What is the comparative effectiveness of Intrauterine Device (IUD) versus Nexplanon (Etonogestrel)?

From the Guidelines

Both IUDs and Nexplanon are highly effective forms of long-acting reversible contraception, but Nexplanon (etonogestrel implant) is slightly more effective with a failure rate of less than 0.1%, making it the most effective reversible contraception available, as supported by the most recent evidence 1.

Key Considerations

• Nexplanon has a failure rate of less than 0.1%, while hormonal IUDs like Mirena, Kyleena, Liletta, and Skyla have failure rates of about 0.1-0.4%, and the copper IUD (Paragard) has a failure rate of about 0.8% 1.
• Nexplanon is a small rod inserted under the skin of the upper arm that lasts for up to 5 years, while IUDs are placed in the uterus and last 3-10 years depending on the type.
• Side effects differ between methods: Nexplanon may cause irregular bleeding patterns and hormonal side effects like headaches or mood changes, while hormonal IUDs typically reduce menstrual bleeding and cramping, and the copper IUD is hormone-free but may increase menstrual bleeding and cramping.

Choosing the Best Option

• The best choice between IUDs and Nexplanon depends on individual factors including medical history, preference for hormonal vs. non-hormonal methods, desired duration of use, and tolerance for potential side effects.
• Both options provide immediate protection when properly inserted by a healthcare provider and are quickly reversible when removed.

Clinical Evidence

• The society for maternal-fetal medicine (SMFM) consult series #48 supports the use of long-acting reversible contraception, including IUDs and Nexplanon, for women at high risk for medical complications 1.
• The American Academy of Pediatrics and other organizations also support the use of IUDs and Nexplanon as safe and effective methods of contraception for adolescents and women with HIV 1.

From the Research

Comparative Effectiveness of IUD and Nexplanon

• The comparative effectiveness of Intrauterine Device (IUD) versus Nexplanon (Etonogestrel) can be evaluated based on several studies 2, 3, 4, 5, 6.
• A study published in 2015 found that long-acting reversible contraceptive (LARC) methods, including IUDs, are recommended as first-line contraception for all women due to their high effectiveness and safety 2.
• Another study published in 2022 reviewed the evidence supporting the use of IUDs and etonogestrel subdermal implants beyond their approved duration of use, and found that extended use may be a safe and effective option for many patients 3.
• A 2016 study compared the efficacy of the etonogestrel-releasing subdermal contraceptive implant (Nexplanon) to the levonorgestrel-releasing subdermal implant, and found that the Nexplanon implant showed 100% efficacy in years 4 and 5, with a 5-year cumulative pregnancy rate of 0.6 per 100 women-years 4.
• The same study also compared the efficacy of the Nexplanon implant to a copper IUD, and found that the IUD had a higher pregnancy rate of 4.1 per 100 women-years 4.
• A 2017 practice bulletin published in Obstetrics and Gynecology stated that IUDs and contraceptive implants are the most effective reversible contraceptive methods, with a major advantage being that they do not require ongoing effort from the patient for long-term use 5.
• A 2012 study published in The New England Journal of Medicine found that long-acting reversible contraception, including IUDs and implants, had a significantly lower failure rate compared to other contraceptive methods, with a failure rate of 0.27 per 100 participant-years 6.

Efficacy Comparison

• The efficacy of IUDs and Nexplanon can be compared based on their pregnancy rates, with Nexplanon showing a 5-year cumulative pregnancy rate of 0.6 per 100 women-years 4.
• IUDs have been found to have a higher pregnancy rate compared to Nexplanon, with a rate of 4.1 per 100 women-years 4.
• However, both IUDs and Nexplanon have been shown to be highly effective contraceptive methods, with failure rates significantly lower than other contraceptive methods 2, 3, 5, 6.

Safety and Extended Use

• The safety and extended use of IUDs and Nexplanon have been evaluated in several studies, with findings suggesting that extended use may be a safe and effective option for many patients 3, 4.
• A 2016 study found that the extended use of the Nexplanon implant showed 100% efficacy in years 4 and 5, with no pregnancies occurring during the additional 2 years of follow-up 4.
• The study also found that the removal procedure for the Nexplanon implant was shorter compared to the levonorgestrel-releasing subdermal implant 4.