Removal
Removal
Nexplanon is licensed for 3 years and after this time it should be replaced if the woman wishes to continue with POIm. However, women may request early removal due to family planning or adverse effects. Troublesome bleeding, for women who are medically eligible, may be managed with 3 months of COC. Evidence is lacking in the safety of long-term concurrent use with POIm. Other alternatives include oral progestogen (off licence) and mefenamic acid (expensive, and not ideal long term). If, after counselling, the woman still seeks removal, it should not be delayed regardless of when it was inserted.
Like insertion, removal should only be attempted by those health care professionals that have the accredited training (see above). The woman should be fully informed about the procedure and consent obtained. Removal should be carried out under sterile conditions, with appropriate local anaesthesia. The implant should be removed through a cut in the skin over its distal end. The site should then be checked to ensure no implants/pieces of implants are left in situ. If another implant is required, a new subdermal track adjacent to the first should be made.
If the implant is not palpable, the woman should be advised to use extra precautions and referred onto a specialist centre for removal under ultrasound guidance.