Review Nexplanon Medical Information

Your Arbor ObGyn physician or nurse practitioner provided you with a manufacturer’s brochure about the Nexplanon.  If you did not receive it or need additional information, please refer to the Nexplanon website: www.nexplanon.com.  There is Important Safety Information you should review prior to scheduling.

Review Your Insurance Benefits

Once your Arbor ObGyn provider requests it, your insurance carrier is contacted to obtain benefits for the Nexplanon device requested and its insertion and/or replacement.  Arbor purchases the Nexplanon and your insurance reimburses us at a contracted rate.  The Nexplanon cost and the actual insertion/removal procedure are separate charges.  Once obtained, your Nexplanon benefits are sent to you via a separate message located in your Patient Portal.  Please log in to the Patient Portal to review.

There is usually no separate office visit charge in addition to the charge for the Nexplanon placement.  Your 4-8 week follow-up visit is considered an office visit however, and will require your standard co-pay as determined by your insurance carrier.

Insurance pre-authorization is not required, but we do contact and carefully review insurance benefits as a courtesy to you.  On rare occasions an Insurance Carrier may not pay as quoted.  Therefore, you may consider contacting your Insurance Carrier directly to confirm the information we have been given, and that it will be valid on the date of the Nexplanon procedure.  If your insurance claim is denied for any reason after the device is placed you will still be responsible for fees which will exceed $1,000.  The billing codes are:  Nexplanon Device (J7307), Insertion Procedure (11981), Removal/Reinsertion Procedure (11983)

Schedule an Appointment for Placement of the Nexplanon

Before you call, please review the preparation information below so that your appointment can be appropriately timed with regards to your menstrual cycle.  Once you also have reviewed your insurance benefits Patient Portal message, simply reply to the message indicating your desire for the Nexplanon placement.  Please lists some dates & times that would work for placement.  Please reply with a good phone number and time to reach you so that we can call you to schedule the placement.

Preparation for Your Nexplanon Placement Appointment

Carefully review the information below so that your Nexplanon placement appointment is correctly scheduled, and so that Arbor ObGyn will not cancel your procedure when you arrive.

Pregnancy Precaution

Placement of Nexplanon at the time of an unknown early pregnancy could cause miscarriage or complications with the pregnancy.  It is important that you take precautions to ensure that you are NOT pregnant at the time of your appointment.  Please make sure that you use effective contraception with any sexual activity for the two weeks prior to your Nexplanon placement.  Your Nexplanon will not be placed if you have sex without contraception within two weeks.  “Breastfeeding”, “withdrawal”, and “natural family planning” for example are NOT considered contraceptive methods in preparation for Nexplanon placement because of the high unintended pregnancy rates.  If you are not using contraception (condoms, pills, etc.) then simply do not have sex for two weeks before your appointment.

Timing of Insertion

The timing of Neplanon insertion depends on your current contraceptive method.  Use the table below to determine the optimal timing of placement for you.

• If you have NOT been using a hormonal contraceptive during the past month:
  Nexplanon should be inserted between Day 1 (first day of bleeding) and Day 5 of the menstrual cycle, even if you are still bleeding.  If you don’t have menstrual cycles you can schedule anytime, but carefully follow the guidance above to avoid unintended/unknown pregnancy.
• If you are switching from combination hormone contraceptive (Birth Control Pill, NuvaRing, or Xulane patch):
  For Pill users, Nexplanon should preferably be inserted between the last active tablet of the oral contraceptive and the last placebo tablet. For women with the ring or patch, Nexplanon should be inserted on the day the ring/patch is removed.
• If you are switching from a Progestin-only contraceptive (Minipill, Injectable, Nexplanon):
  • Minipill (norethindrone only pill):
    Since an active medicated pill is taken every day, you may have the Neplanon placed on any day of the month. It should be inserted within 24 hours after taking a tablet.
  • Injectable Contraceptives (Depo-Provera):
    You should have the Nexplanon inserted on the day the next injection is due.
  • Nexplanon or IUD:
    You should have the Nexplanon inserted on the same day the previous Nexplanon or IUD is removed.
• If you are recently Postpartum:
  Whether you are breastfeeding or not, we will order, schedule, and insert your Nexplanon sometime after your regular six-week postpartum visit. Since you are unlikely to have menstrual cycles, we can insert Nexplanon at any time.

Information for After Your Nexplanon Placement

Incision Site Care

Keep the wrapped compression dressing on for 12 to 24 hours.  Underneath is a Band-Aid and/or tape strips across the insertion site, which should be maintained (or replaced) for three days.  The insertion site is only 4 mm long.  Contact the office you develop a fever above 100.4, or there is expanding redness or pus from the incision site.

Pain

It is normal to have some discomfort and bruising following placement.  Ibuprofen can be used as needed for next few days.  Contact the office if pain becomes too severe.  After the first week, you should be able to feel the Nexplanon implant without any discomfort.  If you cannot feel the implant at all, please call the office.

Bleeding

It is very common to have bleeding after Nexplanon placement.  Irregular bleeding can continue for 3-6 months in some cases.  The majority of patients continue to report some occasional spotting at the follow-up visit.  The most common change with Nexplanon is an irregularity to your normal menstrual bleeding pattern. In studies, one out of ten women stopped using the implant because of an unfavorable change in their bleeding pattern. You may experience longer or shorter bleeding during your periods or have no bleeding at all. The time between periods may vary, and in between periods you may also have spotting.

Sexual Activity

It is important to use condoms for contraception with any sexual intercourse during the first week after Nexplanon placement, to reduce the chance of unintended pregnancy.  Nexplanon will be effective at preventing pregnancy after one week.

Infection Precautions

Nexplanon does not prevent sexually transmitted diseases.  Please continue to use safe sex practices which include condoms and monogamy.  If you are concerned that you may have been exposed to a sexually transmitted infection please contact our office so that we can properly evaluate you.

Unintended Pregnancy

Nexplanon is extremely effective in preventing pregnancy.  If you find out that you are pregnant, however, please contact our office right away so that we can evaluate you.

Other Side Effects

Besides changes in menstrual bleeding patterns, other common side effects reported in women using Nexplanon include: headaches; vaginitis (inflammation of the vagina); weight gain; acne; breast pain; viral infection such as sore throats or flu-like symptoms; stomach pain; painful periods; mood swings, nervousness, or depressed mood; back pain; nausea; dizziness; pain and pain at the site of insertion. Implants have been reported to be found in a blood vessel, including a blood vessel in the lung.  Cysts may develop on the ovaries and usually go away without treatment, but sometimes surgery is needed to remove them.  Some women develop a severe change in their mood, energy, or exacerbation of depression.  Please contact our office right away so that we can evaluate you.

Serious Blood Clots

Nexplanon may increase your chance of serious blood clots, especially if you have other risk factors such as smoking.  If you smoke, you should quit.  It is possible to die from a problem caused by a blood clot, such as a heart attack or a stroke.  Some examples of serious blood clots are blood clots in the: Legs (deep vein thrombosis), Lungs (pulmonary embolism), Brain (stroke), Heart (heart attack), Eyes (total or partial blindness).  Tell your healthcare provider at least 4 weeks before if you are going to have surgery or will need to be on bed rest. You have an increased chance of getting blood clots during surgery or bed rest.

When else should I call my healthcare provider at Arbor ObGyn?

• Pain in your lower leg that does not go away
• Severe chest pain or heaviness in the chest
• Sudden shortness of breath, sharp chest pain, or coughing blood
• Symptoms of a severe allergic reaction, such as swollen face, tongue or throat; trouble breathing or swallowing
• Sudden severe headache unlike your usual headaches
• Weakness or numbness in your arm, leg, or trouble speaking
• Sudden partial or complete blindness
• Yellowing of your skin or whites of your eyes, especially with fever, tiredness, loss of appetite, dark colored urine, or light
• colored bowel movements
• Severe pain, swelling, or tenderness in the lower stomach (abdomen)
• Lump in your breast
• Problems sleeping, lack of energy, tiredness, or you feel very sad
• Heavy menstrual bleeding
• High Blood Pressure

Follow-Up

A 4-8 week follow-up appointment will be scheduled following placement.  It is important that you come for this appointment.  This is a good opportunity to review your menstrual pattern and any concerning side-effects of the Nexplanon.