How Effective is Nexplanon? Pros and Cons

Nexplanon is an implant that a healthcare professional can place under the skin in your upper arm to provide long-lasting birth control. It is a progestin-only contraceptive and protects against pregnancy for three years. It is over 99% effective.

A single, thin rod measuring 1.6 inches long, about the size of a matchstick, Nexplanon is discreet. It is not visibly noticeable, but you may feel it if you run your fingers over your skin. The most common side effect of Nexplanon is irregular menstrual bleeding.

This article covers how Nexplanon works and what to expect if you are thinking about getting one. It discusses the benefits and possible side effects that come with Nexplanon, along with who Nexplanon is not recommended for.

How Does Nexplanon Work?

Nexplanon continuously releases a low dose of a synthetic progestin called etonogestrel for up to three years of use.

This prevents pregnancy by :

• Stopping your ovaries from releasing eggs
• Preventing sperm from reaching an egg
• Thinning the lining of your uterus

The device delivers progestin in decreasing amounts over three years. The level of etonogestrel delivery decreases slightly after one year of use, but remains above the amount needed to suppress ovulation. By the end of the third year, the dose released is too small to prevent pregnancy, and it should be removed.

In most people, ovulation resumes within six weeks of having Nexplanon removed. To continue to be protected against pregnancy, a new implant or another form of birth control is needed.

How Is Nexplanon Implanted?

Nexplanon is inserted under the skin of your upper arm by a trained medical professional.

Before implantation, you will be given a local anesthetic to numb the area. Your healthcare provider will then use a special applicator that will guide Nexplanon under the skin of your arm.

The insertion process only takes a few minutes. After Nexplanon is implanted, you will need to wear a pressure bandage for 24 hours and then a smaller bandage for another three to five days.

The most common side effects of the implantation are short-term pain and swelling. Call your healthcare provider if you develop signs of an infection, including a high fever, bleeding, increasing pain, or a discharge from the implantation site.

What Is the Difference Between Nexplanon and Implanon?

Nexplanon differs from its predecessor Implanon in a number of key ways. For starters, Nexplanon is radiopaque, meaning that it can be seen on an X-ray, computed tomography (CT) scan, ultrasound, or magnetic resonance imaging (MRI).

This is important because, in the past, healthcare providers had to rely on palpation (feeling the area) alone to confirm the correct implantation position. As a result, many rods were implanted far too deeply. This could cause vascular and nerve injury, and it also makes them less effective.

With Nexplanon, healthcare providers can use an X-ray or ultrasound to confirm the rod has been correctly placed and easily locate it when it is time for removal.

Nexplanon also has an improved applicator. The new preloaded device can be operated with one hand, making it easier for a healthcare provider to implant the rod accurately and without assistance.

How Effective Is Nexplanon?

Nexplanon is 99.9% effective when inserted correctly. With typical use, 1 of every 100 women who use Nexplanon for a year will become pregnant.

Hormonal birth control, including Nexplanon, may be less effective if you have overweight or obesity. This is because the concentration of hormone actively circulating in your blood will be lower.

To this end, some healthcare providers will recommend replacement between the second and third years for women with a higher body weight, rather than waiting until the end of the third year.

Benefits of Nexplanon

There are many lifestyle and health benefits to consider when deciding to use Nexplanon.

• Discreet and private
• Does not require maintenance or the need for daily dosing
• Safe for those who can't use estrogen-based contraception
• Effective immediately if inserted between the first and fifth day of your period
• Safe for breastfeeding moms four weeks after implantation
• Comes with fewer hormonal ups and downs than other hormonal birth control due to its steady hormone delivery

In addition, Nexplanon may be a good option for you if you don't want to get pregnant now, but want flexibility with family planning after ending birth control use.

Unlike some forms of hormonal contraception, fertility returns quickly once you stop using Nexplanon, often within 14 days. By comparison, it may take up to a year for fertility to return after stopping Depo-Provera, another long-term contraceptive method.

What Are the Side Effects of Nexplanon?

The most common side effect of Nexplanon is irregular menstrual bleeding, including changes in frequency, intensity, or duration of bleeding. About one in five people will not have a period at all when using Nexplanon. Another 1 in 5 people will have frequent and/or prolonged bleeding.

The bleeding pattern you experience during the first three months of having Nexplanon implanted is generally a good indication of what to expect in the months thereafter.

Other common side effects of Nexplanon include:

• Headaches
• Vaginitis
• Weight gain
• Acne
• Breast pain
• Abdominal pain
• Sore throat

Less common side effects have also been reported, including:

• Increased appetite
• Mood swings
• Decreased sex drive
• Dizziness
• Nausea
• Hot flashes
• Hair loss
• Fatigue
• Increased blood pressure
  

Complications

Serious problems with Nexplanon are rare but most often occur if the rod is placed incorrectly.

If Nexplanon is inserted too deeply, nerve or vascular injury may occur. This can lead to the development of hematomas (blood clots) or paresthesia (abnormal sensations). Both can become serious if left untreated.

Call your healthcare provider if you experience signs of an implantation injury, including persistent pain, numbness, tingling, confusion, vomiting, lethargy, scarring, or disfiguring bruising.

Removal complications can also occur if the rod was improperly placed. In some cases, the rod can migrate from its original position and require costly surgical extraction.

The incorrect placement of the rod can also prevent the progestin from releasing properly. This increases the risk of pregnancy and the likelihood of an ectopic (tubal) pregnancy.

Who Should Not Get Nexplanon?

Nexplanon is a safe birth control option for most healthy people, but it is not for everyone. Nexplanon is not recommended if you are pregnant or think you may be pregnant, or if you have any of the following conditions:

• Allergic reaction to any of the components of Nexplanon
• Liver disease
• Unexplained vaginal bleeding
• Current or past breast cancer
• Progestin-sensitive cancer
• Current or past history of thrombosis or thromboembolic disorders

Nexplanon may also not be suitable if you have:

• Diabetes
• High cholesterol
• Headaches
• Epilepsy
• Gallbladder disease
• Kidney disease
• High blood pressure
• A history of severe depression
• An allergy to anesthetics

Talk with your healthcare provider to learn about your personal risks.

How Much Does Nexplanon Cost?

Nexplanon prices vary, generally ranging from $800 to $1,300. Implantation and removal costs can cost $600 or more per procedure, and it may range depending on where you have it done, as well as other factors, such as health complications.

While Nexplanon requires higher upfront costs compared to other birth control methods, you could save money in the long run versus paying for monthly birth control.

Is Nexplanon Covered by Insurance?

Medicaid and many private health plans will cover the cost of Nexplanon, which is required to be provided for free under plans subject to the Affordable Care Act. There could be a copay for the implantation and removal. To avoid surprises, always check with your insurer to determine what your total out-of-pocket costs will be.

Summary

Nexplanon is a birth control implant that a healthcare provider places under the skin in your upper arm. Nexplanon is more than 99% effective at preventing pregnancy for up to three years. It accomplishes this by stopping the ovaries from releasing eggs, preventing sperm from reaching an egg, and thinning the uterine lining.

Irregular menstrual periods are the most common side effect of Nexplanon, along with headaches, weight gain, breast pain, and acne. Nexplanon isn't right for everyone. If you are thinking about getting it, contact your provider for medical advice.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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7. Hellwinkel J, Konigsberg M, Oviedo J, Castaño P, Kadiyala R. Subfascial-located contraceptive devices requiring surgical removal. Contracept & Reproduct Med. 2021 May;6(1):13. doi:10.1186/s40834-021-00158-5
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By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.

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