Nexplanon
Nexplanon (etonogestrel) is an implant placed in your arm to prevent pregnancy. It's a type of long-acting birth control that can prevent pregnancy for up to 5 years after insertion. It's one of the most effective forms of birth control available. Nexplanon (etonogestrel) only contains one type of hormone, a progestin called etonogestrel. The most common side effects include headaches and irregular vaginal bleeding (e.g., longer periods, spotting).
What is Nexplanon (etonogestrel)?
What is Nexplanon (etonogestrel) used for?
- To prevent pregnancy
How Nexplanon (etonogestrel) works
The Nexplanon (etonogestrel) implant slowly releases etonogestrel, which is a progestin (a lab-made form of progesterone). It works to prevent pregnancy in a few ways.
- It stops your ovaries from releasing an egg.
- It also makes it difficult for sperm to enter the uterus (womb).
- It prevents a fertilized egg from implanting in your uterus.
Drug facts
Side effects of Nexplanon (etonogestrel)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (25%)
- Absence of period (20%)
- More frequent or longer vaginal bleeding (20%)
- Vaginal pain or itching (15%)
- Weight gain (14%)
- Acne (14%)
- Breast pain (13%)
- Stomach pain (11%)
- Sore throat (11%)
- Vaginal discharge (10%)
Less Common Side Effects
- Flu-like symptoms
- Dizziness
- Menstrual cramps
- Back pain
- Body pain
- Pain at insertion site
- Nausea
- Mood swings
- Nervousness
- Depression
Nexplanon (etonogestrel) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Ectopic pregnancy: severe, unexplainable pelvic pain; unusual vaginal bleeding
- Heart attack: chest pain or tightness; pain that spreads up to your shoulder, arm, neck, or jaw; sweating; chills; nausea
- Stroke: sudden trouble talking; trouble walking; numbness on one side of your body or face; sudden, severe headaches
- Blood clot in the lungs: trouble breathing, chest pain
- Liver or gallbladder problems: yellow skin or eyes, chills, nausea or vomiting with severe pain in the upper right part of your stomach, dark urine, light-colored stools
- Breast lumps or pain
More on Nexplanon (etonogestrel) side effects
The following Nexplanon (etonogestrel) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Breast pain
chills
general feeling of discomfort or illness
headache
joint pain
loss of appetite
muscle aches and pain
shivering
sweating
trouble sleeping
unusual tiredness or weakness
vomiting
Less common
Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the insertion site
blurred vision or other changes in vision
breast discharge
breast enlargement
burning feeling while urinating
difficult or painful urination
difficulty with breathing
difficulty with swallowing
dizziness
headache, severe and throbbing
lumps in the breasts
nervousness
noisy breathing
painful or tender cysts in the breasts
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
shortness of breath
slow or fast heartbeat
stomach or pelvic discomfort, aching, or heaviness
swelling of the hands, ankles, feet, or lower legs
tightness in the chest
Rare
Collection of blood under the skin at the insertion site
deep, dark purple bruise at the insertion site
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Back pain
blemishes on the skin, pimples
body aches or pain
crying
depersonalization
discouragement
dysphoria
ear congestion
euphoria
feeling sad or empty
hoarseness
increased clear or white vaginal discharge
increased weight
irregular bleeding cycle
irritability
itching of the vagina or genital area
light vaginal bleeding between regular menstrual periods
loss of interest or pleasure
loss of voice
mental depression
pain, cramps, or heavy menstrual bleeding
pain during sexual intercourse
pain or tenderness around the eyes and cheekbones
paranoia
quick to react or overreact emotionally
rapidly changing moods
stomach pain
tender, swollen glands in the neck
thick, white vaginal discharge with no odor or with a mild odor
trouble concentrating
voice changes
Less common
Abnormal ejaculation
abnormal or decreased touch sensation
belching
bone pain
burning feeling in the chest or stomach
decreased interest in sexual intercourse
difficulty having a bowel movement
difficulty with moving
dull ache or feeling of pressure or heaviness in the legs
excess air or gas in the stomach or intestines
feeling of vaginal pressure
feeling of warmth
hair loss or thinning of the hair
inability to have or keep an erection
increased appetite
increased hair growth on the forehead, back, arms, and legs
indigestion
itching skin near damaged veins
lack or loss of strength
loss in sexual ability, desire, drive, or performance
muscle cramping or stiffness
passing gas
pelvic pain
redness of the face, neck, arms, and occasionally upper chest
redness, swelling in the ear, or earache
sleepiness or unusual drowsiness
stomach bloating and cramping
swollen joints
tenderness in the stomach area
vaginal burning or pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Nexplanon (etonogestrel)
Pros
- Keeps working for 5 years without needing to remember to take the medication every day
- Works better than birth control pills to prevent pregnancy
- Can be inserted and removed at the medical office within a few minutes and without any kind of sedation (medication to put you asleep)
- Can use while breastfeeding as long as it's been 4 weeks since you gave birth
Cons
- Common to have breakthrough bleeding and irregular cycles as side effects
- Can raise your blood pressure or lead to mood changes
- Can raise the risk of an ectopic pregnancy if you do get pregnant
- Risk of the implant moving and not working well
Pharmacist tips for Nexplanon (etonogestrel)
- Nexplanon (etonogestrel) will be inserted by a trained healthcare professional at their office. After it's placed, the implant keeps working for 5 years. You can get it removed before then if you want to try to get pregnant.
- After Nexplanon (etonogestrel) is placed or removed, the healthcare professional will cover the area with two bandages. Keep the larger, top bandage on for at least 24 hours. Keep the smaller, bottom bandage clean, dry, and in place for 3 to 5 days.
- Make sure you can always feel your Nexplanon (etonogestrel) implant under your skin. If you can't feel it at any time, call your care team right away. This might mean that the implant has moved, raising your chances of getting pregnant. Use a barrier method, like condoms or diaphragms, as back up to prevent pregnancy until your care team can check that the implant is in the right place.
- If you get Nexplanon (etonogestrel) removed and don't want to get pregnant, start another form of birth control right away. Some people can get pregnant as soon as 1 to 2 weeks after the implant is taken out.
- If you get injured at or around the area where Nexplanon (etonogestrel) is, let your care team know right away. Although rare, injuries can cause the implant to break. This can affect how well Nexplanon (etonogestrel) works.
- Nexplanon (etonogestrel) can affect your menstrual cycle and menstrual bleeding. It's possible you might not even have a period while using the implant. Call your care team if this worries you or if your bleeding becomes very heavy.
- Nexplanon (etonogestrel) can cause mood changes. If you feel or have felt depressed, ask your family or friends to let you know if they notice any changes in your mood. If mood changes from Nexplanon (etonogestrel) bother you too much, talk to your prescriber about other birth control options.
- Tell your care team about all the medications you take before getting Nexplanon (etonogestrel) placed. Before starting any new medications, ask your pharmacist or prescriber if they're safe to take with Nexplanon (etonogestrel). Some medications can make your birth control work less well.
- You can use Nexplanon (etonogestrel) while breastfeeding as long as it's been at least 4 weeks since you gave birth. The medication from the implant won't hurt your baby, but you might notice a slight drop in your milk supply.
- Nexplanon (etonogestrel) doesn't protect you from human immunodeficiency virus (HIV). It also doesn't protect you from other sexually transmitted infections (STIs). Only abstinence and condoms can help protect you from STIs. Talk to your care team right away if this is a concern for you.
More on Nexplanon (etonogestrel) tips
Common questions about Nexplanon (etonogestrel)
Nexplanon (etonogestrel) is long acting and can prevent pregnancy for up to 5 years. If you want to keep using the implant for birth control, you'll need to get it removed after 5 years and get a new one put in. A trained healthcare professional will help remove the old implant and replace it with a new one.
If Nexplanon (etonogestrel) is placed within 5 days of starting your period, it will start to work right away to prevent pregnancy. This means you won't need to use a backup birth control method, like condoms. If it's placed after day 5 of your period, use a backup method for the first 7 days after the implant gets inserted. If you're switching from another birth control method, ask your prescriber about when Nexplanon (etonogestrel) will start working. Also ask if you need backup protection at first.
Nexplanon (etonogestrel) is one of the most effective methods of birth control available. It's over 99% effective, meaning that fewer than 1 out of every 100 people gets pregnant while using this medication for 1 year. Pregnancy is more likely to happen if your implant isn't in the correct position. Call your care team if you can't feel your implant on the inside of your upper arm. This can be a sign that the implant isn't in a right place for it to work.
A trained healthcare professional will place Nexplanon (etonogestrel) under the skin of the inner side of your upper arm. They'll insert the implant with a needle using an applicator. They might numb the insertion area beforehand to lessen any pain. The procedure should take a few minutes.
You can get Nexplanon (etonogestrel) removed at any time within 5 years after it was placed. A trained healthcare professional will help remove the implant at their office. They'll first put some numbing medication around the area where the implant was inserted. Then, they'll make a small cut there and gently remove the implant with forceps. After it's removed, they'll close your wound and place a bandage over the area. While you can remove the top bandage after 24 hours, you'll need to keep the wound closure adhesive on for 3 to 5 days.
In studies, some people who used Nexplanon (etonogestrel) had some weight gain as a side effect. People gained an average of 3 pounds after having the implant in place for 1 year and 4 pounds after 2 years of insertion. A small group of people stopped using Nexplanon (etonogestrel) because of weight gain. But it's unclear whether the weight gain was caused by the implant or other reasons. If you do gain weight, it could be because your body is holding onto water and you might feel bloated. If you've gained a lot of weight since you started using Nexplanon (etonogestrel), tell your prescriber.
Acne is one of the most common side effects of Nexplanon (etonogestrel). Most acne caused by this medication is mild and can be treated with over-the-counter products. If your acne gets severe or bothers you too much, let your care team know so you can discuss alternatives.
How soon you can get pregnant after you get Nexplanon (etonogestrel) removed can be different for everyone. But it's possible for some people to get pregnant as soon as 1 week after removal. If you're not sure whether you want to get pregnant after getting the implant removed, make sure to use a condom or another birth control method.
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Risks and warnings for Nexplanon (etonogestrel)
Nexplanon (etonogestrel) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of problems from improper insertion and removal
It's important for Nexplanon (etonogestrel) to be put in and taken out properly and safely. If it isn't, it can raise the risk of problems, including pain, bleeding, or infection. Improper insertion can also make the implant not work well, raising the chance of an unplanned pregnancy. If the implant is placed too deep, it can damage nearby muscles, tissues, or blood vessels. Rarely, a deeply placed implant can move to another part of the body.
Because of these risks, Nexplanon (etonogestrel) is only available through a Risk Evaluation and Mitigation Strategies (REMS) program. This safety program is called the Nexplanon REMS. Healthcare professionals must be registered in this program and get special training. It makes sure they're trained to insert and remove the implant safely and properly. This helps lower the risk of complications from the procedure.
Nexplanon (etonogestrel) is placed just under the skin, so you should always be able to feel it in your arm. If you can't feel it at any time, call your care team right away. Use a backup birth control method, like condoms, until a healthcare professional checks that the implant is in the right place. If it isn't, the healthcare professional will need to remove it.
Irregular periods
Nexplanon (etonogestrel) can commonly cause a change from your normal menstrual bleeding patterns. This can include absent periods, spotting, or longer or shorter periods. If you're worried about any menstrual cycle changes, talk to your prescriber. Most of the time, the type of periods you have during the first 3 months after getting the implant inserted will stay the same while the implant is in place.
Risk of ectopic pregnancy
If you happen to get pregnant while using Nexplanon (etonogestrel), there's a small chance that the pregnancy might be ectopic. This means that the fertilized egg has attached outside of the womb. Ectopic pregnancies have a risk of complications. Call your prescriber if you have serious pain in your stomach area so they can check for ectopic pregnancy.
Risk of ovarian cyst
Nexplanon (etonogestrel) can raise the risk of ovarian cysts, or small sacs of fluid in the ovary. Ovarian cysts rarely cause problems and tend to go away without any treatment. But call your prescriber if you have unexplained pelvic pain, serious pain in your stomach area, or bloating. These could be signs of an ovarian cyst that need to get checked out.
Risk of blood clots
- Risk factors: History of blood clots | Having Nexplanon (etonogestrel) placed less than 21 days after giving birth | Medical problems or surgical procedures causing you to be bed-bound for a long time
Combination birth control containing estrogen and progestin have been linked to blood clots. The risk is small, but blood clots can be very dangerous. They can lead to a heart attack, stroke, or pulmonary embolism (blood clot in the lungs). Nexplanon (etonogestrel) only has a progestin. It's not clear if it has the same risk for blood clots as combination birth control.
To be safe, tell your prescriber about your medical history, including any past blood clots. They can make sure Nexplanon (etonogestrel) is safe for you. You shouldn't get the implant within 3 weeks of delivering a baby because the risk of clots is higher then. If you're planning to have surgery that needs bed rest for recovery, ask the surgeon if you should get the implant removed first.
Call 911 or get emergency help right away if you have any signs of a blood clot. Look out for pain in your legs or arms, chest pain, sudden severe headaches, trouble breathing, or sudden changes in vision or speech. If a blood clot happens, you should get Nexplanon (etonogestrel) removed right away.
Possible risk of cancer
- Risk factors: Personal or family history of breast cancer
Experts aren't sure if combination birth control raises the risk of breast cancer or cervical cancer. But some cancers can be sensitive to the hormones found in birth control.
If you have had breast cancer or have a family history with it, talk to your prescriber before using Nexplanon (etonogestrel). They can help you choose a birth control option that might be safer for you. Remember to do monthly breast self-exams and tell your care team if you notice any changes.
Liver problems
Call your prescriber right away if you notice yellow skin or eyes, pain in the upper right part of your stomach, or dark urine. These might be signs of liver problems. If this happens, you should get Nexplanon (etonogestrel) removed right away so your care team can check out what's going on. It's not clear if Nexplanon (etonogestrel) can raise the risk of liver tumors. People who have liver problems or liver cancer shouldn't use Nexplanon (etonogestrel).
High blood pressure
If you have high blood pressure, talk to a healthcare professional before Nexplanon (etonogestrel). This is important if you have blood pressure that isn’t under control or within blood pressure goals.
Your care team might ask you to check your blood pressure regularly to make sure it doesn’t get unusually high. If it stays higher than usual, tell your care team. Also call them right away if you notice changes in your vision, headache, a racing heart, or flushing. These can be signs of seriously high blood pressure.
High blood sugar and cholesterol levels
Nexplanon (etonogestrel) can raise your blood sugar levels. It can also raise your cholesterol levels. If you have a history of having high blood sugar or high cholesterol levels, let your care team know. They might need to check your levels more often to make sure they don’t get unusually high while you're using Nexplanon (etonogestrel).
Weight gain
Some people might gain some weight while using Nexplanon (etonogestrel). In studies, this weight gain wasn't too significant. It's also not clear if the weight gain is from the implant itself or other reasons. Keep track of your weight while using Nexplanon (etonogestrel). If you're gaining weight too much too fast, talk to your care team. They can discuss with you about ways to manage your weight and other birth control options if needed.
Gallbladder problems
- Risk factors: History of gallbladder condition
Studies suggest that combination birth control might slightly raise the risk of gallbladder problems. It's not clear if there's a similar risk with Nexplanon (etonogestrel).
To be safe, tell your provider if you’ve had gallbladder problems before. Get medical help if you have symptoms of gallbladder problems while using Nexplanon (etonogestrel). Watch for yellow skin or eyes, chills, nausea or vomiting with severe pain in the upper right part of your stomach, dark urine, or light-colored stools. Your care team can check your gallbladder.
Vision changes in people who wear contact lenses
Let your care team know if you have any vision changes after starting Nexplanon (etonogestrel). If so, you might need to have your vision checked by an eye specialist.
Fertility after removal
Nexplanon (etonogestrel) wears off quickly after it's removed. Most people start ovulating again within 2 weeks of removal. This means you can become pregnant during your first menstrual cycle without the implant. To keep preventing pregnancy, be sure to switch to another birth control or use a backup method (e.g., condoms, diaphragms) as soon as the implant is removed.
Nexplanon (etonogestrel) dosage
Typical dosage for Nexplanon (etonogestrel)
Nexplanon (etonogestrel) is placed under the skin of your upper arm by a trained healthcare professional at their office. Once it's in place, it can prevent pregnancy for up to 5 years.
Interactions between Nexplanon (etonogestrel) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amobarbital
- Apalutamide
- Aprepitant
- Aprobarbital
- Armodafinil
- Artemether
- Bexarotene
- Bosentan
- Brigatinib
- Butabarbital
- Butalbital
- Carbamazepine
- Cenobamate
- Clobazam
- Dabrafenib
- Darunavir
- Dexamethasone
- Elagolix
- Elvitegravir
- Encorafenib
- Enzalutamide
- Eslicarbazepine Acetate
- Eterobarb
- Etravirine
- Fosaprepitant
- Fosphenytoin
- Griseofulvin
- Heptabarbital
- Hexobarbital
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Mephobarbital
- Methohexital
- Mitotane
- Modafinil
- Mycophenolic Acid
- Nafcillin
- Nevirapine
- Oxcarbazepine
- Pentobarbital
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pitolisant
- Prednisone
- Primidone
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Tazemetostat
- Telaprevir
- Theophylline
- Thiopental
- Topiramate
- Ulipristal
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Nexplanon (etonogestrel) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Nexplanon (etonogestrel) will not be safe for you to take.
- Currently pregnant
- History of breast cancer or other progestin-sensitive cancer
- Have bleeding between your periods of which the cause hasn't been diagnosed by a healthcare professional yet
- History of blood clots or clotting problems
- Liver tumor, either benign or cancerous
- Liver disease
What are alternatives to Nexplanon (etonogestrel)?
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