Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to birth control and family planning.
Nexplanon is an FDA-approved birth control device that’s implanted in the arm and lasts for up to three years. The manufacturer claims it’s as effective as the pill, and is easily reversible by removing the implant if the woman changes her mind and wants to get pregnant.
But is Nexplanon actually proven in research studies to be as effective as the pill? How much does it reduce pregnancy rates? Does the device cause any concerning side effects? And how do real users rate and describe its effects?
In this article we'll answer all of these questions and more, as we review clinical studies on Nexplanon to determine its effectiveness at preventing pregnancy.
We'll compare its effectiveness to other birth control methods, document its side effects (including a discussion of weight gain), and feature unsponsored patient reviews.
Can Nexplanon Prevent Pregnancy?
An extensive systematic review published in the Reproductive Health journal examined the effectiveness of Nexplanon.
The researchers found that among the clinical trials reviewed, the rate of unintended pregnancy while using Nexplanon ranged from 0 to 1.4 unintended pregnancies per 100 years used. This is an extremely high level of efficacy, and makes Nexplanon a good birth control option.
Another recent medical review confirmed these results, and the study authors even wrote that Nexplanon and its class of medical devices are the most effective form of birth control on the market.
We will conclude from the available research that Nexplanon is effective for significantly reducing the risk of unintended pregnancy, which is unsurprising given that the device is approved by the FDA for that indication.
Does Nexplanon Cause Side Effects?
One of the research reviews cited in the previous section also documented the side effects of Nexplanon.
Amenorrhea, which is the medical term for a missed period, was the most common side effect, with 41% of patients affected. Infrequent bleeding affected 24% of patients and frequent bleeding affected 18%.
The two most notable non-menstrual side effects were breast tenderness (19%) and acne (10%).
The side effects page on Nexplanon’s official website explains that 1 in 10 women in clinical trials stopped using Nexplanon due to unfavorable changes in their menstrual bleeding pattern.
There does appear to be an extremely rare risk (reported as 3.17 out of 100,000 in this medical review) of the device migrating and blocking an artery which could cause serious harm and even death.
Real People Try Nexplanon
A YouTube creator named "Amy Lee Life Coaching" has a Nexplanon review after three years of use, that discusses side effects she personally experienced, what the removal process was like, what the cost was and whether she would get it again:
A YouTube creator named "Samantha Alyssa TV" claims to have had a more positive experience with Nexplanon:
Is Removing Nexplanon Dangerous?
The risk of complications from insertion and removal of the Nexplanon device creates an additional risk vector to the side effects from the device and drug itself.
A recent medical review published in the Contraception journal examined real-world data on Nexplanon procedure-related events (both insertion and removal).
In over 5,000 removal procedures, all were successful except for one, and even the one documented non-standard removal (caused by the implant migrating into deep muscle tissue) did not cause any serious health issues.
Insertions were actually more likely to cause adverse events than removals, with the incidence of incorrect insertion reported as 12.6 events out of 1,000.
Overall we would not consider the removal of Nexplanon to be dangerous or a serious health risk.
Nexplanon vs. Other Contraceptives
The effectiveness of Nexplanon can be directly compared to the effectiveness of other birth control methods based on clinical data.
A medical review on preventing unintended pregnancy published in the Journal of Women’s Health found that long-acting reversible contraceptive (LARC) methods such as Nexplanon were 20x more effective than non-LARC methods such as the pill or condom use.
This is mostly due to human error: with implanted devices like Nexplanon, there is no chance for human error that can affect the risk of unintended pregnancy.
But for methods like the condom or oral pills, they can be used incorrectly or patients may even forget to or choose not to use them, which greatly increases the chance of pregnancy.
A meta-study published in the Reproductive Health journal found that even when compared with other LARC devices, Nexplanon is more effective. Nexplanon users were 7x less likely to experience unintended pregnancy than users of copper intrauterine (IUD) devices.
Nexplanon is the most effective birth control method we've reviewed to date on Illuminate Health.
How Does Nexplanon Work?
Nexplanon is a device inserted into the arm, so it requires a prescription and a clinic visit.
It contains 68 milligrams (mg) of etonogestrel, which is released throughout the day and circulates in the body.
Etonogestrel is a synthetic progestin molecule, meaning it’s chemically similar to the hormone that regulates pregnancy and menstruation in women. This is the only active ingredient in Nexplanon and is what makes it so effective.
Nexplanon causes etonogestrel levels in the body to remain around 200 picograms (pg) per milliliter (mL), which is well above the 90 pg/mL level which prevents ovulation, according to this medical review.
Because Nexplanon’s efficacy involves artificially increasing circulating levels of etonogestrel, its effects are transient and conception is possible if the woman chooses to remove the device with the help of a doctor.
The animated video below published by Design Science provides a visual example of how Nexplanon works and how it's fitted:
How Long Does Nexplanon Last?
Nexplanon's FDA label indicates that the device can be used for up to three years.
After three years, the device is typically removed and a new device is re-inserted if the patient chooses to continue using Nexplanon for birth control.
A clinical trial examined extended use of Nexplanon, and found that using it for five years rather than three didn’t increase pregnancy risk. No pregnancies occurred during the additional two years.
Although studies suggest Nexplanon is likely safe and effective for five years, it is currently only FDA approved for three years.
However, if more safety data emerges proving the device safe for periods beyond three years, the FDA may approve Nexplanon for longer durations which would be a benefit for patients given that some of the side effects relate to insertion and removal.
Does Nexplanon Cause Weight Gain?
Patients are often curious about whether Nexplanon can cause weight gain, given that some hormonal contraceptives (such as "the pill") can cause weight gain.
An extensive medical review analyzed data from over 1,000 Nexplanon patients and did not find any evidence that the device caused weight gain.
Patients did gain weight while on Nexplanon, but they also gained an equal amount of weight prior to insertion (which was tracked), so there was no evidence that the device caused the weight gain.
Adults in industrialized nations tend to gain weight over the course of their life, so it's impossible to attribute that weight gain to a drug or medical device unless that treatment is proven to cause more rapid weight gain than the patient was experiencing already.
A 2020 clinical trial documented weight gain in a specific subset of Nexplanon patients.
In this small study, women who had 2 copies of the ESR1 gene gained a significant amount of weight while using Nexplanon. This group gained an average of 31.1 pounds more than other Nexplanon patients.
Women who have completed genetic analysis using a service such as 23andMe may benefit from checking with their doctor if they have this ESR1 variant prior to considering Nexplanon.
If they have the genetic variant associated with a negative response to the drug, their doctor may be able to prescribe a different birth control medication.
Patients Rate Nexplanon
Drugs.com is a website that allows prescription medication patients to rate and review the drugs they're taking.
We cannot verify the accuracy or authenticity of any reviews on this site.
Nexplanon has been reviewed over 4,000 times on Drugs.com, and has an average review rating of 5.1 out of 10 at the time of updating this article (slightly lower than the 5.7 rating for IUD Paragard that we recently reviewed).
A top positive review comes from a user named "Rikky" who gave the device a 10/10 rating, and claims it was effective and side-effect-free:
"My experience with Nexplanon was amazing and I enjoyed every minute of it. I did not even notice it was there. I lost weight, my skin has never been better and I have been so happy!"
A top negative review is written by a user named "Megan" who gave the device a 1/10 rating, and claims it had a negative impact on mental health:
"The first year was fine but after that my whole life turned upside down. I didn’t relate it to the birth control but I’ve had severe depression and anxiety, which I’ve never experienced in my life until nexplanon. This needs to be taken off the market. I’m a very mean person on it and I get my period for weeks at a time. I’m always crying and being irrational and not to mention the horrible acne this thing puts out."
