Contraceptive Pearl: contraception implant types and removal - a global perspective

Washington State Health Care Authority sent this bulletin at 04/29/2025 08:00 AM PDT

April 29, 2025

Can’t access the links? Add “lnks.gd” to the allowlist of your content blocking software.

Contraceptive implant types and removal - a global perspective

This bulletin is being sent by the Health Care Authority (HCA) in partnership with the Reproductive Health Access Project (RHAP).

Written by Ellen Stoke, MD

In the US, the contraceptive implant has become increasingly popular.^1-2 This soft, flexible progestin implant is the size of a matchstick and is inserted subdermally in the upper arm. It was first licensed in 1983 as a six-rod contraceptive system (Norplant), and by 1984, the World Health Organization recommended the system worldwide. Newer 2-rod systems (Jadelle & Norplant II) were subsequently developed, and Norplant was eventually removed from the US market in 2002.³ In 2006, the US Food and Drug Administration approved the first single-rod system (Implanon), followed by Nexplanon in 2011, which included a new pre-loaded insertion device and a rod that contained barium sulphate to allow for detection by X-ray/CT. In the US, Nexplanon is now the only commercially available implant. Its identical counterpart, Implanon NXT, is available outside of the US. Worldwide, two-rod systems (Jadelle and Sino-implant II) are also available, and some people still have the six-rod Norplant in place even though production was discontinued globally in 2008.

Clinicians should be aware of the different types of implants available globally and can consider further developing their procedural skills to remove these different implant types. Table 1 outlines the different contraceptive implants and Table 2 shows their insertion.

Table 1. Characteristics of different contraceptive implants^4-5

Name	Progestin	Number of Units	Lifespan According to Current Evidence	Countries Registered In
Nexplanon/ Implanon NXT	Etonogestrel	Single Rod	5 years	80
Jadelle	Levonorgestrel	Two rods	5 years	47
Sino-Implant (II)	Levonorgestrel	Two rods	4 years	19
Norplant	Levonorgestrel	Six Rods	5 years	Off-Market

Table 2. Examples of Different Contraceptive Implants

See original RHAP post for images

Contraceptive implants can be removed or replaced based on current evidence-based durations or at any time the person requests removal. The removal procedure of palpable implants varies depending on the type of implant used. Prior to removal:

Administer appropriate local anesthetic (typically 1-3cc of 1% lidocaine with or without epinephrine) at planned incision site and underneath the implant, depending on the technique used.
Use antiseptic to clean the removal site.
If available, consider a fenestrated sterile drape and sterile gloves, especially when teaching/learning new techniques to keep the area uncontaminated during repeated tissue dissection.

Single Rod Implants: See “Contraceptive Pearl: Implant Removal: Pop Out Technique” for guidance on removing single rod implants.

Multi-Rod Implants: For multi-rod implants that are easily palpated, the pop-out method and a variety of other approaches can be used:

Standard Norplant Removal: (aka Population Council Method) suggested by the Norplant manufacturer. Make a 3-4 mm incision at the apex of the insertion site. Individually, gently push one of the implants toward the incision until the tip is visible. Use a scalpel to clear the fibrous sheath over the tip of the implant. Remove each individual implant.

See original RHAP post for image of Figure 1

Figure 1. “Standard Norplant Removal” technique. Yellow arrows outline the six total implants. The red circle depicts where lidocaine is injected, and the green arrow indicates the site of the 4 mm incision made by #11 scalpel. Image by Old et al. (2024).⁹

U Technique: Potentially an easier technique for clinicians who are not highly experienced in Norplant removal, using a modified vasectomy clamp. (See Rosenberg [1997])¹⁰
Modified U Technique: A more versatile technique also using a modified vasectomy clamp so that implants can be removed along the implant shaft. (See Reynolds [1995])¹¹

After Removal:

Ensure the implant is intact on removal
Hold gentle pressure. Apply Steri-Strips/other adhesive bandages or sterile gauze over the removal site.
Apply a cohesive bandage wrap over the gauze, being cautious not to compress the arm too tightly.
Instruct patients to keep the cohesive bandage wrap on for 24 hours and remove any adhesive bandage after 3-5 days.
Patients should monitor for signs of infection and contact their clinician’s office with any questions or concerns.
If appropriate, patients should be reminded that pregnancy can occur as early as a week after removal of contraceptive implants.

If an implant is unable to be removed after 15-30 minutes of using an above technique, then consider referral to another clinician.

References

See RHAP's original post for sources and images.

About HCA and RHAP partnership

HCA and RHAP are partnering to support the reproductive health provider community’s access to accurate, evidence-based clinical information.

If you are an enrolled Apple Health provider, HCA will pay to print items from the RHAP resource library.

Materials such as the birth control choices fact sheet or MEC for initiating contraception chart are available for bulk printing.

To order bulk printing

Email: Brandy Bautista
Include the following information:

"Washington Health Care Authority" in the body of the email
Items you'd like to order
Quantities
Business address
Delivery address (if different than your business address)

Contact

Email Andrea Estes, Sexual and Reproductive Health Programs Innovation Manager at HCA, with questions regarding this partnership.

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

Disclosure notice

All messages we send via GovDelivery are subject to public disclosure, as are the names and email addresses of those who sign up for email notifications.

Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.