Is Nexplanon (etonogestrel) suitable for a 14-year-old?

Nexplanon Use in a 14-Year-Old

Nexplanon is highly appropriate and safe for use in a 14-year-old adolescent, as it is one of the most effective contraceptive methods available for this age group with a failure rate of less than 1%. 1

Age Appropriateness and FDA Approval

• The FDA explicitly states that safety and efficacy of etonogestrel implants have been established in women of reproductive age, with efficacy expected to be the same for postpubertal adolescents under age 18 as for users 18 years and older. 2
• Use before menarche is not indicated, but for postmenarchal adolescents (including 14-year-olds), Nexplanon is fully approved. 2

Clinical Advantages for Adolescents

• Nexplanon is ideal for adolescents because it does not require regularly scheduled adherence, eliminating the risk of missed pills or forgotten doses that commonly occur in this age group. 1
• The implant provides 3 years of continuous contraceptive protection with failure rates consistently less than 0.05%, making it one of the most effective reversible contraceptive methods available. 3
• The American Academy of Pediatrics recommends using a "tiered" approach to contraceptive counseling, starting with the most effective methods like long-acting reversible contraceptives (LARCs), which includes Nexplanon. 1

Insertion and Removal Considerations

• Insertion takes approximately 1 minute and is performed by a trained medical professional into the inner nondominant upper arm, 6-8 cm above the elbow. 1
• Removal can be accomplished in under 5 minutes, with complications being rare (fibrosis around the implant occurs in approximately 4.4% of cases). 1, 4
• The device contains barium sulfate, making it visible on radiography if localization is needed. 1

Important Counseling Points

• Backup contraception (condoms or abstinence) must be used for at least the first week after insertion for full contraceptive efficacy. 3
• The most common adverse effect is irregular menstrual bleeding patterns, which should be discussed before insertion. 1, 5
• Despite irregular bleeding, continuation rates remain high at 84% at 1 year, reflecting overall user satisfaction. 3
• Fertility returns rapidly once the implant is removed. 5

Drug Interactions to Consider

• Standard oral antibiotics do not interfere with Nexplanon effectiveness. 3
• Only hepatic enzyme-inducing drugs (such as efavirenz, nevirapine, or most protease inhibitors used in HIV treatment) can reduce contraceptive efficacy, requiring alternative or additional contraceptive methods. 1, 3

Noncontraceptive Benefits

• Nexplanon is medically necessary and appropriate for management of primary dysmenorrhea in adolescents. 6
• It can be beneficial for adolescents with conditions such as severe dysmenorrhea, endometriosis, abnormal uterine bleeding, and bleeding disorders. 1