Published: 6 September 2013


Removal Difficulties with Jadelle and Implanon

Prescriber Update 34(3):27–28
September 2013

Key Messages

  • Jadelle and Implanon must only be administered by healthcare professionals who have been fully trained in insertion and removal procedures.
  • Women should be informed of the risks of removal or location difficulties prior to receiving Jadelle or Implanon.
  • Women should be advised to return to their healthcare professional if they notice any changes with their implant or if they cannot feel their implant.
  • Removal instructions in the data sheet must be carefully followed.
  • If difficulty arises with implant removal, it should be localised by ultrasound before being removed.

Jadelle (levonorgestrel) and Implanon (etonogestrel) are long acting reversible contraceptive implants that are inserted sub-dermally in the upper arm. Removal and/or location difficulties have been reported in clinical studies and with post-marketing use of both these devices. Patients should be advised of these risks prior to insertion.

Since PHARMAC funding began in August 2010, more than 38,000 women have received Jadelle in New Zealand. It is unknown how many women have received Implanon.

Up until June 2013, the Centre for Adverse Reactions Monitoring (CARM) had received 21 reports of location or removal difficulties with Jadelle and three reports with Implanon. In many of these reports, the implant required removal under ultrasound guidance.

Jadelle and Implanon provide effective contraception for at least three years to five years depending on the implant used. Following insertion, women should be advised to return to their healthcare professional if:

  • they cannot feel their implant
  • they notice any change to the shape of the implant
  • the implant appears to have broken
  • there are skin changes or pain around the site of the implant.

As with other progestogen-only contraceptives, menstrual bleeding changes (irregular, prolonged and/or inter-menstrual bleeding, spotting and amenorrhoea) are very common with both products. In clinical studies, 14% of Jadelle users and 33% of Implanon users had their implant removed early because of menstrual difficulties1,2.

The CARM reports are consistent with the implants being removed early. However, insufficient information was provided in the reports to confirm that this was due to menstrual bleeding changes.

Please report any adverse reactions to Jadelle or Implanon, including any removal difficulties, to CARM.

  1. Faculty of Sexual and Reproductive Healthcare. 2009. Faculty of Sexual and Reproductive Healthcare Clinical Guidance: Progestogen-only Implants. London: Faculty of Sexual and Reproductive Healthcare. URL: (accessed 1 August 2013).
  2. Bayer New Zealand Limited. 2010. Jadelle Data Sheet 30 August 2010. URL: (accessed 1 August 2013).
  3. Merck Sharp & Dohme. 2012. Implanon Data Sheet 4 July 2012. URL: (accessed 1 August 2013).
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