Same-Day Nexplanon Removal and Reinsertion
Yes, a Nexplanon can be removed and a new one immediately reinserted on the same day with no waiting period required, providing continuous contraceptive coverage. 1, 2, 3
Immediate Reinsertion Protocol
The CDC guidelines explicitly support same-day removal and reinsertion of contraceptive implants as a straightforward method transition that requires no gap between procedures. 1, 2 This approach maintains uninterrupted contraceptive protection and eliminates any risk of pregnancy during a transition period.
Contraceptive Coverage Considerations
No backup contraception is needed when a new Nexplanon is inserted immediately after removing the old one, as the new implant begins releasing etonogestrel immediately upon insertion. 1, 3
The only scenario requiring backup contraception would be if there is a delay between removal and reinsertion: if more than 5 days pass after removal before inserting the new implant, use backup contraception (condoms) or abstain from intercourse for 7 consecutive days after the new insertion. 2
Procedural Requirements
Provider Training
- The healthcare provider must have completed the manufacturer's required Nexplanon training program before performing either removal or insertion procedures. 3
Timing Efficiency
Removal typically takes under 5 minutes when performed by a trained clinician, and insertion takes approximately 1 minute, making same-day removal and reinsertion highly feasible in a single office visit. 4, 3
Real-world data from 5,159 removal procedures showed that all but one removal was successful, with the most common challenge being encasement within fibrotic tissue rather than inability to remove. 5
Clinical Advantages of Same-Day Reinsertion
Immediate reinsertion eliminates any contraceptive gap, which is particularly important given that fertility returns rapidly after Nexplanon removal. 6
Same-day procedures reduce patient burden by requiring only one office visit rather than two separate appointments. 5
The failure rate remains <1% with proper insertion technique, maintaining the same high efficacy as initial insertion. 4, 3
Common Pitfalls to Avoid
Unnecessarily delaying reinsertion after removal increases pregnancy risk, as ovulation can resume quickly after implant removal. 1, 2
Failing to verify that the provider has completed required training for both removal and insertion procedures can lead to complications such as incorrect insertion (incidence of 12.6 per 1,000 insertions in untrained or inadequately trained providers). 5
Not counseling patients about potential changes in bleeding patterns with the new implant, as bleeding irregularities are the most common reason for early discontinuation. 4, 6