This article was last updated on December 9, 2021.
What if there was an extremely effective long-term birth control option that you only had to think about once every three years? no, it’s not witchcraft (well, not really), it’s real. if this sounds good, the contraceptive implant, or nexplanon, might be right for you. Read on for answers to these questions about the nexplanon implant.
jump to any of the following sections:
- what is the contraceptive implant and how does it work?
- what are the benefits and risks of the implant?
- How can the implant affect fertility?
- how much does the contraceptive implant cost?
- Who should and who should not receive the implant?
- How is the implant inserted and removed? (and… can it fall?)
- thicken cervical mucus
- thinning of the lining of the uterus
- ovulation suppression
- you can’t abuse it: once your doctor inserts the implant, that’s it! there is nothing to remember to take or update.
- It is not visible once inserted, so no one can tell if you have a nexplanon implant.
- You don’t have to pause during sex to insert it.
- can reduce painful menstrual cramps.
- doesn’t contain estrogen, so if you’re worried about estrogen (i.e., have a risk or history of blood clots), you can still use it.
- 1 in 3 people using nexplanon stop having their periods after one year.
- It is a reversible contraceptive, so you can get pregnant immediately after taking it off.
- breast/chest pain
- weight gain
- pain or bruising where the implant was inserted
- an infection where the implant was inserted
- abdominal or back pain
- an increased risk of non-cancerous ovarian cysts
- decreased sexual desire
- mild insulin resistance
- mood swings and depression
- potential interaction with other medications (some seizure medications, certain sedatives, some hiv medications, St. John’s wort)
- vaginal inflammation or dryness
- severe or sharp chest pain (including chest heaviness or tightness)
- signs or symptoms of an infection at the insertion site, such as tenderness, redness, swelling, or discharge
- signs or symptoms of pregnancy at any time after insertion of the contraceptive implant
- breast/chest lumps
- prolonged heavy vaginal bleeding
- signs or symptoms of a blood clot in the leg, such as persistent pain and swelling in the calf
- signs or symptoms of jaundice, such as yellowing of the skin or whites of the eyes
- the copay for your initial gynecological exam
- place your implant
- copayments for any follow-up visit
- removal of your implant, which can cost between $0 and $300
- You will lie on your back with the arm that will receive the implant bent at the elbow and positioned near your head.
- Your healthcare provider will place a groove between the biceps and triceps muscles on the inner side of your upper arm.
- A local anesthetic will be injected into the site.
- the implant is inserted just under the skin, through an applicator.
- You don’t need stitches, but you will probably have bruising, pain or bleeding, and maybe a small scar at the implant site.
- Your healthcare provider will ask you to feel your arm to check for the presence of the implant, and they will do the same. if they can’t feel the device, they may do an ultrasound or x-ray.
- If you have nexplanon inserted during the first five days of your period, you can have intercourse immediately after insertion and avoid pregnancy.
- If you don’t have nexplanon inserted during those first five days, use a backup method of birth control for one week after it is implanted.
- You can remove the pressure bandage in 24 hours, but keep the small bandage clean and in place for three to five days. (Be sure to follow your doctor’s instructions on how to care for the insertion site.)
- Local anesthetic will be injected into the arm below the implant.
- They will make a small incision in your skin.
- The implant will be pushed into the incision until the tip is visible and can be grasped with forceps.
- The implant is removed and a pressure bandage is applied. stitches are not required.
- As soon as the nexplanon is removed, a new one can be implanted. If you choose not to continue using nexplanon and you don’t want to get pregnant, use another birth control option instead.
a tiny contraceptive implant method with great results
nexplanon, a long-acting form of birth control, is a small, clipped, flexible plastic rod about the size of a matchstick. your health care provider places it under the skin of your upper arm. once implanted, it releases a low but constant dose of progestin (a synthetic progesterone) and prevents pregnancy by:
nexplanon is currently approved for use for three years, but there is evidence that it can be used for up to five years (but don’t prolong the use of your implant without first talking to a healthcare professional).
implanon, the predecessor to nexplanon, was discontinued in the united states in 2014, and the nexplanon implant is its updated version. while implanon is still used in other countries, nexplanon is the only birth control implant available in the united states.
the pros, cons and what is good to know about the implant
Since there is only one option for the birth control implant, you just need to use your decision-making muscles to determine if this birth control option is right for you. With so many other types of birth control out there, here are the pros and cons of the implant to help you make an informed decision.
what are the benefits of the contraceptive implant, nexplanon?
nexplanon is super effective; in fact, less than 1% of people who use it for a year get pregnant. but that’s not the only benefit:
what are the common side effects of the contraceptive implant, nexplanon?
according to the guttmacher institute, only 0.5% of all people with ovaries who use birth control choose nexplanon. “It’s really a shame because it’s the most effective form of contraception out there; [it has] better effectiveness rates than having your tubes tied,” says dr. eva luo, an obstetrician-gynecologist at beth israel deaconess medical center in boston, massachusetts. So why don’t more people use it?
“nexplanon can cause irregular vaginal bleeding,” says luo. “generally a third [of users] maintain their regular bleeding patterns and are happy. a third will have irregular bleeding, but they don’t mind and are happy. the last third develop irregular bleeding and it drives them crazy and [they want] to go out .”
Unfortunately, there is no good way to predict which population you might fall into. “I always tell patients that if they’re motivated to try it, there’s nothing wrong with trying it, and if you love it, that’s great. if not, I’m always here to remove it and we can talk about other options,” she says.
In addition to changes in menstrual bleeding patterns, common side effects of nexplanon include:
The following may be signs of serious conditions that require immediate medical attention. contact your healthcare provider if you develop:
how can nexplanon affect fertility?
After nexplanon is withdrawn, there may be a rapid return to pre-implantation menstrual cycles, even if your menstrual bleeding patterns have been affected. In clinical trials with implanon (the earlier version of nexplanon), the amount of etonogestrel (the progestin in nexplanon) in the blood decreased one week after removal, and pregnancies occurred in as little as 7 to 14 days. If you don’t want to get pregnant after your implant is removed, you should continue to use birth control.
nexplanon does not protect you from sexually transmitted infections (STIs), which can cause infertility if left untreated. Remember to keep getting tested for STIs while you use the implant.
An ectopic pregnancy can occur while using the nexplanon implant, but the percentage of people who experience it is very low. In the unlikely event that it does happen, this poses a serious threat to health and fertility, as the development of the fertilized egg outside the uterus can lead to internal bleeding and rupture of a fallopian tube.
how much does the birth control implant cost (and will insurance cover it)?
Without insurance, nexplanon can cost up to $1,300 (but that’s birth control for up to five years). The Affordable Care Act requires that any birth control option, including Nexplanon, be covered, but you should check with your insurance provider to be sure. If you have insurance, Nexplanon could be low-cost or even free. planned parenthood offers programs to make the implant (and other birth control methods) affordable.
Keep in mind, however, that the total cost of your nexplanon involves more than just the actual device. Please note:
Is there anyone who should not get the contraceptive implant?
The most common side effect of nexplanon is irregular bleeding: this could mean shorter and lighter periods, longer and heavier periods, spotting between periods, or different lengths of time between periods. irregular bleeding patterns are especially common during the first 6 to 12 months of use.
If regular periods are important to you, the nexplanon implant may not be the right choice, as irregular bleeding is the most common side effect. Interrupted menstrual bleeding patterns are especially common during the first 6 to 12 months of use and may include shorter and lighter periods, longer and heavier periods, spotting between periods, or different lengths of time between periods.
“for my patients who want a regular and predictable bleeding pattern,” says dr. luo says “I don’t recommend a nexplanon”.
imc and nexplanon
Research has indicated that nexplanon and other forms of hormonal birth control may not be as effective in women with a body mass index (BMI) greater than 30, but does that mean it’s not worth using? it’s complicated (and so is bmi as a general health measurement tool, which is worth noting).
“what I tell patients is that yes, there are studies (like this one) that show [less efficacy] in patients with a bmi greater than 30, since there is less circulating hormone than in patients with a bmi less than 30,” says Dr. luo. “However, the amount circulating is still sufficient to be an effective and reliable form of contraception.”
what is it like to receive and have the contraceptive implant?
Before inserting nexplanon, your healthcare provider will ask about your medical history and perform a physical exam to confirm that the implant is appropriate. once this has been fixed, you are good to go!
This is what happens when a provider inserts the implant:
can nexplanon move once implanted?
“nexplanon can come off,” says dr. luo, “but it rarely ‘disappears’ in the same way an IUD can be expelled [since] the nexplanon is inserted just under the skin through a minor surgical procedure.”
dr. Luo emphasizes that everyone’s body heals and scars a little differently, and during that process, “the nexplanon might migrate a little bit from the initial insertion site.” But before that possibility becomes too scary: “I’m talking about distances from millimeters to centimeters, not feet! Like a dental implant, this requires a surgical procedure to remove it. it won’t fall off on its own,” says dr. luo explains.
For nexplanon to continue to work as a long-term contraceptive, you must remove it and replace it with a new device every three years. (Again, it might work for five years, but be sure to talk to your doctor before continuing to use a nexplanon implant you’ve already had for three years.)
you need a healthcare professional, do not try to remove the nexplanon yourself! “insertion and removal is a small, minor surgical procedure that can be performed in the office, but requires a degree of infertility surgery,” says dr. luo.
removing the implant takes less than five minutes. this is what happens when your health care provider removes it:
So, there you have it: the 101 on nexplanon. If you like what you’ve learned, talk to your health care provider for more information. And if you’re thinking about having kids in the future, check out the Modern Home Fertility Test, which can answer your questions about the status of your fertility hormones now, before you ditch that birth control and start trying to conceive. /p>
This article was medically reviewed by dr. Eva Marie Luo, Obstetrician/Gynecologist at Beth Israel Deaconess Medical Center and Health Policy and Management Fellow at Harvard Medical College Phds, the organization of physicians affiliated with the Beth Israel-Lahey Health System.