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

Table 2. Examples of Different Contraceptive Implants

Single Rod System (ex. Nexplanon6)	Two Rod System (ex. Jadelle7)	Six Rod System (ex. Norplant8)

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:

1. 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.
2. Use antiseptic to clean the removal site.
3. 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.

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:

1. Ensure the implant is intact on removal
2. Hold gentle pressure. Apply Steri-Strips/other adhesive bandages or sterile gauze over the removal site.
3. Apply a cohesive bandage wrap over the gauze, being cautious not to compress the arm too tightly.
4. Instruct patients to keep the cohesive bandage wrap on for 24 hours and remove any adhesive bandage after 3-5 days.
5. Patients should monitor for signs of infection and contact their clinician’s office with any questions or concerns.
6. 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.

RHAP Resources:

Your Birth Control Choices Fact Sheet

Progestin Implant Fact Sheet

Progestin Implant User Guide

Progestin-Only Birth Control Sheet

Sources:

1. Guttmacher. (2021). Contraceptive use in the United States by method. https://www.guttmacher.org/fact-sheet/contraceptive-method-use-united-states.

2. Gupta AH. Hormonal Implants, A Once Unpopular Birth Control, Surge Among Teens. The New York Times. https://www.nytimes.com/2023/12/21/well/live/birth-control-implant-teens.html. Published December 21, 2023. Accessed April 15, 2025.

3. Reproductive Health Access Project. (2013, January 17). A history: the progestin implant. Reproductive Health Access Project. https://www.reproductiveaccess.org/2013/01/a-history-the-progestin-implant/

4. Sam Rowlands & Stephen Searle (2014) Contraceptive implants: current perspectives, Open Access Journal of Contraception, 73-84, DOI: 10.2147/OA JC.S55968

5. Thaxton L, Lavelanet A. Systematic review of efficacy with extending contraceptive implant duration. Int J Gynaecol Obstet. 2019;144(1):2-8. doi:10.1002/ijgo.12696

6. Merck & Co, Inc. (2018). NEXPLANON®. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021529s018lbl.pdf

7. Bayer Scherling Pharma. (2016). JADELLE®. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020544s010lbl.pdf

8. Wyeth-Ayerst Laboratories. (1990). NORPLANT.

9. Old, E. A., Gajarawala, S., Knight, D. R., Pak, K., & Carrubba, A. R. (2024). Successful removal of six levonorgestrel silastic subcutaneous implants (Norplant) 25 years after insertion: a case report. Cureus, 16(7).

10. Rosenberg, M. J., Alvarez, F., Barone, M. A., Waugh, M. S., Brache, V., & Pollack, A. E. (1997). A comparison of “U” and standard techniques for Norplant removal. Obstetrics & Gynecology, 89(2), 168-173.

11. Reynolds, R. D. (1995). The ‘Modified U’ technique: a refined method of Norplant removal. Journal of Family Practice, 40(2), 173-181.

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