From the Guidelines
Nexplanon (etonogestrel) implant is effective for up to 3 years, as indicated by the most recent and highest quality studies available 1. The duration of effectiveness of the Nexplanon implant is a crucial factor in determining its suitability as a long-acting reversible contraceptive (LARC) method.
Key Points
- The implant works by releasing a steady, low dose of the hormone etonogestrel, which prevents pregnancy primarily by inhibiting ovulation, thickening cervical mucus, and altering the endometrial lining.
- The effectiveness of the implant is highly reliable, with failure rates of less than 1% 1.
- Users should be aware that while the implant is approved for 3 years, it can be removed earlier if pregnancy is desired, with fertility typically returning quickly after removal.
- Side effects may include irregular bleeding patterns, especially in the first year of use, as well as headaches, mood changes, and breast tenderness.
Clinical Considerations
- The American College of Obstetricians and Gynecologists (ACOG) and the CDC support the use of contraceptive implants as a safe and effective practice, including immediate postpartum insertion 1.
- Studies have found no significant effects of contraceptive implant use on breastfeeding performance or infant health and growth 1.
- Patients should be counseled to use a backup method, such as condoms or abstinence, for at least the first week after implant insertion for contraceptive efficacy, and to use condoms at all times for protection against STIs 1.
From the Research
Duration of Effectiveness of Nexplanon Implant
- The Nexplanon implant is effective for up to 3 years, as indicated by the manufacturer and supported by studies such as 2.
- However, research has shown that the implant can be effective for up to 5 years, with a study published in 2016 finding that the extended use of the one-rod etonogestrel-releasing subdermal contraceptive implant showed 100% efficacy in years 4 and 5 3.
- Another study published in 2021 confirmed that the implant should be removed by the end of the third year of use, but also noted that persons will experience a rapid return to fertility once the implant is removed 2.
- The efficacy of the Nexplanon implant has been demonstrated in several studies, including a 3-year multicentre randomized controlled trial that found a cumulative pregnancy rate of 0.4 per 100 women-years for both the etonogestrel and levonorgestrel implants 4.
Removal of the Implant
- The implant should be removed by a trained healthcare provider, and the removal procedure is typically quick and easy, with a median duration of 2 minutes 5.
- The removal procedure can be performed in an office-based setting, and the implant is visible on X-ray and palpable before removal 5.
- A study published in 2016 found that the median duration of the implant removal procedure was 64 seconds shorter for the one-rod etonogestrel implant compared to the two-rod levonorgestrel implant 3.