Contraceptive implants removal: a simple and quick procedure in a nonspecialized family planning clinic

Most studies on contraceptive implant removal come from specialised centres, with limited data from general clinical settings. This study aimed to evaluate difficulties in single-rod implant removal in a nonspecialized clinic.

We conducted a cross-sectional study of women requesting etonogestrel (ENG) implant removal. Difficulty was assessed using a visual analog scale (VAS), and women rated their pain on a VAS score. Multivariable logistic regression analysed factors associated with removal difficulty.

A total of 184 women participated (mean age 31 ± 8.6 years). The implant location was appropriate in most cases (88.1%). Nearly all implants showed a positive scrolling sign (96.7%), four cases were deeply located but above the fascia, and in two cases, the implant was found deep within the muscle. A total of 37 cases (26.4%) showed fibrosis. The median scores for difficulty and pain were low during removal. Nurses removed 21% of implants, with no significant differences in difficulty (p = 0.679) or pain scores (p = 0.582) compared to physicians. Logistic regression showed that implants with absent scrolling sign were 21.2 times more likely to be difficult to remove (OR 21.2, 95% CI 2.32-193.43, p = 0.003), and fibrosis increased difficulty fourfold (OR 4.2, 95% CI 1.26-14.11, p < 0.001).

ENG implant removal is generally a simple and quick procedure with low difficulty and minimal pain. Challenges arise with non-palpable or fibrotic implants, particularly when the scrolling sign is absent. Deeply placed implants can still be successfully removed in a nonspecialized clinic.