A patient once told me about her “party trick” – she would show her friends the inside of her bicep, press down, and there it appeared – a little matchstick, visible under her skin. She would stop pressing and it would disappear. It reminded her of the body modifications some of her other friends had – but lo and behold, this one was contraception! What was it? Nexplanon!

Nexplanon is a small hormonal contraceptive device

…. placed under the skin. Like the “party trick” describes – it’s placed on the inside of the arm, between the bicep and tricep. If you flex your bicep, you may see a little space below the muscle – that’s where it goes! 

Sometimes it’s referred to as “the implant” or “the rod”.  Nexplanon is the only brand available in the US currently. Earlier iterations were Norplant and Implanon and outside the US there are other options (Jadelle, Zarin, Femplant, Sino-implant). Because the only one available to me and my patients is Nexplanon, I simply say Nexplanon.  

Nexplanon secretes a continuous, small amount of the hormone progesterone. The version in Nexplanon, a synthetic version, is called etonogetrel (no, you won’t be quizzed later). It is absorbed in the blood stream.

Nexplanon works to prevent pregnancy in a few ways: 

1. Stops ovulation in about 50% of users. No ovulation = no pregnancy
2. Thickens cervical mucus. This stops most sperm
3. Changes fallopian tube motility. This usually stops the rest
4. Thins lining of uterus to make it “inhospitable” to pregnancy. The top 3 reasons work so well, this last one is an extra benefit but not the primary way it works! 

The good? 

• Nexplanon is a LARC – Long Acting Reversible Contraception. LARCs methods work well for long periods of time but are also 100% reversible. Remove it and fertility returns to baseline!

• It’s FDA approved for 3 years, but data from additional studies show it maintains contraceptive effects through 5 years! 

• One of the most effective methods of contraception. Not user dependent

• Not surgery! A simple office procedure with a tiny amount of local numbing is all that’s required. A pelvic exam isn’t even needed! 

The not-so good:

About 50% of people will have irregular and unscheduled bleeding. Here are some things to know about this bleeding: 

• Not typically heavy, but it can be annoying
• Most common in the first 3 months of use
• Usually improved significantly by 6 to 12 months
• This is the number one reason people will have it removed early
• Counseling and setting expectations can play a big role here. 
• There are some good treatment options: temporary use of NSAIDs, birth control pills, estrogen alone. These all have been shown to improve annoying bleeding, and, once stopped, bleeding doesn’t get worse again.  

A small percentage of people (10% or less) will have one of the following: headaches, bloating, mood symptoms, weight gain (5 lbs in several years)

Ready for it! Great!

• The procedure itself barely hurts and can be done in the office in just a few minutes. No need to change activity after insertion (ok to go back to work, or exercise, or whatever was planned)

• A small piece of tape is usually placed over the insertion site and then a bandage wrapped around the arm. The bandage can be removed in 24 hours, the tape in 72 hours (you do this on your own at home!). 

• Effective after 7 days (so use condoms or some other contraceptive method in the meantime)

• DOES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS. Use a condom with a new partner

Other Female Health Collective articles about contraception:

Emergency Contraception

IUD

We’ll keep adding more!