Nexplanon: A Single-Rod Birth Control Implant

This device offers three years of pregnancy protection

Nexplanon is a single-rod birth control implant that is placed in your upper arm to provide up to five years of protection against pregnancy. Measuring about the size of a matchstick at 1.6 inches long, Nexplanon is a progestin-only contraceptive that is discreet, effective, and long-lasting.

How It Works

Nexplanon prevents pregnancy by continually releasing a low dose of progestin over a three-year period. The amount of progestin released slowly decreases over time. By the end of the third year, the dose released is too small to prevent pregnancy, which is why the implant must be removed at that time.


This birth control implant is inserted under the skin of your upper arm by a trained medical professional. Before implantation, you will be given a local anesthetic to numb the area. Your healthcare provider will then use a special applicator that will guide Nexplanon under the skin of your arm.

The insertion process only takes a few minutes. After Nexplanon is implanted, you will need to wear a pressure bandage for 24 hours and then a smaller bandage for three to five days after.

The most common side effects of the implantation are short-term pain and swelling. Call your healthcare provider if you develop signs of an infection, including a high fever, bleeding, increasing pain, or a discharge from the implantation site.

Improvements Over Implanon

Nexplanon differs from its predecessor Implanon in a number of key ways. For starters, Nexplanon is radiopaque, meaning that it can be seen on an X-ray, computed tomography (CT) scan, ultrasound, or magnetic resonance imaging (MRI).

This is important because, in the past, healthcare providers had to rely on feel alone to confirm the correct implantation position. As a result, many rods were implanted far too deeply, where they were not only less effective but could cause vascular and nerve injury.

With Nexplanon, healthcare providers can use an X-ray or ultrasound to confirm the rod has been correctly placed and easily locate it when it is time for removal.

Nexplanon also has an improved applicator. The new preloaded device can be operated with one hand, making it easier for a healthcare provider to implant the rod accurately and without assistance.


Nexplanon is 99.9% effective when inserted correctly. With typical use, 1 of every 100 women who use Nexplanon for a year will become pregnant.

Nexplanon may be less effective if you are overweight. This is because the amount of hormone actively circulating in the blood will be lower in women with a high body mass index (BMI) compared to those with a normal BMI.

To this end, some healthcare providers will recommend replacement between the second and third years in women with a higher body weight, rather than waiting until the end of the third year.


There are many lifestyle and health benefits to consider when deciding to use Nexplanon. These include:

  • Discreet and private
  • Does not require maintenance or the need for daily dosing
  • Safe for those who can't use estrogen-based contraception
  • Effective immediately if inserted between the first and fifth day of your period
  • Safe for breastfeeding moms four weeks after implantation
  • Comes with fewer hormonal ups and downs than other hormonal birth control due to its steady hormone delivery

In addition, Nexplanon may be a good option for you if you don't want to get pregnant now, but want flexibility with family planning after ending birth control use.

Unlike some forms of hormonal contraception, fertility returns quickly once you stop using Nexplanon, often within 14 days. By comparison, it may take up to a year for fertility to return after stopping Depo-Provera, another long-term contraceptive method.

Common side effects of nexplanon birth control implant
Verywell / Cindy Chung

Side Effects

The most common side effect of Nexplanon is irregular menstrual bleeding, including changes in frequency, intensity, or duration of bleeding. About 1 in 5 people will not have a period at all when using Nexplanon. Another 1 in 5 people will have frequent and/or prolonged bleeding.

The bleeding pattern you experience during the first three months of having Nexplanon implanted is generally a good indication of what to expect in the months thereafter.

Other common side effects of Nexplanon include:

  • Headaches
  • Vaginitis
  • Weight gain
  • Acne
  • Breast pain
  • Abdominal pain
  • Sore throats

Other less common side effects have also been reported, including increased appetite, mood swings, decreased sex drive, dizziness, nausea, hot flashes, hair loss, fatigue, and increased blood pressure.


Serious problems with Nexplanon are rare but most often occur if the rod is placed incorrectly.

If Nexplanon is inserted too deeply, nerve or vascular injury may occur. This can lead to the development of blood clots (hematomas) or the abnormal firing of peripheral nerve cells (paresthesia). Both can become serious if left untreated.

Call your healthcare provider if you experience signs of an implantation injury, including persistent pain, numbness, tingling, confusion, vomiting, lethargy, scarring, or disfiguring bruising.

Removal complications can also occur if the rod was improperly placed. In some cases, the rod can migrate from its original position and require costly surgical extraction.

The incorrect placement of the rod can also prevent the progestin from releasing properly. Not only would this increase the risk of pregnancy, but there would also be a greater likelihood of an ectopic (tubal) pregnancy.


Nexplanon is a safe birth control option for most healthy people, but it is not for everyone. Nexplanon is not recommended if you are pregnant or think you may be pregnant, or if you have any of the following conditions:

Nexplanon may also not be suitable if you have diabetes, high cholesterol, headaches, epilepsy, gallbladder disease, kidney disease, high blood pressure, or an allergy to anesthetics. Talk with your healthcare provider to learn about your personal risks.


Nexplanon prices vary from area to area but generally range from $800 to $1,000. Implantation and removal costs can range from $300 to $600 per procedure.

While Nexplanon requires higher upfront costs compared to other birth control methods, you could save money in the long run versus paying for monthly birth control.

Medicaid and many private health plans will cover the cost of Nexplanon, which is required to be provided for free under plans subject to the Affordable Care Act. There could be a copay for the implantation and removal. To avoid surprises, always check with your insurer to determine what your total out-of-pocket costs will be.

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3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Planned Parenthood. Birth control implant.

  2. Xu H, Wade JA, Peipert JF, Zhao Q, Madden T, Secura GM. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese womenObstet Gynecol. 2012;120(1):21–26. doi:10.1097/AOG.0b013e318259565a

  3. U.S. Food and Drug Administration. NEXPLANON (etonogestrel implant).