How soon after Nexplanon (etonogestrel implant) removal can a patient start oral birth control?

Timing of Oral Contraceptive Initiation After Nexplanon Removal

Oral contraceptives can be started immediately after Nexplanon removal with no waiting period required. 1

Immediate Start Protocol

• Oral contraceptives (both combined hormonal pills and progestin-only pills) can be started on the same day as Nexplanon removal with no gap in contraceptive coverage 1
• The CDC guidelines classify this as a straightforward method switch that requires no waiting period between discontinuing one method and starting another 1
• Fertility returns rapidly after Nexplanon removal, making immediate start of a new method important for continued pregnancy prevention 2

Backup Method Requirements

• If combined oral contraceptives are started within 5 days of Nexplanon removal, no backup method is needed 1
• If starting oral contraceptives more than 5 days after Nexplanon removal, use a backup method (condoms) or abstain from intercourse for:
  • 7 consecutive days if starting combined hormonal pills 1
  • 2 consecutive days if starting progestin-only pills 1

Special Considerations

• Patients switching from Nexplanon to oral contraceptives should be counseled about:
  • The importance of daily pill-taking compared to the implant's maintenance-free use 1
  • Potential changes in bleeding patterns when transitioning between methods 1
  • The significantly lower typical-use effectiveness of oral contraceptives (91%) compared to Nexplanon (>99%) 3

Common Pitfalls to Avoid

• Unnecessary Delay: Waiting for the next menstrual period before starting oral contraceptives after Nexplanon removal is unnecessary and increases pregnancy risk 1
• Missing the First Pills: The first week of oral contraceptive use is critical for establishing contraceptive effect, especially when transitioning from another method 1
• Underestimating Rapid Return to Fertility: Fertility can return immediately after Nexplanon removal, with documented pregnancies occurring within days of removal 3

Algorithm for Oral Contraceptive Initiation After Nexplanon Removal

1. Remove Nexplanon implant using proper technique 2
2. Start oral contraceptives on the same day as removal (preferred approach) 1
3. If same-day start is not possible:
   • Start within 5 days of removal: no backup method needed 1
   • Start >5 days after removal: use backup method for 7 days (combined pills) or 2 days (progestin-only pills) 1
4. Consider emergency contraception if unprotected intercourse occurs during the transition period 1

By following these guidelines, patients can maintain continuous contraceptive protection when transitioning from Nexplanon to oral contraceptives 1.