Counseling After Nexplanon Removal
After Nexplanon removal, patients should receive comprehensive counseling about immediate return to fertility, contraceptive options with emphasis on LARCs as first-line methods, and the need for immediate initiation of alternative contraception if pregnancy prevention is desired. 1
Key Counseling Points After Nexplanon Removal
Return to Fertility
- Inform patients about rapid return to fertility after implant removal 2
- Emphasize that ovulation can resume immediately, potentially within days of removal
- Explain that there is no delay in return to fertility, unlike some other contraceptive methods
Immediate Contraception Options
- If continued contraception is desired, initiate new method immediately to prevent unintended pregnancy 3
- No gap in contraceptive coverage is recommended if pregnancy prevention is desired
- For those wanting another implant, same-day removal and reinsertion can be performed
Alternative Contraceptive Methods
Counsel using a tiered approach based on effectiveness 1, 4:
Long-Acting Reversible Contraception (LARC) - Most Effective (<1% failure rate)
- IUDs (Copper IUD effective for up to 12 years, Hormonal IUD for 3-7 years depending on type)
- New implant (Nexplanon effective for 3 years)
Moderately Effective Methods (5-9% typical failure rate)
- Injectable contraception (DMPA)
- Combined hormonal contraceptives (pill, patch, ring)
- Progestin-only pills
Less Effective Methods (14-25% typical failure rate)
- Barrier methods (condoms)
- Fertility awareness methods
- Withdrawal
Managing Menstrual Changes
- Inform patients that menstrual patterns will likely return to pre-implant patterns 1, 5
- For those who experienced favorable bleeding patterns with Nexplanon (reduced bleeding or amenorrhea):
- Discuss hormonal methods that might provide similar benefits
- Consider LNG-IUD if reduced menstrual bleeding was beneficial 4
- For those who experienced unfavorable bleeding with Nexplanon:
- Acknowledge this common side effect (occurred in approximately 18% of users) 5
- Discuss alternative methods with more predictable bleeding patterns
Special Considerations
For Patients Desiring Pregnancy
- No waiting period required before attempting conception
- Consider prenatal vitamins and folic acid supplementation
- Discuss optimal pregnancy spacing if relevant
For Patients Who Had Implant Removed Due to Side Effects
- Identify specific side effects that led to removal
- Recommend alternative methods less likely to cause similar side effects
- For those with bleeding irregularities (main reason for discontinuation in 11.3% of users) 5:
- Consider methods with more predictable bleeding patterns
- Discuss non-hormonal options if hormonal side effects were problematic
For Patients With Specific Medical Conditions
- Tailor contraceptive recommendations based on medical history
- Consider non-hormonal methods for those with contraindications to hormonal contraception
- For patients with dysmenorrhea, note that most women (77%) experience resolution with implant use 5
Common Pitfalls to Avoid
Delayed Initiation of New Contraception
- Avoid gaps in contraceptive coverage
- Start new method immediately if pregnancy prevention is desired
Inadequate Counseling About Bleeding Patterns
- Failure to discuss that bleeding patterns with Nexplanon are not predictive of patterns with other methods
- Insufficient explanation of expected bleeding patterns with new method
Overlooking Patient Preferences
- Not considering why the patient chose to remove Nexplanon
- Failing to address specific concerns that led to discontinuation
Missing Opportunity for Same-Day Initiation
- Not offering same-day initiation of new method
- Requiring unnecessary waiting periods before starting new contraception
By providing thorough counseling after Nexplanon removal, healthcare providers can help patients make informed decisions about future contraception, optimize continuation rates with new methods, and prevent unintended pregnancies during the transition between contraceptive methods.