What to Know About the Nexplanon Birth Control Implant

How It Compares to Implanon

Nexplanon
Image via Nexplanon.com

Nexplanon is the newer form of the birth control implant, Implanon. This single-rod implant is about the size of a matchstick (1.6 inches long). Nexplanon is a progestin-only contraceptive that contains 68 milligrams (mg) of etonogestrel and provides pregnancy protection for up to three years once inserted.

Approved Use

Nexplanon is made of a soft, flexible, medical-grade polymer. The U.S. Food and Drug Administration (FDA) has approved it as an effective means of long-term contraception. Once implanted, Nexplanon can provide up to three years of pregnancy protection. It can then be removed and replaced with a new implant.

Implantation

This birth control implant is inserted under the skin of your upper arm. Nexplanon must be put in place by a specially trained medical professional. You will be given a local anesthetic to numb the area. Your doctor 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 doctor if you develop signs of an infection, including a high fever, bleeding, increasing pain, or a discharge from the implantation site.

Mechanism of Action

Nexplanon continually releases a low dose of etonogestrel over a three-year period. The amount of progestin will slowly decrease over time as follows:

  • During the first six weeks, 60 to 70 micrograms (mcg) of the progestin are released per day.
  • By the end of the first year, approximately 35 to 45 mcg are released per day.
  • By the end of the second year, approximately 30 to 40 mcg are released per day.
  • By the end of the third year, approximately 25 to 30 mcg are released per day.

If Nexplanon is not removed after three years, the amount of etonogestrel released will not be effective in preventing pregnancy.

Nexplanon vs. Implanon

Nexplanon differs from Implanon in a number of key ways.

Firstly, Nexplanon is radiopaque, meaning that it can be seen on an X-ray, CT scan, ultrasound scan, or MRI. This is important because many doctors were not inserting Implanon correctly, leading to increased failure rates among users.

Because Implanon cannot be seen on X-ray, the only way to confirm the correct position is by feel. As a result, less experienced doctors would often implant the rods far too deeply, where they were not only less effective but could cause vascular and nerve injury.

With Nexplanon, doctors 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 to implant the rod without assistance.

Effectiveness

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

Nexplanon may be less effective in you are overweight. Simply put, the amount of etonogestrel 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 doctors will recommend replacement between the second and third years in obese or overweight women.

Benefits

Nexplanon is considered a major improvement over its predecessor with more than its share of benefits. Among them, Nexplanon:

  • Is discreet and private
  • Does not require maintenance or the need for daily dosing
  • Is a good option for women who can't use estrogen-based contraception
  • Is effective immediately if inserted between the first and fifth day of your period
  • Allows for sexual spontaneity
  • Is appropriate for teenagers
  • Allow you to breastfeed four weeks after implantation
  • Has fewer hormonal ups and downs due to its steady delivery

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

Side Effects

The most common side effect of Nexplanon is irregular menstrual bleeding, including changes in frequency, intensity, or duration of bleeding. Bleeding irregularities were the most common reason that women stopped using Nexplanon.

About one in five women will not have a period at all. Another one in five women will have frequent and/or prolonged bleeding. The bleeding pattern you experience during the first three months is generally a good indication of what to expect in the months ahead.

Other common side effects include:

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

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

Complications

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 (known as paresthesia). Both can become serious if left untreated.

Call your doctor 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 impair the release of etonogestrel. Not only would this increase the risk of a pregnancy, but there would also be a greater likelihood of an ectopic (tubal) pregnancy.

Contraindications

Nexplanon is a safe birth control option for most healthy women, but it is not for everyone. Nexplanon is not recommended if you:

  • Are pregnant or think you may be pregnant
  • Have liver disease
  • Have unexplained vaginal bleeding
  • Have or have had breast cancer
  • Have a progestin-sensitive cancer
  • Have a history of severe depression
  • Have or have had hematomas in the past

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.

Cost

Nexplanon prices vary from area to area but are generally in the region of $800 to $1,000. On top of that, you would need to factor in implantation and removal costs which run anywhere from $300 to $600 each.

While Nexplanon requires higher upfront costs compared to other birth control methods, you would likely end up saving money over the long run.

Medicaid and many private health plans will cover the cost of Nexplanon but still require 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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