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The ins and outs of the contraceptive implant: side effects, effectiveness, and cost

The ins and outs of the contraceptive implant: side effects, effectiveness, and cost

8 min read

What if there was an extremely effective, long-term birth control method that you only had to think about once every three years? Nope, it's not sorcery (well, not really) — it's actually a real thing. If this sounds good, the contraceptive implant, or Nexplanon, could be right for you. Read on to learn the answers to these questions:

  • What is the contraceptive implant and how does it work?
  • What are the different types of contraceptive implants?
  • What are the benefits and risks of the implant?
  • Who shouldn’t use the implant?
  • How is the implant inserted and removed? (And... can it fall out?)

A tiny contraceptive method with *huge* results

Nexplanon, a long-acting method of contraception, is a small, trim, flexible plastic rod, about the size of a matchstick. It's placed under the skin of your upper arm by your healthcare provider. Once implanted, it releases a low-yet-steady dose of progestin (a synthetic progesterone) and prevents pregnancy by:

  • Thickening the cervical mucus
  • Thinning the lining of the uterus
  • Suppressing ovulation

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 use of your implant without first talking with your doctor).

Implanon, Nexplanon's predecessor, was discontinued in the US in 2014, and Nexplanon is its updated version. While Implanon is still used in other countries, Nexplanon is the only birth control implant available in the US.

The upsides, the downsides, and the good-to-knows

Since there’s only one option for the contraceptive implant, you only need to use your decision-making muscles to figure out if this method is the right one for you. With so many other types of birth control out there, we’re bringing you the pros and cons of the implant to help you make an informed choice.

Let’s talk benefits

Nexplanon is super effective — in fact, fewer than 1% of people who use it for one year will get pregnant. But that's not the only benefit:

  • You can't misuse it — once it's in, that's it! There’s nothing to remember to take or update.
  • It's not visible once inserted, so no one can tell when you have it in.
  • You don’t have to pause during sex to insert it.
  • It can reduce painful period cramps.
  • It's estrogen free, so if estrogen is of concern for you (i.e., you have a risk or history of blood clots), you can still use it.
  • 1 in 3 people using Nexplanon stop getting their periods entirely after a year.
  • It's reversible contraception, so you can get pregnant right after you take it out.

Now, side effects and risks

According to the Guttmacher Institute, only 0.5% of all people with ovaries using contraception opt for Nexplanon. "It's really such a shame because it is the most effective form of contraception out there — [it has] better efficacy rates than tying your tubes," says Dr. Eva Luo, an OB-GYN at Beth Israel Deaconess Medical Center in Boston, Massachusetts. So, why aren't more folks using it?  

"The Nexplanon can cause irregular vaginal bleeding," Luo says. "Generally, one-third [of users] maintain their regular bleeding patterns and are happy. One-third will have irregular bleeding, but it doesn't bother them and they are happy. The last one-third develops irregular bleeding and it drives them crazy and [they want] it out.”

Unfortunately, there isn’t a great way to predict which population you might fall into. “I always tell patients that if they are motivated to try, no harm in trying — and if you love it, it is so great. If not, I'm always here to remove it and we can talk about other options,” she says.

In addition to irregular bleeding, common side effects of Nexplanon include:

  • Headaches
  • Breast 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 noncancerous ovarian cysts
  • Decreased sex drive
  • Dizziness
  • 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

The following may be signs of serious conditions that require immediate medical attention. Contact your healthcare provider if you develop:

  • 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 the contraceptive implant is inserted
  • Breast lumps
  • Heavy, prolonged vaginal bleeding
  • Signs or symptoms of a blood clot in your leg, such as persistent pain and swelling in your calf
  • Signs or symptoms of jaundice, such as yellowing of the skin or whites of the eyes

How can Nexplanon impact fertility?

After Nexplanon is removed, there can be a quick return to pre-implant menstrual cycles. 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 early as 7 to 14 days. If you don't want to get pregnant after getting your implant taken out, you should continue using contraception.

Nexplanon doesn't protect you from sexually transmitted infections (STIs), which can cause infertility if they're not treated. Remember to keep getting tested for STIs while you're using the implant.

Ectopic pregnancy can occur while Nexplanon is in use, but the percentage of people who experience this is very low. In the unlikely event that it does happen, this poses a serious threat to health and fertility, since the development of the fertilized egg outside of the uterus can result in internal bleeding and the bursting of a fallopian tube.

How much does the 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 mandates that birth control, including Nexplanon, is covered, but you should check in with your insurance provider to be sure. If you do have insurance, Nexplanon could be low cost or even free. Planned Parenthood offers programs to make the implant (and other birth control) affordable.

Keep in mind, though, that the total cost of your Nexplanon involves more than just the actual device. You should factor in:

  • The co-pay for your initial GYN exam
  • Getting your implant inserted
  • The co-pays for any follow-up visits
  • Getting your implant removed, which can cost between $0 and $300

Who shouldn’t get the implant

Nexplanon’s most common side effect 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 6-12 months of use.

If having consistent periods is important to you, then the implant might not be the right choice. “For my patients who want a regular and predictable pattern of bleeding,” Dr. Luo says, “I do not recommend a Nexplanon.”

BMI 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) above 30, but does that mean it's not worth using? It's complicated (and so is BMI as a health measurement tool in general, which is worth noting).

"What I tell patients is that yes, there are studies (like this one) that demonstrate [less efficacy] in patients with a BMI above 30, since there is less circulating hormone than in patients with a BMI under 30," says Dr. Luo. "However, the amount circulating is still enough to be an effective and reliable form of contraception.”

What it’s like to get and have an implant

Before Nexplanon is inserted, your healthcare provider will ask you questions about your medical history and perform a physical exam to confirm that the implant is the right fit. Once this has been taken care of, you're ready to go!

Here's what happens when you get the implant:

  • You'll 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 locate a groove between the biceps and triceps muscles on the inner side of your upper arm.
  • A local anesthetic will be injected into the spot.
  • The implant is inserted right beneath your skin, via an applicator.
  • You don't need stitches, but you will probably have bruising, pain, or bleeding, and maybe a tiny scar at the implant site.
  • Your healthcare provider will ask you to feel your arm to verify the presence of the implant, and they will do the same. If they can’t feel the device, they may perform an ultrasound or X-ray.
  • If you get Nexplanon inserted during the first five days of your period, you can have sex right away after insertion and prevent pregnancy.
  • If you don't get Nexplanon inserted during those first five days, use backup birth control for a week after it's 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 about how to take care of the insertion site.)

Can Nexplanon move around once it's implanted?

"Nexplanon can become dislodged," says Dr. Luo, "but rarely does it ‘go missing’ in the same way that an IUD can be expulsed. The reason is that the Nexplanon is inserted just under your skin through a minor surgical procedure. Everyone's body heals and scars a little differently, and during that process, the Nexplanon could migrate a bit from the initial insertion site.” But before that possibility becomes too scary: “I'm talking distances of millimeters to centimeters, not feet! Like a tooth implant, this requires a surgical procedure to remove. It will not just fall out on its own,” Dr. Luo explains.

Removing the implant

In order for Nexplanon to continue to work as long-term contraception, you must have it removed and replaced with a new device every three years (again, it could work for five years, but make sure to talk to your doctor about this before you prolong the use of one that's already been in for three years).

Don't try to remove Nexplanon yourself. "Insertion and removal is a small minor surgical procedure that can be performed in the office, but requires a degree of surgical sterility," says Dr. Luo.

Removing the implant takes less than five minutes. Here's what happens when your healthcare provider takes it out:

  • You'll be injected with local anesthetic in your arm beneath the implant.
  • They’ll make a small incision in your skin.
  • The implant will be pushed toward the incision until the tip is visible and can be grasped with forceps.
  • The implant is pulled out and a pressure bandage is applied. No stitches are required.
  • As soon as Nexplanon is removed, you can have a new one implanted. If you opt to not keep using Nexplanon and you don't want to get pregnant, use another type of contraception instead.

So, there you have it: the 101 on Nexplanon. If you like what you've learned, check with your healthcare provider to learn more. And if you're thinking about having kids in the future, check out Modern Fertility's at-home test, which can answer your questions about the state of your fertility hormones now, before you ditch that birth control and start trying to conceive.

This article was medically reviewed by Dr. Eva Marie Luo, an OB-GYN at Beth Israel Deaconess Medical Center and a Health Policy and Management Fellow at Harvard Medical Faculty Physicians, the physicians organization affiliated with the Beth Israel-Lahey Health System.

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Chanel Dubofsky

Chanel's writing has appeared in Cosmo, Rewire, Lilith, HelloFlo, & Extra Crispy. She has an MFA in Fiction from Vermont College of Fine Arts & lives in New York. Follow her @chaneldubofsky.

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