Nexplanon Removal: A Comprehensive Step-by-Step Guide
Nexplanon is a popular and effective form of long-acting reversible contraception (LARC). It’s a small, flexible rod implanted under the skin of your upper arm that releases progestin to prevent pregnancy. While Nexplanon can be effective for up to three years, there may come a time when you decide to have it removed. Whether it’s due to side effects, wanting to start a family, or simply because the three years are up, understanding the removal process is crucial.
This comprehensive guide provides a detailed, step-by-step explanation of Nexplanon removal, covering everything from preparing for the procedure to aftercare. It’s important to remember that Nexplanon removal should always be performed by a trained healthcare professional, such as a doctor, nurse practitioner, or physician assistant. Do not attempt to remove it yourself.
## Why Remove Nexplanon?
There are several reasons why you might choose to have your Nexplanon removed:
* **End of its Effective Lifespan:** Nexplanon is effective for three years. After this time, it needs to be removed and, if desired, replaced with a new implant or another form of contraception.
* **Side Effects:** Some women experience side effects from Nexplanon, such as irregular bleeding, headaches, mood changes, weight gain, or acne. If these side effects are bothersome, removal might be considered.
* **Desire to Conceive:** If you’re planning to become pregnant, you’ll need to have your Nexplanon removed. Fertility typically returns quickly after removal.
* **Medical Reasons:** In rare cases, medical reasons might necessitate the removal of Nexplanon. Your healthcare provider can advise you on whether this is necessary.
* **Personal Preference:** You may simply decide that Nexplanon is no longer the right contraceptive option for you.
## Preparing for Nexplanon Removal
Before your Nexplanon removal appointment, there are a few things you should do to prepare:
* **Schedule an Appointment:** The first step is to schedule an appointment with your healthcare provider. Inform them that you want to have your Nexplanon removed.
* **Discuss Your Options:** If you wish to continue using contraception, discuss your options with your healthcare provider. They can help you choose the best method for your needs.
* **Inform Your Provider of Any Medications or Allergies:** Let your provider know about any medications you are taking, including over-the-counter drugs and supplements, as well as any allergies you have, especially to local anesthetics.
* **Consider Pain Relief Options:** Discuss pain relief options with your healthcare provider. While the procedure is usually quick and relatively painless with local anesthesia, you may want to discuss options like taking an over-the-counter pain reliever before the appointment.
* **Arrange for Transportation:** While you should be able to drive yourself home after the procedure, consider having someone drive you if you are concerned about feeling lightheaded or experiencing any discomfort.
## The Nexplanon Removal Procedure: A Step-by-Step Guide
The Nexplanon removal procedure is generally straightforward and takes only a few minutes. Here’s a detailed breakdown of the steps involved:
**Step 1: Preparation and Positioning**
* You will be asked to lie down on an examination table, with your arm extended and supported.
* Your healthcare provider will examine your arm to locate the Nexplanon implant. They will palpate (feel) the area to determine the exact location and orientation of the rod.
**Step 2: Anesthesia**
* The healthcare provider will clean the insertion site with an antiseptic solution, such as iodine or chlorhexidine, to minimize the risk of infection.
* A local anesthetic, usually lidocaine, will be injected under the skin near the implant. This will numb the area and prevent you from feeling pain during the removal. You might feel a brief sting or pinch during the injection.
* The provider will wait a few minutes for the anesthetic to take full effect before proceeding. They will test the area to ensure it is adequately numb.
**Step 3: Incision**
* Once the area is numb, the healthcare provider will make a small incision (usually about 2-3 mm) in the skin at or near the original insertion site. The incision is typically made just below the end of the Nexplanon implant.
* The incision is usually very small and may be barely noticeable after it heals.
**Step 4: Locating and Grasping the Implant**
* The provider will gently push the Nexplanon towards the incision site. They may use their fingers or a small instrument to help move the implant into a position where it can be easily grasped.
* Using a small surgical instrument, such as a hemostat or forceps, the provider will carefully grasp the end of the Nexplanon implant.
**Step 5: Removing the Implant**
* With a firm but gentle motion, the provider will slowly pull the Nexplanon implant out through the incision. It’s important that the implant is removed in one piece.
* If the implant is difficult to remove, the provider may need to make a slightly larger incision or use a different technique. However, this is rare.
**Step 6: Confirming Complete Removal**
* After the Nexplanon is removed, the provider will examine it to ensure that it is intact and that no fragments are left behind.
* They will also palpate the area under the skin to confirm that the entire implant has been removed.
**Step 7: Closing the Incision**
* Once the provider is satisfied that the Nexplanon has been completely removed, they will close the incision. This is usually done with a small adhesive bandage (Steri-Strip) or a single stitch.
* If a stitch is used, it will typically be absorbable and will dissolve on its own within a week or two. In some cases, a non-absorbable stitch may be used, which will need to be removed by your healthcare provider after a few days.
**Step 8: Applying a Dressing**
* A sterile bandage will be applied to the incision site to protect it and keep it clean.
* The bandage should be kept in place for the amount of time recommended by your healthcare provider, usually 24-48 hours.
**Step 9: Applying Pressure**
* The provider may apply pressure to the area for a few minutes to help minimize bleeding and bruising.
* You may be instructed to continue applying pressure to the area at home for a short period of time.
**Step 10: Post-Removal Instructions and Aftercare**
* The healthcare provider will provide you with detailed instructions on how to care for the incision site and what to watch out for.
* They will also schedule a follow-up appointment, if necessary, to check on the healing process.
## What to Expect After Nexplanon Removal: Aftercare and Recovery
After the Nexplanon removal procedure, it’s essential to follow your healthcare provider’s instructions carefully to ensure proper healing and prevent infection. Here’s what you can expect during the recovery period:
* **Pain and Discomfort:** You may experience some mild pain, soreness, or bruising at the incision site. This is normal and can usually be managed with over-the-counter pain relievers, such as ibuprofen or acetaminophen. Apply ice packs to the area for 15-20 minutes at a time, several times a day, to help reduce swelling and pain.
* **Bleeding:** Some minor bleeding or spotting from the incision site is normal in the first 24-48 hours. If the bleeding is excessive, contact your healthcare provider.
* **Infection:** Watch for signs of infection, such as increased pain, redness, swelling, pus or drainage from the incision site, or a fever. If you notice any of these symptoms, contact your healthcare provider immediately.
* **Wound Care:** Keep the incision site clean and dry. Follow your healthcare provider’s instructions on how to clean the area. Avoid scrubbing or picking at the incision site. Change the bandage as directed.
* **Showering and Bathing:** You can usually shower 24-48 hours after the procedure, but avoid soaking the incision site in a bath or swimming pool until it has healed completely. Ask your healthcare provider for specific instructions.
* **Activity:** Avoid strenuous activities or heavy lifting for a few days after the procedure to allow the incision site to heal properly. Listen to your body and rest when you need to.
* **Scarring:** A small scar may remain at the incision site after the Nexplanon removal. The appearance of the scar will vary depending on individual factors, such as skin type and healing ability. You can use over-the-counter scar creams or ointments to help minimize the appearance of the scar once the incision has fully healed.
* **Return of Fertility:** Fertility typically returns quickly after Nexplanon removal. If you do not wish to become pregnant, you should start using another form of contraception immediately after the procedure. Discuss your options with your healthcare provider.
* **Emotional Changes:** Some women experience emotional changes after Nexplanon removal, such as mood swings or anxiety. This is often due to hormonal fluctuations. If you are concerned about these changes, talk to your healthcare provider.
## Potential Risks and Complications of Nexplanon Removal
While Nexplanon removal is generally a safe procedure, there are some potential risks and complications to be aware of:
* **Infection:** Infection at the incision site is a potential risk with any surgical procedure. Proper wound care can help minimize this risk. Symptoms of infection include increased pain, redness, swelling, pus or drainage from the incision site, and fever.
* **Bleeding:** Excessive bleeding from the incision site is rare, but it can occur. Applying pressure to the area can usually control the bleeding. If the bleeding is significant, contact your healthcare provider.
* **Nerve Damage:** There is a small risk of nerve damage during Nexplanon removal. This can cause numbness, tingling, or pain in the arm or hand. Nerve damage is usually temporary, but in rare cases, it can be permanent.
* **Scarring:** A scar will remain at the incision site after the procedure. The appearance of the scar can vary depending on individual factors.
* **Incomplete Removal:** In rare cases, the Nexplanon implant may break or fragment during removal, making it difficult to remove the entire implant. If this happens, additional procedures may be necessary to remove the remaining fragments.
* **Pain:** Some pain, soreness, or bruising is normal after Nexplanon removal. However, if the pain is severe or persistent, it could be a sign of a complication.
* **Allergic Reaction:** An allergic reaction to the local anesthetic or antiseptic solution is possible, although rare. Symptoms of an allergic reaction can include rash, hives, itching, swelling, difficulty breathing, or dizziness. Seek immediate medical attention if you experience any of these symptoms.
* **Hematoma:** A hematoma, a collection of blood under the skin, can form at the incision site. This usually resolves on its own over time, but it can be painful and may require drainage in some cases.
If you experience any unusual or concerning symptoms after Nexplanon removal, contact your healthcare provider immediately.
## What Happens If Nexplanon Cannot Be Removed?
In very rare cases, the Nexplanon implant may be difficult or impossible to remove. This can happen if the implant has migrated from its original location, if it is embedded in scar tissue, or if it has broken into pieces. If your healthcare provider is unable to remove the Nexplanon implant, they will discuss your options with you. These options may include:
* **Observation:** If the implant is not causing any symptoms and is not interfering with your health, your healthcare provider may recommend simply observing it. They will monitor the implant regularly to ensure that it is not causing any problems.
* **Imaging Studies:** Imaging studies, such as ultrasound or MRI, may be used to locate the implant and determine its position and orientation.
* **Surgical Removal:** If the implant is causing symptoms or is interfering with your health, surgical removal may be necessary. This may involve a more extensive incision or a more complex procedure.
* **Referral to a Specialist:** In some cases, your healthcare provider may refer you to a specialist, such as a surgeon, for assistance with the removal.
It’s important to remember that even if the Nexplanon implant cannot be removed, it is still possible to prevent pregnancy by using other forms of contraception. Discuss your options with your healthcare provider.
## Replacing Nexplanon
If you are happy with Nexplanon and want to continue using it for contraception, you can have a new implant inserted at the time of removal. This is often done during the same appointment. Your healthcare provider will remove the old implant and insert the new one through the same incision site or a new incision nearby. The procedure for inserting a new Nexplanon implant is similar to the original insertion procedure.
If you decide to switch to a different form of contraception, discuss your options with your healthcare provider. They can help you choose the best method for your needs and provide you with instructions on how to use it effectively.
## Alternatives to Nexplanon
If Nexplanon is not the right choice for you, there are many other effective contraceptive options available. These include:
* **Hormonal Methods:**
* Birth control pills
* The patch (Ortho Evra)
* The vaginal ring (NuvaRing)
* The Depo-Provera shot
* Hormonal IUDs (Mirena, Kyleena, Liletta, Skyla)
* **Non-Hormonal Methods:**
* Copper IUD (Paragard)
* Condoms (male and female)
* Diaphragm
* Cervical cap
* Spermicide
* Fertility awareness methods
* **Permanent Methods:**
* Tubal ligation (for women)
* Vasectomy (for men)
Talk to your healthcare provider about which contraceptive method is right for you based on your individual needs and preferences.
## Questions to Ask Your Healthcare Provider Before Nexplanon Removal
It’s always a good idea to ask your healthcare provider questions before undergoing any medical procedure. Here are some questions you might want to ask before your Nexplanon removal:
* What are the risks and benefits of Nexplanon removal?
* What can I expect during the procedure?
* How long will the procedure take?
* What type of anesthesia will be used?
* What are the possible complications?
* What should I do to prepare for the procedure?
* What can I expect after the procedure?
* How long will it take for the incision site to heal?
* What are the signs of infection?
* When can I resume normal activities?
* When can I start using another form of contraception?
* Will there be a scar?
* How much will the procedure cost?
* Do you recommend replacing the Nexplanon implant at the time of removal?
* What are my other contraceptive options?
## Conclusion
Removing Nexplanon is a relatively simple and safe procedure when performed by a trained healthcare professional. By understanding the process and following your healthcare provider’s instructions carefully, you can ensure a smooth and successful removal. Remember to discuss any concerns or questions you have with your provider, and don’t hesitate to seek medical attention if you experience any unusual symptoms after the procedure. Whether you’re removing Nexplanon due to side effects, the end of its effectiveness, or a desire to conceive, this guide provides a comprehensive overview of what to expect. Always consult with your healthcare provider for personalized medical advice and treatment.