Can a patient who has had a Nexplanon (etonogestrel implant) inserted start oral birth control until the date of removal?

Starting Oral Contraceptives Before Nexplanon Removal

Yes, she can and should start oral contraceptives immediately without waiting for the expired Nexplanon to be removed, as the CDC guidelines explicitly support starting a new contraceptive method at any time when switching from an implant. 1, 2

Immediate Initiation Protocol

• Oral contraceptives can be started on the same day or at any time while the expired Nexplanon remains in place, with no mandatory waiting period required. 2
• The CDC classifies switching from an implant to oral contraceptives as a straightforward method transition that does not require discontinuing one method before starting another. 1, 2

Backup Contraception Requirements

Since the Nexplanon has expired and may no longer provide reliable contraceptive protection, backup contraception needs depend on timing:

• If starting combined oral contraceptives within 5 days of menstrual bleeding onset, no backup method is needed. 1, 2
• If starting combined oral contraceptives more than 5 days after menstrual bleeding started, use backup contraception (condoms) or abstain from intercourse for 7 consecutive days. 1, 2
• If starting progestin-only pills more than 5 days after menstrual bleeding started, use backup contraception (condoms) or abstain from intercourse for 2 consecutive days. 2

Critical Considerations for This Scenario

• Because the Nexplanon has expired, it should be considered as providing no contraceptive protection, making immediate initiation of oral contraceptives essential to prevent pregnancy during the 2-month delay until removal. 3, 4
• The patient should be counseled that she will be using dual hormonal methods temporarily (expired implant plus oral contraceptives), though the expired implant likely provides minimal to no contraceptive effect. 5
• Once oral contraceptives are started with appropriate backup contraception as outlined above, she will have reliable pregnancy prevention until the Nexplanon removal appointment. 1, 2

Important Counseling Points

• Emphasize the critical importance of daily pill-taking, as this represents a significant change from the maintenance-free nature of the implant. 2
• Counsel about potential changes in bleeding patterns when transitioning between methods, which may be more pronounced given the overlapping hormonal exposure. 2
• Missing pills during this transition period significantly increases pregnancy risk, especially since the expired implant cannot be relied upon for contraceptive backup. 2

After Nexplanon Removal

• When the Nexplanon is eventually removed in 2 months, she should simply continue her oral contraceptives without interruption. 2, 6
• No additional backup contraception is needed after removal if she has been taking her oral contraceptives consistently. 2