The Nexplanon implant, which releases the progestin hormone etonogestrel, is a highly effective, long-acting form of contraception. When the device is removed, your body will begin a process of hormonal readjustment. Understanding this transition is important for managing physical changes and making informed decisions about future health and family planning. This guide covers immediate aftercare, the expected return of fertility and the menstrual cycle, and guidance for choosing your next steps.
Immediate Care and Expected Side Effects
The removal of the implant is a quick, minor surgical procedure performed by a healthcare professional. You will be given a local anesthetic, so the actual removal should not be painful, though you may feel some pressure or tugging during the process. The immediate focus is caring for the small incision site on your upper arm.
Your provider will cover the incision with sterile bandages and a pressure bandage to minimize bruising and bleeding. Keep the pressure bandage on for at least 24 hours and keep the entire area clean and dry for several days to prevent infection. Bruising, soreness, and minor swelling around the removal site are common and should resolve within one to two weeks. Avoid strenuous activity or heavy lifting with that arm for a few days to allow the site to heal properly.
In the first 24 to 72 hours, some people experience a short-lived reaction due to the sudden drop in synthetic progestin. This hormonal shift can trigger temporary symptoms such as light removal bleeding or spotting, which typically lasts only a few days. Any discomfort should be manageable with over-the-counter pain relievers, but persistent or worsening pain is a sign to contact your provider.
The Timeline for Fertility and Cycle Return
The etonogestrel hormone clears from the body quickly after the implant is taken out. Because of this fast clearance, fertility can return almost immediately, with ovulation potentially resuming within a week of removal. This immediate return to fertility is a major point to consider if you are sexually active and wish to avoid pregnancy.
While ovulation may return right away, the re-establishment of a regular menstrual cycle often takes longer. The first period after removal can be unpredictable in timing and flow, and it may take up to three months for the cycle to return to its pre-implant pattern. If your period has not returned to a predictable cycle after three months, or if you had a very irregular cycle before the implant, consult with your healthcare provider.
Choosing Your Next Steps for Contraception or Conception
Since fertility returns quickly, you must begin another method of contraception immediately if you do not wish to become pregnant. Barrier methods, such as condoms, offer an effective, temporary solution while you consider a long-term option.
For continued high effectiveness, many people transition to a hormonal intrauterine device (IUD), which releases hormones locally and lasts for several years. Alternatively, the non-hormonal copper IUD is an option if you prefer to avoid synthetic hormones entirely. Daily oral contraceptives, or “the pill,” can offer more control over your cycle.
If your goal is conception, healthcare professionals advise waiting until you have one natural menstrual cycle before trying to conceive. This waiting period allows for more accurate dating of the pregnancy and ensures your body is adjusted to the absence of the synthetic hormone.
Monitoring Persistent Hormonal Changes
Beyond the return of your menstrual cycle, you may notice other systemic changes as your body adjusts to natural hormone levels. Fluctuations in mood, including temporary irritability or anxiety, are common as the hormonal balance shifts. These mood changes are temporary and should subside as your body stabilizes.
Skin health can also be affected, with some people experiencing an increase in acne flare-ups, especially if the implant had suppressed acne. Other possible changes include breast tenderness, temporary weight fluctuations, and a change in libido. These symptoms are part of the adjustment process and tend to resolve within a few months.
Contact your healthcare provider immediately if you experience severe or prolonged symptoms, such as very heavy or extended bleeding, signs of deep depression, or signs of infection at the removal site like fever, spreading redness, or pus.