Management of Missed Implanon :
– Etonogestrel implant (Implanon) is a single-rod progestin contraceptive placed subdermally in the inner upper arm for long-acting reversible contraception (3 yr).
– The implant may migrate a short distance (<2 cm) over time.
– Women who are postabortion or postpartum (even if breastfeeding) can have the implant inserted immediately after termination of pregnancy or delivery.
– Unscheduled bleeding is the most common side effect & reason for discontinuation.
– Back-up contraception for 7 days after insertion is important if inserted away from the LMP.
– The hormonal effects end promptly after removal &>90% of women ovulate within 3-4 wk of removal.
– If the implant is not removed after 3 yr, the contraceptive effects persist, possibly for as long as 2 years more.
– Rods too deeply placed can’t be palpated under the skin, but can be seen with imaging studies (Implanon can be identified with high resolution U/S or MRI; Nexplanon is radioopaque & can be identified with just plain X-ray).
– Such “lost” rods should be located with a high frequency (10-15 mega Hz), short focus, linear U/S transducer prior to attempting the removal. Our target here is to identify an acoustic shadow (the rod itself is more difficult to see), measure the depth & draw a line representing the rod location on the surface of the skin. If the rod is very deep (>1.5-2 cm), U/S should be used during the removal procedure because movement of the patient’s arm may change the location of skin marks in relation to the underlying implant.
– Removal of contraceptive implants is never an emergency; there is no evidence that their presence adversely affects pregnancies or other conditions.
– Finally, I will upload videos for Implanon insertion & removal later. After sonographic localization of the implant, make a 3 mm incision transversely above the implant, open the modified vasectomy forceps over the implant, close the forceps around the implant, and then use the forceps to remove the implan.