and mild bruising, by contrast, resolve on their own and do not need medical attention.