What are the contraindications to receiving Nexplanon (etonogestrel implant)?

Contraindications to Nexplanon (Etonogestrel Implant)

Nexplanon is absolutely contraindicated in women with current or history of breast cancer, and should not be used in those with active liver disease, undiagnosed abnormal uterine bleeding, pregnancy, or known hypersensitivity to any component of the device. 1, 2

Absolute Contraindications (Category 4 - Unacceptable Health Risk)

Current Breast Cancer

• Current diagnosis of, or history of, breast cancer is an absolute contraindication, as this may be a hormone-sensitive malignancy 2
• This represents the primary Category 4 contraindication according to US Medical Eligibility Criteria 1

Liver Disease

• Active liver tumors (benign or malignant) 2
• Current liver disease with abnormal liver function 2

Pregnancy-Related

• Known or suspected pregnancy - there is no indication for contraceptive use during pregnancy 2
• Undiagnosed abnormal uterine bleeding requires evaluation before insertion 2

Hypersensitivity

• Known hypersensitivity reactions, including anaphylaxis and angioedema, to any component of Nexplanon 2
• Rare cases of allergic reaction to barium sulfate (the radiopaque component) have been documented 3

Important Clinical Distinctions from Combined Hormonal Contraceptives

A critical advantage of Nexplanon is that it contains no estrogen, making it safe for many women who cannot use combined hormonal contraceptives. 1 This means several conditions that are contraindications for estrogen-containing methods are NOT contraindications for Nexplanon:

Conditions Where Nexplanon IS Safe (Unlike Combined Hormonal Contraceptives)

• Smoking over age 35 - not a contraindication for progestin-only methods like Nexplanon 1
• History of stroke or cardiovascular disease 1
• Peripheral vascular disease 1
• Diabetes mellitus with vascular complications 1
• Thromboembolic disorders (deep vein thrombosis, pulmonary embolism) 1
• Systemic lupus erythematosus 1
• Morbid obesity 1
• Migraine headaches (including with aura) 1

Common Pitfalls to Avoid

Do not confuse contraindications for combined hormonal contraceptives with those for progestin-only implants. The evidence provided includes contraindications for ethinyl estradiol/norgestimate and vaginal rings 4, 2, which contain estrogen and have extensive cardiovascular contraindications that do NOT apply to Nexplanon. 1

The most important screening question is about current or past breast cancer - this is the primary absolute contraindication that applies specifically to progestin-only methods like Nexplanon. 1, 2