Everything you need to know about Nexplanon, the birth control implant

Nexplanon, which is also known as the birth control implant, is one of the most effective types of hormonal contraceptives currently available. Once it’s correctly in place, the birth control implant is over 99% effective in preventing pregnancy for up to four years, making it more effective than the birth control patch, ring, or injection. And it has less of a commitment than an intrauterine device (IUD). Read on to see if it could be a good option for you.

What is Nexplanon?

Nexplanon (etonogestrel) is an FDA-approved small, flexible plastic rod about the size of a standard matchstick. A healthcare provider will implant and remove the implant; once in place, the implant will last between three and five years (or less, if you decide to have it taken out). This birth control method—a long-acting reversible contraceptive device (also known as LARC)—works by steadily releasing progestin, a derivative of a natural hormone, into your body to control your menstrual cycle, thin the lining of your uterus, prevent ovulation (the release of an egg that’s ready to be fertilized), and thicken the cervical mucus to prevent sperm from fertilizing any eggs that might have released from your ovaries. 

Nexplanon is radiopaque, so your implant will show up on X-rays, magnetic resonance imaging (MRI), ultrasound scanning, and computed tomography (CT or CAT) scans, which means your provider can use an X-ray or ultrasound to see if your implant is in the right place.

Birth control implants have been available in the United States since 1998, when Wyeth Pharmaceuticals released Norplant. Norplant was taken off the market in 2002 and replaced by Implanon, which has since been updated and renamed Nexplanon, making it one of the newer birth control options on the market. Like Implanon, Nexplanon is a single-rod subdermal implant, but it is radiopaque—which means it’s easier to insert, visualize, and remove than previous iterations of the birth control implant.

How is Nexplanon inserted?

The insertion process for Nexplanon (also known as the etonogestrel implant) is very simple, straightforward, and relatively painless. It is considered a minor procedure, but your healthcare provider can do it in their office, and it only requires a local anesthetic. 

After thoroughly cleaning the area with an antiseptic, your provider will numb the area of your upper arm where she will insert the implant. Once you’re numb, your provider will use a special applicator to insert the implant under the skin in your upper arm. The implant insertion process only takes a few minutes, and while you may feel a slight pinch or stinging feeling when the implant goes in, it shouldn’t be too painful. 

The doctor will make sure it’s implanted correctly before sending you home. You’ll need to wear a pressure bandage on the implant site for the next 24 hours, and then a regular bandage for a few more days. During this time, you’ll need to avoid heavy lifting or exercising to prevent disturbing the implantation site healing. 

Some healthcare providers will only schedule your insertion during the first five days of your period; if so, Nexplanon will provide birth control immediately. If you do not get the birth control implant during the first five days of your period, you should use a secondary birth control measure, such as external condoms, for the first week after getting the implant. Your healthcare provider should require you to take a pregnancy test beforehand.

Once your birth control implant is inserted, you should be able to feel it under your skin. This is to ensure that your healthcare provider will be able to find it later when it needs to be removed. If you can’t feel it, it may not be working effectively, and you could get pregnant. If you can’t feel your implant, talk with your provider. Deep insertion could also make for a more complicated removal process.

How is it removed?

While the lifespan of the Nexplanon birth control implant is three to five years, you may need to take out the implant sooner—for example, if you are trying to get pregnant, or if you decide that the side effects don’t outweigh the benefits of the implant. 

Like its insertion, the birth control implant removal process is quick, with minimum pain or discomfort, and relatively straightforward. However, it will take a little bit more time to remove your implant than it did to have it inserted. To remove it, your healthcare provider will numb your upper arm and make a small incision at the site of the implant. Then, using special tools, he or she will pull the small rod out of your arm and use steri-strips or sutures to close the incision site. At this point, you can have another implant put in immediately if you wish to continue using Nexplanon as your main method of birth control. 

Once your contraceptive implant is out, you may experience soreness or bruising around the incision site. Make sure to follow the instructions that your healthcare provider gives you for washing and caring for the area to avoid infection or scarring. You’ll have to skip heavy weights once again to make sure you don’t disrupt the healing process. 

After the implant is removed, you’ll be able to conceive immediately. If you’re not trying to get pregnant, you’ll need to get another implant or use a different method of birth control.

How effective is Nexplanon?

The Nexplanon implant is over 99% effective at preventing pregnancy when implanted correctly, which makes it one of the best contraceptive options for people who opt to use hormonal birth control. It’s also a good choice for anyone who is sensitive to estrogen, since Nexplanon relies on progestin to prevent pregnancy.

Although the implant is not as widely used as the pill, it is far more effective and just as safe. Because it is a “get it and go” type of birth control, the likelihood of user error—such as forgetting to take your birth control pill every day, change your patch weekly, or swap out your NuvaRing every three weeks—is eliminated. 

What are the advantages of Nexplanon?

Although the side effects and risks shouldn’t be discounted, there are many advantages to this form of birth control. It’s totally private; only you and your provider need to know the implant is there. It’s not necessary to stop intercourse to get condoms (although, condoms should be used to prevent STIs). You don’t have to take medication daily. And there’s no need to keep track of a dosage schedule—you can get it and forget it for up to five three years, depending on what your provider advises.

Once the implant is removed, you can get pregnant right away. It is also a safe option for breastfeeding women who want highly effective contraception; in fact, if you’re taking birth control at all while breastfeeding, a progestin-only contraceptive is your safest bet. You can get the birth control implant four weeks after giving birth. It also won’t change how much breast milk you’re producing. 

What are the common side effects of Nexplanon?

The majority of people using Nexplanon do not experience long-term side effects, and most side effects go away after three to six months as your body adjusts to the implant. However, you will want to consider if the risks of these possible side effects are acceptable for you:

• Changes in your menstrual period, including spotting, heavier or irregular bleeding, or no periods at all
• Pain, bruising, infection, or scarring at the implant insertion site
• Mood swings or other changes, such as anxiety or depressionAcne
• Local allergic reaction 
• Changes in appetite
• Hair thinning or loss
• Headaches
• Weight gain 

What are the risks of the birth control implant?

Your healthcare provider will also provide information about the possible risks of using Nexplanon as a method of birth control, which include: 

• Broken or bent implants
• Problems with inserting or removing the implant that could require surgery
• The plant may also move under the skin or come out by itself. If this happens, contact your provider immediately.
• Blood clots, such as deep vein thrombosis, pulmonary embolism, stroke, or heart attack
• Gallbladder problems
• High blood pressure
• Rare cancerous or noncancerous liver tumors
• Ectopic pregnancy

Overall, all forms of birth control are safer than an unintended pregnancy.

Who shouldn’t get Nexplanon?

There are some significant, life-threatening risks involved with using the birth control implant that you should discuss with your healthcare provider before choosing the implant. According to its prescribing information, you should not use Nexplanon if you have the following risk factors: 

• Are pregnant or think you may be pregnant
• Have blood clots anywhere in your body
• Have liver disease, tumors, or cancer
• Experience non-menstrual vaginal bleeding
• Have had or are currently diagnosed with cancer, especially breast cancer (copper IUD may be a better option)
• Are allergic to the Nexplanon implant
• Are looking for birth control that offers protection against sexually transmitted infections

Other contradictions to consider include:

• A history of mood disorders
• An allergy to anesthetics
• Diabetes
• High blood pressure
• High cholesterol or triglycerides
• Migraine with aura
• Kidney or gallbladder problems

How to get the Nexplanon birth control implant

You must get Nexplanon from a doctor, gynecologist, or nurse practitioner who’s familiar with the process of subdermally inserting or removing the implant. Nexplanon isn’t available through traditional pharmacies like many forms of birth control.

Talk to your healthcare professional to make sure Nexplanon is the best birth control option for you, keeping in mind the side effects and risks involved. The cost of the procedure (which includes the implant) can range from $0 to $1,300, depending on your insurance coverage. Removal of the implant can cost up to $300. Your insurance may cover both the procedure and the implant itself, but check with them first; it’s usually considered a medical benefit. Most insurances cover the Nexplanon implant, its insertion, and removal. If your insurance does not pay for it, you may contact the CoverHer program at nwlc.org/coverher for assistance.

You may be able to get Nexplanon for free or at a discounted rate at certain health centers. In the end, the birth control implant may be as expensive or even less expensive as what you’d pay for other forms of birth control in the long run, depending on your insurance coverage. You can also use SingleCare for discounts on Nexplanon at some specialty pharmacies. You’ll also find SingleCare discounts for other forms of birth control, such as the NuvaRing, the Xulane patch, the Depo-Provera shot, the combination birth control pill, and the minipill.