Long-acting reversible contraceptive (LARC) devices, such as intrauterine devices (IUDs) or contraceptive implants, require a minor medical procedure for removal. Unlike pills or shots, this process must be performed by a trained professional. The removal is generally quick and straightforward, allowing the body to return to its pre-contraception state almost immediately. This article focuses on the practical steps and expectations surrounding the removal of these physical devices.
Types of Providers Who Perform Removal
LARC removal must be performed by a healthcare professional specifically trained in the procedure. Patients often start with their primary care physician or gynecologist. Authorized professionals include Obstetrician-Gynecologists (OB/GYNs), Family Practice Doctors, Nurse Practitioners (NPs), and Physician Assistants (PAs).
These procedures are routinely done in various clinical settings, including private medical offices, specialized women’s health clinics, and family planning centers like Planned Parenthood. Patients with insurance should contact their provider to identify in-network specialists. For those without insurance, community health centers and family planning clinics often provide services on a sliding scale or at a reduced cost.
Finding a provider is often as simple as contacting the clinic where the device was originally placed, as insertion certification includes removal training. For complex situations, such as a deeply embedded implant or an IUD with missing strings, a specialist or a clinic with advanced imaging, like ultrasound, may be required. When scheduling, inquire if the provider has experience with the specific type of device being removed.
Preparing for the Removal Appointment
Preparation for LARC removal focuses on logistics and preventing unintended pregnancy immediately afterward. If the patient is not switching methods, they should abstain from intercourse or use a barrier method, like a condom, for five to seven days before the removal date. This precaution is necessary because fertility returns immediately after removal, and sperm can survive for several days.
Patients should discuss plans for new contraception beforehand, as a new IUD or implant can often be inserted immediately after the old one is removed. For IUD removal, some providers suggest scheduling the appointment during the menstrual cycle. This timing can make the procedure slightly easier because the cervix is naturally softer and slightly more open.
To minimize discomfort, it is recommended to take an over-the-counter pain reliever, such as ibuprofen, about an hour before the removal. No other physical preparations are typically required, and the patient can eat and drink normally. The most important step is verifying whether a pregnancy test is needed at the visit, especially if there is concern about recent exposure.
What Happens During the Removal Procedure
LARC removal is generally faster and involves less discomfort than the insertion process. For an IUD, the patient lies on an examination table while the provider inserts a speculum to visualize the cervix, similar to a routine pelvic exam. The IUD has small threads, or strings, that typically hang out of the cervical opening into the vagina.
The provider uses specialized grasping tools or forceps to gently take hold of the strings and pull with a steady motion. As the IUD is drawn out, its flexible arms fold upward, allowing the device to pass through the cervix. The patient may feel a brief, sharp cramp or pinch, but the entire procedure usually takes only a minute or two.
If the IUD strings cannot be located, the provider may use a small brush or hook to retrieve them from the cervical canal. If this is unsuccessful, an ultrasound or X-ray may confirm the IUD’s position. A specialized procedure, such as a hysteroscopy, may be necessary if the IUD has become embedded in the uterine wall.
For a contraceptive implant, such as Nexplanon, the procedure takes place in the upper arm, where the device is located just under the skin. The provider first injects a local anesthetic to numb the site. A tiny incision, usually about 2 millimeters long, is then made near the tip of the implant. The provider gently pushes the implant toward the incision until it is visible, grasps it with forceps, and slides it out. The incision is closed with adhesive strips or a single suture, and a pressure bandage is applied to minimize bruising.
Post-Removal Expectations and Next Steps
Following LARC removal, patients may experience mild, temporary side effects. Light bleeding or minor cramping are common after IUD removal, typically resolving within a few hours to a couple of days. For implant removal, the site may be sore, bruised, or slightly itchy for a few days, and patients are advised to keep the pressure bandage on for 24 hours.
Fertility returns very quickly after LARC removal, often within the first menstrual cycle. Since these methods do not suppress long-term hormonal mechanisms of ovulation, there is no significant delay in the ability to conceive. Patients who do not wish to become pregnant must begin a new form of contraception immediately, either at the removal appointment or the same day.
The body will adjust to the absence of hormones released by a hormonal IUD or implant. This adjustment may lead to temporary changes in the menstrual cycle, with the return of a period similar to the one experienced before insertion. Some people report temporary symptoms like mood fluctuations, breast tenderness, or acne as their natural hormone levels re-establish themselves.