How long is Nexplanon (etonogestrel) subdermal implant effective for contraception?

Nexplanon Duration of Effectiveness

Nexplanon provides highly effective contraception for 3 years from insertion and must be replaced by the end of the third year. 1, 2, 3

FDA-Approved Duration

• The etonogestrel implant is approved for 3 years of contraceptive protection from the time of insertion 1, 2
• After 3 years, the device should be removed and replaced with a new implant if continued contraception is desired 1, 3
• The implant can be removed and a new one inserted on the same day without any gap in contraceptive coverage 4

Contraceptive Efficacy During the 3-Year Period

Nexplanon is one of the most effective reversible contraceptive methods available, with exceptional performance throughout its approved duration:

• The failure rate is less than 0.05% during the 3-year period, making it more effective than sterilization procedures 5, 1, 2
• Both typical-use and perfect-use failure rates are less than 1% 5, 1
• A large real-world study of 7,364 users documented a Pearl Index of 0.02 for during-use pregnancies 6
• The continuation rate at 1 year is 84%, reflecting high user satisfaction despite irregular bleeding patterns 1, 2

Important Timing Considerations

Initial Protection Window

• Backup contraception (condoms or abstinence) must be used for at least 7 days after insertion for full contraceptive efficacy 1, 2

Same-Day Replacement

• When replacing an expired implant, no backup contraception is needed if the new implant is inserted immediately after removing the old one 4
• If more than 5 days pass between removal and reinsertion, backup contraception should be used for 7 consecutive days 4

Extended Use Beyond 3 Years (Not Standard Practice)

While not FDA-approved or recommended for routine clinical practice, emerging evidence suggests potential extended efficacy:

• Recent studies indicate the implant may remain effective for up to 4 years, with no documented pregnancies during the fourth year 1
• One case report documented detectable etonogestrel levels and apparent contraceptive effect even 6 years after insertion 7
• However, this extended use is not approved and should not be relied upon in standard clinical practice 1, 3

Common Pitfalls to Avoid

• Do not delay replacement beyond 3 years, as contraceptive efficacy beyond the approved duration is not guaranteed 1, 3
• Do not unnecessarily delay reinsertion after removal, as ovulation can resume quickly and pregnancy risk increases 4
• Ensure patients understand that irregular bleeding (the most common side effect) does not indicate reduced contraceptive efficacy 5, 2
• Remember that only hepatic enzyme-inducing drugs (such as efavirenz, nevirapine, or most protease inhibitors) reduce Nexplanon effectiveness—standard oral antibiotics do not interfere 1, 2