Removing the etonogestrel implant

The etonogestrel implant should be replaced every 3 years and can be continued until menopause (see Reviewing hormonal contraception at perimenopause).

Removal of the etonogestrel implant requires specific clinician training. A deeply inserted implant should only be removed by an experienced practitioner. Patients may present for removal of an implant inserted in another country; these implants may contain two rods.¹

Bleeding patterns cannot be readily interpreted to assess the likelihood of pregnancy when etonogestrel implant replacement is delayed. Pregnancy can be excluded if it is more than 3 years since implant insertion, but:

• there has been no unprotected sex since implant replacement was due
• the last episode of unprotected sex since implant replacement was due was more than 3 weeks ago and a urine pregnancy test is negative.

Replace the implant; it will be effective in 7 days.

If a urine pregnancy test is negative, but the last episode of unprotected sex occurred less than 3 weeks ago, offer Quick Start. Alternatively, replace the implant when pregnancy can be excluded (by a further negative urine pregnancy test performed 3 weeks after the last episode of unprotected sex). Offer levonorgestrel emergency contraception if unprotected sex has taken place in the last 4 days.