What Are the Side Effects of Nexplanon?

You may have heard about a very effective and long-acting birth control known as the implant. Nexplanon (etonogestrel) is a birth control implant that can prevent pregnancy for up to 3 years. It requires a short office visit with your healthcare provider to be placed in your upper arm. And after it’s placed, it’s the most effective birth control option, preventing pregnancy more than 99% of the time. This makes it more effective than anything else on the market, including birth control pills, patches, or shots.

Like most medications, side effects can happen. And Nexplanon is no exception. Here, we’ll discuss some of Nexplanon’s side effects. 

What is Nexplanon?

Nexplanon is a birth control implant that’s placed in your upper arm. It has less than a 0.1% failure rate when placed correctly. Having the Nexplanon implant placed requires a visit to a healthcare provider. During a quick in-office procedure, your healthcare provider will insert Nexplanon just beneath the skin on the inner side of the arm. Then, it can stay in place for up to 3 years.

How does it work for birth control?

Nexplanon slowly releases a hormone known as etonogestrel. Etonogestrel is a type of progestin, a lab-made version of the sex hormone progesterone. By slowly releasing etonogestrel, the Nexplanon implant prevents pregnancy in a few ways:

• It prevents the release of an egg from the ovaries (ovulation) to prevent fertilization. If there’s no egg to fertilize, pregnancy can’t happen.

• It thickens mucus made by the cervix. This helps slow or trap sperm so they have a harder time getting to an egg.

• It thins the lining of the uterus. So, even if an egg is fertilized by sperm, it would have a difficult time implanting in the uterus.

10 common Nexplanon side effects

Because everyone reacts differently to hormonal medications, side effects may be different for everyone. Most side effects get better or go away within a few months of having Nexplanon placed. But side effects may not improve for everyone. If you find side effects to be too bothersome, let your healthcare provider know.

Here are 10 of the most common Nexplanon side effects to know about, along with how often they happened during clinical trials:

1. Headache (25%)

2. Inflammation of the vagina (vaginitis) (15%)

3. Weight gain (14%)

4. Acne (14%)

5. Breast pain (13%)

6. Abdominal pain (11%)

7. Sore throat (11%)

8. Whitish-yellow discharge from the vagina (leukorrhea) (10%)

9. Flu-like symptoms (8%)

10. Dizziness (7%)

Irregular bleeding, like spotting, irregular periods, or heavy periods, is also common with Nexplanon. About 11% of people end up having it removed because of this side effect. And although less common, mood changes can also lead some people to stop the use of Nexplanon.

Not all Nexplanon side effects are bad, though. Some people find that their period gets lighter or goes away while using it. During studies, almost 34% of people said they had less frequent bleeding while using Nexplanon. And about 22% said their period went away completely.

Serious side effects of Nexplanon

Healthcare providers have to get special training to insert and remove Nexplanon. So complications from placement are rare. But if after your implant is placed, and you notice that you can’t feel it in its typical spot, contact your healthcare provider right away.

In rare cases, Nexplanon can move from where it’s inserted. This might be more common if it’s inserted too deeply in the arm. Movement of Nexplanon raises your risk of getting pregnant. It can also cause pain and bleeding.

Other complications of Nexplanon placement include infection or scarring where it was inserted. These are also rare. One sign of an infection is pus at the insertion site. If this happens, you may also experience pain, swelling, or fever.

Although very rare, other serious side effects to watch out for include:

• Ectopic pregnancy: This is a pregnancy occurring outside of the uterus. It can be life-threatening. Signs of ectopic pregnancy can include abdominal pain or unusual vaginal bleeding.

• Blood clots: This includes blood clots in the lungs (pulmonary embolism) or legs (deep vein thrombosis). Signs of a blood clot in the lung can be trouble breathing or chest pain. Signs of a blood clot in the leg can include leg pain or swelling.

• Heart attacks and strokes: It’s not known how common heart attacks or strokes are while using Nexplanon. There’s a possibility they could develop. But these events may be more common if you use a birth control option that contains both an estrogen and a progestin.

• Cysts on the ovaries: These tend to disappear on their own, but should still be monitored by a healthcare provider. A sign of ovarian cysts is abdominal pain. But some people have no symptoms at all.

• Liver damage: In rare cases, Nexplanon can cause liver damage. If you have a history of liver disease, the implant can make it worse. Signs of liver damage can include yellowing eyes or skin (jaundice).

• Breast cancer: Nexplanon may raise the risk of breast cancer or worsen current breast cancer. Since some breast cancers are sensitive to hormones, you shouldn't use Nexplanon if you have these conditions.

What can I do to manage the side effects of Nexplanon?

Sometimes side effects will improve if you wait a few months after Nexplanon is inserted. If you like the convenience of Nexplanon and don't want to have it removed, over-the-counter (OTC) options can be used to manage headaches, acne breakouts, or other common side effects that pop up.

When should I contact my healthcare provider about side effects from Nexplanon?

After a few months, some people find that the common side effects of Nexplanon don't go away. Or they may find they don't like how they feel while on Nexplanon. If that’s the case for you, contact your healthcare provider about switching to a different birth control option. There are lots of birth control options to choose from.

It’s important to remember you can get pregnant right away after Nexplanon is removed. So, it’s a good idea to talk to your healthcare provider about a replacement for the implant to use as birth control.

If you experience any symptoms of a serious side effect or other burdensome side effects, contact your healthcare provider right away. You may need another medication to manage complications, like an antibiotic for infection. Or you might need to have your Nexplanon implant replaced or removed. If you ever experience trouble breathing or chest pain, call 911.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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