What information should be provided to patients considering Nexplanon (etonogestrel) for contraception?

Nexplanon Patient Education: Key Information for Patients

Patients considering Nexplanon should be informed that it is a highly effective contraceptive implant with a failure rate of only 0.05%, making it one of the most reliable birth control options available. 1

Efficacy and Method Information

• Nexplanon is a long-acting reversible contraceptive (LARC) that contains etonogestrel and provides contraception for up to 3 years 1
• With typical use, Nexplanon has an extremely low failure rate of 0.05%, making it more effective than most other contraceptive methods 1, 2
• The implant does NOT protect against HIV infection or other sexually transmitted infections - condoms should be used for STI protection 1, 3

Insertion and Removal Process

• The implant is inserted subdermally in the inner upper arm through a minor procedure that takes only a few minutes 1
• The insertion site should be properly cared for with a sterile dressing and local disinfection until healing occurs (usually 1-7 days) 1
• Removal takes approximately 2 minutes on average and should be performed by a trained healthcare provider 4
• Fibrosis (scar tissue) around the implant is the most common removal complication, occurring in about 4.4% of cases 1, 5

Side Effects and Management

Common Side Effects:

• Irregular bleeding patterns - the most common reason for discontinuation 1
• Other potential side effects include:
  • Emotional changes
  • Weight gain
  • Headache
  • Acne 1

Management of Side Effects:

• Discuss potential strategies to deal with side effects, particularly irregular bleeding 6
• Emphasize that side effects often improve over time 6
• Develop a follow-up plan to address any difficulties the patient experiences 6

Special Considerations

• Drug interactions: Certain medications (particularly enzyme-inducing drugs) may reduce Nexplanon's effectiveness, requiring additional contraceptive methods 1, 3
• Postpartum use: If starting after childbirth and before normal periods resume, an additional non-hormonal method should be used for the first 7 days 3
• Removal timing: The implant should be removed after 3 years or sooner if pregnancy is desired 3
• Checking placement: Patients should periodically verify the implant's presence by gently feeling for it 3

Warning Signs

Patients should be instructed to contact their healthcare provider if they experience:

• The implant coming out or changing position
• Inability to feel the implant
• Signs of pregnancy
• Severe pain, swelling, or redness at the insertion site 3, 5

Follow-up Planning

• Discuss an appropriate follow-up schedule based on the patient's individual needs 6
• Consider alternative follow-up methods such as telephone, email, or text messaging (with confidentiality assured) 6
• Use the teach-back method to confirm understanding of key information about Nexplanon 6

Documentation of Understanding

Healthcare providers should document the patient's understanding of:

• Method effectiveness (0.05% failure rate)
• Correct use and duration (3 years)
• Lack of STI protection
• Warning signs and when to seek care
• Follow-up plan 6

By providing comprehensive education about Nexplanon, healthcare providers can help patients make informed decisions about this highly effective contraceptive option and improve satisfaction and continuation rates.