The contraceptive implant, such as Nexplanon, is a small, flexible rod placed under the skin of the upper arm that releases the progestin hormone etonogestrel to prevent pregnancy. After removal, individuals often wonder how quickly their natural reproductive cycle will resume. The return of fertility is notably swift, allowing for the possibility of ovulation and subsequent pregnancy soon after removal.
Why Effects Cease Immediately After Removal
The implant works by delivering etonogestrel, a synthetic progestin, to suppress the hormonal signals that trigger ovulation. This constant dose prevents the ovaries from releasing an egg and also thickens cervical mucus, creating a barrier to sperm entry.
Once the implant is physically removed, the source of the hormone is immediately gone. Etonogestrel has a relatively short elimination half-life of approximately 25 hours. This rapid clearance means the hormone concentration in the blood drops quickly, with levels becoming undetectable within about one week of removal. Because the body does not store a large reservoir of hormone, the reproductive system can reactivate without significant delay.
Expected Timeline for Ovulation
Ovulation can resume very quickly after the implant is taken out. Studies show that fertility returns rapidly, with some individuals ovulating within a few days or weeks of removal. The majority of people will experience the return of ovulation within the first 30 days.
While ovulation can occur almost immediately, the first menstrual period may take longer to appear. The body needs time to re-establish communication between the brain and the ovaries to govern the regular menstrual cycle. Most people will see their period return to its pre-implant pattern within three months. The absence of a period does not necessarily mean ovulation has not occurred.
Tracking the Return of Fertility
For those who wish to confirm the return of their cycle, several at-home methods can track the signs of fertility.
Ovulation Predictor Kits (OPKs)
Ovulation Predictor Kits (OPKs) detect the surge of Luteinizing Hormone (LH) in the urine, which happens 24 to 36 hours before ovulation. Tracking this surge can pinpoint the most fertile window.
Cervical Mucus Monitoring
Observing changes in cervical mucus is another method, as the implant’s progestin previously thickened it. The presence of thin, clear, and stretchy mucus, often compared to raw egg whites, is a physical sign that estrogen levels are rising and ovulation is imminent. This change typically precedes the LH surge.
Basal Body Temperature (BBT)
Basal Body Temperature (BBT) tracking requires measuring the body’s lowest resting temperature each morning. After ovulation, the rise in progesterone causes the BBT to spike by about 0.5 to 1.0 degrees Fahrenheit. This higher temperature remains until menstruation begins, confirming that ovulation has already taken place in that cycle.
When to Seek Medical Advice
While a rapid return to ovulation is the norm, consult a healthcare provider if certain milestones are not met. If a regular menstrual period or confirmed signs of ovulation have not returned within three to six months following removal, a medical evaluation may be helpful. A delayed return could indicate a pre-existing condition, such as Polycystic Ovary Syndrome, that was masked by the implant’s steady hormone delivery.
Seek prompt medical attention for any signs of infection at the removal site, including increasing redness, swelling, warmth, or pus. Additionally, any unexplained abdominal pain or abnormal bleeding after removal should be discussed with a doctor to rule out complications like an ectopic pregnancy. A healthcare professional can perform blood tests and offer guidance to support the successful return of a regular reproductive cycle.