What is the duration of effectiveness of Nexplanon (etonogestrel implant)

Duration of Effectiveness of Nexplanon (Etonogestrel Implant)

Nexplanon is FDA-approved for 3 years of contraceptive effectiveness, although research suggests it may remain effective for up to 5 years. 1

Efficacy and Duration

• Nexplanon is a single-rod subdermal implant containing 68 mg of etonogestrel
• It has an extremely high efficacy rate with a failure rate of only 0.05% 1
• The Pearl Index in real-world use is 0.02 (95% CI, 0.00-0.06) for during-use pregnancies 2
• FDA approval and standard recommendation is for 3 years of use 1, 3
• Research evidence shows continued effectiveness beyond the labeled duration:
  • A 2016 study demonstrated 100% efficacy in years 4 and 5 of use 4
  • No pregnancies occurred during extended use in years 4 and 5 4

Clinical Implications

• Despite evidence of extended effectiveness, current clinical guidelines recommend replacement after 3 years 1, 3
• The implant should be removed by the end of the third year of use unless new guidelines are adopted 3
• Fertility returns rapidly after removal 3

Advantages of Nexplanon as a LARC

• Highest continuation rate among reversible contraceptive methods (84% at 1 year) 1
• User-independent and coitus-independent method 5
• Significantly more effective than injectable contraceptives like Depo-Provera (0.05% vs 6% failure rate) 1

Important Considerations

• Potential Pitfall: Efficacy may be reduced with hepatic enzyme-inducing medications 1

  • Additional contraceptive methods may be needed for patients on certain antiretroviral medications (efavirenz, nevirapine, or protease inhibitors) 1

• Common Side Effects:

  • Changes in menstrual bleeding patterns are the most common side effect and primary reason for discontinuation 1
  • Other potential side effects include emotional lability, weight gain, headache, and acne 5

• Removal Considerations:

  • Fibrosis around the implant is the most common removal complication (4.4% of cases) 6
  • Mean removal time is approximately 2 minutes 6

In summary, while Nexplanon has demonstrated effectiveness beyond 3 years in research settings, current clinical practice guidelines still recommend replacement after 3 years to ensure optimal contraceptive protection.