Can I remove Nexplanon (etonogestrel implant) and place Mirena (levonorgestrel intrauterine device)?

Switching from Nexplanon to Mirena

Yes, you can remove Nexplanon and immediately place a Mirena IUD during the same visit without any waiting period or gap in contraceptive coverage. 1

Immediate Same-Day Transition Protocol

The CDC explicitly recommends that when switching contraceptive methods, the new method can be started immediately if it is reasonably certain the woman is not pregnant. 1 This applies directly to transitioning from Nexplanon to an IUD:

• No waiting period is necessary between Nexplanon removal and IUD insertion 1
• The IUD can be inserted immediately after implant removal 1
• No backup contraception is needed when the IUD is placed immediately 1

Clinical Advantages of This Approach

For optimal contraceptive coverage, have the Mirena available at the time of Nexplanon removal to avoid any gaps in protection. 1 This same-day approach:

• Prevents contraceptive gaps that could occur if the patient needs to return for a separate IUD insertion visit 1
• Maintains continuous highly effective contraception (both methods have <1% failure rates) 2
• Allows immediate return to fertility if the patient later desires pregnancy, as both methods are rapidly reversible 2

Practical Considerations for the Procedure

Nexplanon removal can be performed at any time during the menstrual cycle, and the Mirena can be inserted immediately thereafter. 1 Key procedural points:

• No specific examinations or tests are needed before Nexplanon removal in healthy women 1
• The procedure should not be performed if there is active infection at the removal site 1
• For IUD insertion, screen for gonorrhea and chlamydia on the day of insertion if the patient is at risk; treatment can be provided afterward without IUD removal if needed 2
• Current purulent cervicitis, active gonorrhea/chlamydia, or current PID are contraindications to IUD placement 2

Expected Bleeding Pattern Changes

Patients should be counseled about the different bleeding profiles between these two methods:

• With Nexplanon, unpredictable bleeding or spotting is common and a frequent reason for discontinuation 2
• With Mirena (52 mg levonorgestrel IUD), menses become more irregular initially, but overall bleeding decreases significantly, with many women experiencing amenorrhea 2
• Women with painful menses may experience significant symptom improvement with the levonorgestrel IUD 2

Safety Profile of Both Methods

Both Nexplanon and Mirena are considered among the safest and most effective contraceptive options, classified as long-acting reversible contraception (LARC). 2

• IUDs are safe for nulliparous women and do not cause tubal infertility 2
• The risk of pelvic infection with IUDs occurs only during insertion and does not extend beyond the first 21 days 2
• Mirena is approved for 5 years but data support efficacy up to 7-8 years 2, 3