Nexplanon vs. Mirena: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

When deciding on an effective and safe birth control method, you may be met with several options, such as birth control pills, birth control implants, and hormonal IUDs (intrauterine devices). The most effective options, however, are the etonogestrel contraceptive implant and the levonorgestrel intrauterine system (LNG IUD). During the course of a year, fewer than 1 in 100 women will get pregnant while using an implant or intrauterine device. 

Nexplanon (etonogestrel) and Mirena (levonorgestrel) are non-pill forms of birth control that can help prevent pregnancy. Both drugs contain female hormone analogs called progestins. They do not contain estrogen.

Nexplanon is implanted under the skin of the upper arm while Mirena is an intrauterine device (IUD) inserted into the uterus. They work by creating a hostile environment for sperm to prevent the fertilization of an egg. Progestins can also help stop the release of an egg from the ovaries (ovulation). Continue reading to learn more about the similarities and differences between Nexplanon and Mirena.

What are the main differences between Nexplanon vs. Mirena

Nexplanon 

Nexplanon is an etonogestrel implant, formerly known as Implanon. It is the size of a matchstick, and it is implanted under the skin of the upper arm by a trained healthcare professional. Nexplanon was approved in 2001 to prevent pregnancy. 

Nexplanon contains 68 mg of etonogestrel, a type of progestin that closely resembles progesterone. After implantation, Nexplanon releases etonogestrel to help prevent pregnancy for up to three years. After this period of time, it needs to be removed and replaced. However, some studies have shown that Nexplanon may be effective for up to five years. 

Mirena

Mirena is a levonorgestrel-releasing IUD that is inserted into the uterus as a small T-shaped device. It is inserted directly into the uterus by a trained healthcare professional. Mirena was approved in 2000 to prevent pregnancy and decrease heavy menstrual bleeding. 

Mirena contains 52 mg of levonorgestrel that is released slowly over time. After implantation, Mirena can help prevent pregnancy for up to seven years and decrease menstrual bleeding for up to five years. Mirena should be removed and replaced after five years in order to remain effective for menstrual bleeding. Otherwise, it can remain in place for another two years for a total of seven years to prevent pregnancy.

Main differences between Nexplanon vs. Mirena
	Nexplanon	Mirena
Drug class	Hormonal contraceptive Progestin-only	Hormonal contraceptive Progestin-only
Brand/generic status	No generic version available	No generic version available
What is the generic name?	Etonogestrel implant	Levonorgestrel intrauterine system
What form(s) does the drug come in?	Subdermal implant	Intrauterine device (IUD)
What is the standard dosage?	Nexplanon contains a total of 68 mg of etonogestrel, which is released at a rate of 60 to 70 mcg/day in week 5 to 6. This rate decreases to 35 to 45 mcg/day at the end of the first year, 30 to 40 mcg/day at the end of the second year, and 25 to 30 mcg/day at the end of the third year.	Mirena contains a total of 52 mg of levonorgestrel, which is released at a rate of 20 mcg/day over the first 3 months. This rate decreases to 18 mcg/day after 1 year, 10 mcg/day after 5 years, and 8 mcg/day after 7 years.
How long is the typical treatment?	3 years	5 to 7 years
Who typically uses the medication?	Women over 18 years old	Women over 18 years old

Conditions treated by Nexplanon and Mirena

Both Nexplanon and Mirena are hormonal contraceptives FDA approved to prevent pregnancy. Nexplanon is implanted under the skin (subdermal) to prevent pregnancy for up to three years. Mirena is inserted into the uterus (IUD) to prevent pregnancy for up to seven years. 

Mirena is also approved to treat heavy menstrual bleeding. Nexplanon is not approved for heavy menstrual bleeding, although it may be used off-label for this purpose. 

Condition	Nexplanon	Mirena
Prevention of pregnancy	Yes	Yes
Heavy menstrual bleeding	Off-label	Yes

Is Nexplanon or Mirena more effective?

Both Nexplanon and Mirena are effective methods of birth control with a failure rate of less than 1%. They contain progestin, a synthetic form of progesterone, to help suppress ovulation and thicken the cervical mucus. This mechanism of action helps prevent the release and fertilization of an egg. 

As long-acting reversible contraceptives (LARCs), these birth control methods can be used for several years. Nexplanon is approved to prevent pregnancy for up to three years while Mirena is approved to prevent pregnancy for up to seven years. Compared to the percentage of women who experience pregnancy with LARCs (less than 1%), there is a higher percentage of women who experience a pregnancy in the first year with other forms of birth control: 18% with male condoms, 9% with NuvaRing, 9% with combined or progestin-only oral contraceptives, and 6% with Depo-Provera.

While both Nexplanon and Mirena are highly effective, studies have shown that more women who use Nexplanon may discontinue treatment due to side effects after one year. However, both birth control methods are approved as effective and safe. 

Consult a gynecologist for medical advice on the best contraceptive for you. A healthcare provider can also assist with other aspects of family planning. 

Coverage and cost comparison of Nexplanon vs. Mirena

Many health insurance plans may help cover the cost of Nexplanon or Mirena. In general, Medicare plans do not provide coverage for birth control. Because no generic versions are available for Nexplanon or Mirena, costs can run high. 

Contact your insurance provider or healthcare provider to determine the exact cost of Nexplanon or Mirena. A savings card from SingleCare may help lower the cost of Nexplanon and Mirena. 

	Nexplanon	Mirena
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	No	No
Quantity	One implant	One device
Typical Medicare copay	N/A	N/A
SingleCare cost	$1,071+	$1,034+

Common side effects of Nexplanon vs. Mirena

The most common side effects of Nexplanon include headache, menstrual changes, vaginal inflammation (vaginitis), weight gain, acne, breast tenderness, abdominal cramping, and mood changes, such as depression. Other side effects may include nausea, dizziness, and back pain. 

The most common side effects of Mirena are headache, vaginal inflammation (vaginitis), vaginal discharge, abdominal cramping, and menstrual changes or irregular bleeding patterns. Other side effects include nausea, back pain, acne, breast tenderness, and depression.

	Nexplanon		Mirena
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Headache	Yes	25%	Yes	16%
Vaginitis	Yes	15%	Yes	11%
Weight gain	Yes	14%	Yes	6%
Acne	Yes	14%	Yes	7%
Breast tenderness	Yes	13%	Yes	9%
Abdominal pain	Yes	11%	Yes	23%
Menstrual changes	Yes	11%	Yes	32%
Dizziness	Yes	7%	No	–
Back pain	Yes	7%	Yes	8%
Nausea	Yes	6%	Yes	<5%
Depression	Yes	6%	Yes	6%

Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Nexplanon), DailyMed (Mirena)

Drug interactions of Nexplanon vs. Mirena

Drugs that induce or block certain enzymes in the liver, including the CYP3A4 enzyme, can affect blood levels of Nexplanon and Mirena. CYP3A4 inducers like phenytoin, carbamazepine, oxcarbazepine, felbamate, and rifabutin can decrease blood levels of Nexplanon and Mirena, which can decrease the effectiveness of the contraceptive. St. John’s wort can also act as a CYP3A4 inducer. 

Drugs that inhibit, or block, the CYP3A4 enzyme can cause increased blood levels of Nexplanon and Mirena. CYP3A4 inhibitors include fluconazole and ketoconazole. Taking these drugs with Nexplanon or Mirena may increase the risk of adverse effects of the contraceptive. 

Drug	Drug Class	Nexplanon	Mirena
Carbamazepine  Oxcarbazepine Efavirenz Felbamate  Griseofulvin Nevirapine  Phenytoin  Phenobarbital  Rifabutin  Rifampin  St. John’s wort Topiramate	CYP3A4 inducers	Yes	Yes
Ketoconazole Itraconazole Fluconazole Grapefruit juice	CYP3A4 inhibitors	Yes	Yes

*This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking. 

Warnings of Nexplanon and Mirena

Both Nexplanon and Mirena can cause changes in menstrual bleeding patterns. Consult a healthcare provider if bleeding is irregular, painful, or particularly severe. 

The use of Nexplanon or Mirena is associated with an increased risk of thrombosis, or blood clots. These contraceptives should be avoided in women with a history of smoking and a cardiovascular event like a heart attack or stroke. 

Although rare, an ectopic pregnancy can occur while using Nexplanon or Mirena. Consult a healthcare provider if you experience unusual vaginal bleeding or severe abdominal pain with Nexplanon or Mirena. 

It is not recommended to use Nexplanon or Mirena if you have liver problems, like liver disease or liver tumors. 

The use of Nexplanon or Mirena can lead to the development of ovarian cysts. These cysts usually go away on their own but may require surgery in some cases. 

Nexplanon may cause mild insulin resistance and changes in blood sugar levels, especially in women with diabetes.

There is an increased risk of group A streptococcal infections, pelvic inflammatory disease, perforation, and expulsion of the device while using Mirena. 

Frequently asked questions about Nexplanon vs. Mirena

What is Nexplanon?

Nexplanon is a birth control implant that contains etonogestrel. It is implanted in the skin of your upper arm to prevent pregnancy. Nexplanon is effective for up to three years, after which it must be removed and replaced. Nexplanon contains 68 mg of etonogestrel. 

What is Mirena?

Mirena is a hormone-releasing intrauterine device (IUD). It contains 52 mg of levonorgestrel that is released slowly over time. Mirena is effective for preventing pregnancy for up to seven years. It is also approved to treat heavy menstrual bleeding for up to five years. 

Are Nexplanon and Mirena the same?

Nexplanon and Mirena are available non-pill birth control options. Although they are both considered long-acting reversible contraceptives (LARCs) that contain a form of progestin, they are not the same. Nexplanon contains etonogestrel and is implanted in the upper arm. Mirena contains levonorgestrel and is inserted into the uterus. 

Is Nexplanon or Mirena better?

Both Nexplanon and Mirena are long-acting reversible contraceptives that are more effective than other methods of birth control methods, like birth control pills, diaphragms, and male condoms. The rate of failure is less than 1% with both Nexplanon and Mirena. Mirena may be preferred for women who have heavy menstrual bleeding and want a form of contraception. In addition, Mirena provides protection from pregnancy longer than Nexplanon at seven years versus three years. 

Consult a healthcare provider for the best contraceptive for you. Different types of birth control may be recommended instead of Nexplanon or Mirena. The copper IUD, also known under the brand name Paragard, is a potential alternative to Mirena. Other hormonal IUDs include Skyla, Kyleena, and Liletta. 

Can I use Nexplanon or Mirena while pregnant?

Nexplanon and Mirena are contraindicated in known or suspected pregnancy. Consult a healthcare provider if you suspect you are pregnant while using Nexplanon or Mirena. 

Can I use Nexplanon or Mirena with alcohol?

Nexplanon and Mirena may potentially cause problems in the liver, and excessive alcohol consumption may increase the risk of liver damage. However, there are no known interactions between alcohol and Nexplanon or Mirena. Drinking alcohol should have no effect on how well contraceptive implants or IUDs work.

Can you gain weight on Nexplanon? 

Yes, Nexplanon may cause weight gain. In clinical trials, women using Nexplanon gained an average of 2.8 pounds after one year and 3.7 pounds after two years. However, it is not known how much of that weight gain is attributed to Nexplanon. 

Does Mirena cause weight gain?

Yes, Mirena may cause weight gain. In a study of 362 women using Mirena for more than five years, weight gain was reported. Approximately 6% of women reported weight gain between the fifth and seventh year of use. However, it is not known how much of that weight gain is directly caused by Mirena. 

What is the Mirena crash?

There are reports of women experiencing short-term side effects after the removal of Mirena. While there is no concrete evidence on the cause of it, the Mirena crash may be associated with a temporary hormone imbalance after removal. Symptoms of Mirena crash may include headache, nausea, mood swings, insomnia, fatigue, and acne. These effects are usually temporary.