Original research article| Volume 76, ISSUE 1, P35-39, July 2007

Removal of etonogestrel contraceptive implants in the operating theater: report on 28 cases



      We describe removal procedures for etonogestrel contraceptive implants in the operating theater. In addition, we discuss the management of removal of contraceptive implants that are difficult to palpate or are impalpable.


      We conducted a retrospective single-center case series analysis of Implanon��� removals conducted at a university hospital between January 2002 and April 2005.

      Materials and Methods

      We analyzed case notes for 28 patients who had their contraceptive implant removed in the operating theater.


      Intermenstrual bleeding was the principal reason for removal (52.4%). Ten patients already had one attempted removal of their implant. Preoperative ultrasound localized the implant in all cases. Half of the removals were done under local anesthetic, with three cases progressing to general anesthesia (11%). Thirty percent of the implants had migrated from their initial implantation, 37% were in intramuscular tissue and 11% were in the humeral neurovascular sheath. The only postoperative complications were one small seroma and transient paresthesia in the territory of the ulnar nerve. The implant was not found in one case.


      The removal of an implant that is not palpable or difficult to palpate should take place in the operating theater following localization by ultrasound. Patients must be fully informed about the procedure, including its complications and the risk for failure.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wenzl R.
        • van Beek A.
        • Schnabel P.
        • Huber J.
        Pharmacokinetics of etonogestrel released from the contraceptive implant Implanon��.
        Contraception. 1998; 58: 283-288
        • Croxatto H.B.
        • M��k��r��inen L.
        The pharmacodynamics and efficacy of Implanon��. An overview of the data.
        Contraception. 1998; 58: 91S-97S
        • Sergent F.
        • Clamageran C.
        • Bastard A.M.
        • Verspyck E.
        • Marpeau L.
        Acceptabilit�� de l'implant contraceptif �� l'��tonogestrel (Implanon��).
        J Gynecol Obstet Biol Reprod. 2004; 33: 407-415
        • Reuter S.
        • Smith A.
        Implanon��: user views in the first year across three family planning services in the Trent Region, UK.
        Eur J Contracept Reprod Health Care. 2003; 8: 27-36
        • Cravioto M.C.
        • Alvarado G.
        • Canto-de-Cetina T.
        • et al.
        A multicenter comparative study on the efficacy, safety, and acceptability of the contraceptive subdermal implants Norplant�� and Norplant��-II.
        Contraception. 1997; 55: 359-367
        • Affandi B.
        • Korver T.
        • Paul T.
        • Geurts B.
        • Coelingh H.
        • Benninck J.T.
        A pilot efficacy study with a single-rod contraceptive implant (Implanon��) in 200 Indonesian women treated for ���4 years.
        Contraception. 1999; 59: 167-174
        • Croxatto H.B.
        • Urbancsek J.
        • Massai R.
        • Coelingh Benninck H.
        • van Beek A.
        • and the Implanon�� Study Group
        A multicenter efficacy and safety study of the single contraceptive implant Implanon��.
        Hum Reprod. 1999; 14: 976-981
        • Zheng S.R.
        • Zheng H.M.
        • Qian S.Z.
        • Sang G.W.
        • Kaper R.F.
        A randomized multicenter study comparing the efficacy and bleeding pattern of a single-rod (Implanon��) and six-capsule (Norplant��) hormonal contraceptive implant.
        Contraception. 1999; 60: 1-8
        • Sarma SP.
        • Wamsher JG.
        Removal of deeply inserted, nonpalpable levonogestrel (Norplant��) implants..
        Contraception. 1996; 53: 159-161
        • Affandi B.
        An integrated analysis of vaginal bleeding patterns in clinical trials of Implanon��.
        Contraception. 1998; 58: 99S-107S
        • Graesslin O.
        • Hoffet M.
        • Barjot P.
        • et al.
        Le suivi �� long terme d'une cohorte de femmes porteuses d'un implant contraceptif (Implanon��): analyse interm��diaire de donn��es de l'observatoire de l'OPNI.
        Gynecol Obstet Fertil. 2005; 33: 315-321
        • Urbanscek J.
        An integrated analysis of nonmenstrual adverse events with Implanon��.
        Contraception. 1998; 58: 109S-115S
        • Bitzer J.
        • Tschudin J.
        • Alder J.
        • and the Swiss Implanon Study Group
        Acceptability and side-effects of Implanon in Switzerland: a retrospective study by the Implanon Swiss Study Group.
        Eur J Contracept Reprod Health Care. 2004; 9: 278-284
        • Darney P.D.
        • Klaisle C.
        • Walker D.M.
        The ���pop out��� method of Norplant removal.
        Adv Contracept. 1992; 8: 188-189
        • Mascarenhas L.
        Insertion and removal of Implanon��.
        Contraception. 1998; 58: 79S-83S
        • Bensouda-Grimaldi L.
        • Jonville-B��ra A.P.
        • Beau-Salinas F.
        • Llabres S.
        • Autret-Leca E.
        • le r��seau des centres r��gionaux de pharmacovigilance
        Insertion problems, removal problems, and contraception failures with Implanon��.
        Gynecol Obstet Fertil. 2005; 33: 986-990
        • Twickler D.M.
        • Schwarz B.E.
        Imaging of the levonorgestrel implantable contraceptive device.
        Am J Obstet Gynecol. 1992; 167: 572-573
        • Lantz A.
        • Nosher J.L.
        • Pasquale S.
        • Siegel R.L.
        Ultrasound characteristics of subdermally implanted Implanon��� contraceptive rods.
        Contraception. 1997; 56: 323-327
        • Amman P.
        • Botta U.
        • Montet X.
        • Bianchi S.
        Sonographic detection and localization of a clinically nondetectable subcutaneous contraceptive implant.
        J Ultrasound Med. 2003; 22: 855-859
        • Merki-Feld G.
        • Brekenfeld C.
        • Migge B.
        • Keller P.J.
        Nonpalpable ultrasonographically not detectable Implanon rods can be localized by MR imaging.
        Contraception. 2001; 63: 325-328
        • Westerway S.C.
        • Picker R.
        • Christie J.
        Implanon implant detection with ultrasound and magnetic resonance imaging.
        Aust N Z J Obstet Gynaecol. 2003; 43: 346-350
        • Hatasaka H.
        Implantable levonorgestrel contraception: 4 years of experience with Norplant.
        Clin Obst Gynecol. 1995; 38: 859-871
        • Oloto E.
        • Bromham D.
        Norplant removal: a review.
        Br J Fam Plann. 1995; 21: 21-24
        • Sicot C.
        Responsabilit�� civile professionnelle: rapport du conseil m��dical du Sou M��dical - Groupe MACSF sur l'exercice 2003.
        Responsabilit��. 2004; 11: 3-24
        • Sicot C.
        Responsabilit�� civile professionnelle: rapport du conseil m��dical du Sou M��dical - Groupe MACSF sur l'exercice 2004.
        Responsabilit��. 2005; 3: 3-27
        • Rai K.
        • Gupta S.
        • Cotter S.
        Experience with Implanon in a northeast London family planning clinic.
        Eur J Contracept Reprod Health Care. 2004; 9: 39-46