The contraceptive implant is a form of long-acting reversible contraception that continuously releases the synthetic progestin hormone etonogestrel into the body. This hormone works primarily by preventing ovulation and thickening cervical mucus, offering a highly effective method of birth control. When the implant is removed, the steady supply of etonogestrel immediately stops, triggering a rapid hormonal shift. This transition involves predictable physical and hormonal changes as the body resumes its natural endocrine function.
The Removal Procedure and Immediate Aftercare
The implant removal is a brief, minor surgical procedure performed in a healthcare provider’s office. The area of your upper arm is numbed with a local anesthetic, which may cause a slight stinging sensation. The provider then makes a small incision, gently extracts the rod, and closes the cut, often with an adhesive strip or a single stitch.
After the procedure, the site is covered with an adhesive dressing and a pressure bandage to minimize bleeding and bruising. Keep the pressure bandage on for 24 hours and the dressing clean and dry for three to five days, avoiding strenuous activity or heavy lifting with that arm. Bruising, swelling, and mild soreness at the removal site are common and typically resolve within a couple of weeks. Seek medical attention if you notice signs of infection, such as increasing redness, warmth, discharge, or fever.
Rapid Hormonal Adjustment and Short-Term Symptoms
Once the implant is removed, the level of etonogestrel drops quickly, leading to a hormonal “withdrawal” effect as the body’s own hormone production reactivates. This shift can cause a cluster of short-term symptoms in the first few weeks. Common immediate effects include headaches, breast tenderness, and fatigue, which are temporary markers as the body attempts to find its new hormonal baseline.
Many women also experience temporary mood fluctuations, such as increased irritability or anxiety, as they adjust to the absence of the synthetic progestin. Initial bleeding patterns are highly variable; some may notice spotting, while others may have a heavier withdrawal bleed within days or weeks of removal. These acute symptoms usually subside as your natural cycle takes over.
Resumption of Natural Cycle and Fertility Timeline
The most significant change following implant removal is the rapid return of fertility. Ovulation can resume quickly, sometimes within days or weeks after removal. Because sperm can survive for several days, it is possible to become pregnant almost immediately if you do not begin an alternative method of contraception right away.
The first true menstrual period, which is preceded by ovulation, typically arrives within 30 to 90 days for most people. This is distinct from any initial withdrawal bleed that may occur shortly after removal. Initial cycles may be irregular, potentially being heavier, lighter, or different in duration than your pre-implant periods, while the body re-establishes a consistent ovulatory rhythm.
If pregnancy is not desired, it is necessary to start a new form of birth control immediately upon removal, as the implant offers no residual protection. While the speed of fertility return is an advantage for those planning conception, it requires caution for those who are not. It may take a few months for your menstrual cycle to settle into its long-term pattern.
Managing Longer-Term Body Normalization
Beyond the initial hormonal adjustment, the body continues to normalize over the next several months as it fully resets to its natural state. Many physical changes experienced while on the implant begin to reverse. For example, implant-related acne may begin to clear, though some people may experience a temporary flare-up as hormones fluctuate before the skin stabilizes. Changes in appetite or fluid retention may also resolve, leading to a stabilization of weight over time.
Mood and libido altered by the continuous presence of etonogestrel will often return to the individual’s baseline emotional state. This longer-term normalization process can take up to six months as the body gradually finds its pre-contraception equilibrium. If your menstrual cycle has not returned after 90 days, or if you experience severe or persistent symptoms, consult your healthcare provider to rule out other underlying conditions.