How often should Nexplanon (etonogestrel implant) be replaced in a female patient?

When to Replace Nexplanon

Nexplanon must be replaced every 3 years from the time of insertion to maintain contraceptive protection. 1, 2, 3

FDA-Approved Duration

• The etonogestrel implant (Nexplanon) provides contraceptive protection for exactly 3 years from insertion, after which it should be removed and replaced with a new implant if continued contraception is desired. 1, 2
• This 3-year timeframe is the FDA-approved duration and represents the standard of care for clinical practice. 1

Contraceptive Efficacy During the 3-Year Period

• Nexplanon demonstrates exceptional effectiveness with a failure rate of less than 0.05% throughout the entire 3-year approved duration, making it one of the most effective reversible contraceptive methods available. 1, 2
• Both typical-use and perfect-use failure rates remain less than 1% during this period. 1

Timing of Replacement

• At the end of 3 years, the implant should be removed by a trained healthcare provider. 3, 4
• If continued contraceptive protection is desired, a new Nexplanon can be inserted immediately after removal of the old implant, typically through the same incision site. 3
• The removal procedure typically takes less than 5 minutes when performed by a trained provider. 2

Extended Use Beyond 3 Years (Not Standard Practice)

• While recent evidence suggests the implant may remain effective for up to 4 years with no documented pregnancies during the fourth year, this is not currently recommended for standard clinical practice. 1
• Clinicians should adhere to the FDA-approved 3-year replacement schedule unless specific research protocols are being followed. 1

Important Clinical Considerations

• Backup contraception (condoms or abstinence) must be used for at least the first 7 days after insertion of a new implant for full contraceptive efficacy. 1, 2
• Patients on hepatic enzyme-inducing drugs (efavirenz, nevirapine, or most protease inhibitors) may experience reduced contraceptive efficacy and should use alternative or additional contraceptive methods throughout the duration of the implant. 1, 2
• The device contains barium sulfate, making it visible on radiography if localization is needed before removal. 2

Return to Fertility

• Fertility returns rapidly once the implant is removed, so if continued contraception is desired, the new implant should be inserted immediately. 3