From the Guidelines
Nexplanon should be replaced with a new implant if you've had it for more than 3 years and are experiencing dizziness, as the effectiveness of the implant may be impaired and hormone levels may be decreasing. When considering the use of Nexplanon for more than three years, it's essential to weigh the potential risks and benefits, particularly in relation to dizziness as a side effect. According to a study published in Pediatrics in 2016 1, the effectiveness of the implant is unchanged at 4 years of use, but changes in menstrual bleeding patterns are the most common side effect, and data on the effect of progestin implants on bone mineral density are scant. Some key points to consider include:
- The efficacy of progestin implants may be impaired by hepatic enzyme–inducing drugs that act on the cytochrome P450 pathway, as noted in the study 1.
- Emerging evidence indicates reduced levonorgestrel concentrations in women who use levonorgestrel implants and receive efavirenz‑containing antiretroviral therapy, which may also apply to etonogestrel implants like Nexplanon 1.
- The National Institutes of Health (NIH) guidance is to use an alternative or additional contraceptive method when efavirenz, nevirapine, or most protease inhibitors (PIs) are administered to HIV‑infected individuals, but the CDC and the World Health Organization (WHO) state that the benefits of using progestin implants outweigh any risks with concomitant administration of an antiretroviral agent in HIV‑infected women 1. Given the potential for decreased hormone levels and impaired effectiveness, replacing the Nexplanon implant with a new one is the most appropriate course of action to ensure consistent hormone levels and effective contraception, and to potentially resolve dizziness related to fluctuating hormone levels.
From the Research
Nexplanon for More Than Three Years and Dizziness
- There is limited information available on the specific topic of dizziness associated with the use of Nexplanon (etonogestrel implant) for more than three years.
- However, studies have shown that the etonogestrel implant is a highly effective and safe contraceptive method, with some evidence suggesting that it can be used for up to 5 years without a significant decrease in efficacy 2.
- A systematic review of the safety and benefits of contraceptive implants, including the etonogestrel implant, found that abnormal menstrual bleeding is a common side effect, but did not mention dizziness as a specific side effect 3.
- Another study found that the etonogestrel implant is highly effective and safe for up to 5 years, with no pregnancies reported during the additional 2 years of follow-up 2.
- A review of tips and tricks for the management of the etonogestrel implant in clinical practice did not mention dizziness as a potential side effect 4.
- A randomized controlled trial found that women with bleeding complaints related to the etonogestrel implant may experience improvement with continuous combined oral contraceptives, but did not mention dizziness as a side effect 5.
- A systematic review of the clinical effectiveness, side-effect profile, and continuation rate of the etonogestrel implant found that abnormal menstruation is the most commonly reported side effect, but did not mention dizziness 6.