**3. Implants and rings**

Removing the implant is often an easy and uncomplicated procedure. In a clinical trial performed by Bahamondes et al., women perceived the pain of the as none (444, 86%), mild (65, 13%), moderate (8, 2%) or severe (0) for the ENG (etonorgestrel) implant; and none (252, 81%), mild (49, 16%), moderate (6, 2%) or severe (1%) for the LNG (levonorgestrel) implant [82]. The ease of removal was reported as easy (492, 94%), slightly difficult (22, 4%) or difficult (8, 2%) for the ENG implant and easy (254, 81%), slightly difficult (47, 15%) or difficult (12, 4%). In this study, two (0.4%) ENG removals were complicated (the implant broke) and seven (2.2%) LNG removals were complicated (in seven cases the implant broke).

The ACOG has published some recommendations regarding the clinical challenges posed by LARC, including the implants [83]. Ultrasonography can be helpful if the implant is impalpable when removal is attempted [84]; in rare cases magnetic resonance might be required to locate it.

There is no evidence fertility is delayed after removal of contraceptive implants [13]. In a study Etonogestrel became not detectable within 1 week of removal of Implanon® implant [85]. Pregnancies have been observed to occur as early as 7–14 days after removal [86]. Within 1 month of Implanon removal ovulation has been observed to return in 40% (16/40) women; and 12 months conception rate was 96% (23/24) in women who had the implant removed and did not implement other contraceptive methods [87].

NuvaRing® is the only ring available to the United States; it releases 15 μg ethinyl estradiol +120 μg etonogestrel per day (which are rapidly absorbed through the vaginal epithelium [88]) and lasts 3 weeks. Ovulation returns after removal of the vaginal ring (in a mean time of 19 days [89]). In the majority of women who discontinue NovaRing ovulation and spontaneous menstrual cycles return within a month [90].

Many other contraceptive preparations are being developed, and prompt return of fertility is usually the rule. After discontinuation of a transdermal patch ovulation has been described to return in the first cycle in 86% of women [91].

The considerations on pregnancy outcomes for OCs can be extrapolated to those methods in which estrogens and progestogens are administered non-orally.
