Nexplanon®
Etonogestrel 68mg Subdermal Implant
Version 2025-04 · Last reviewed April 1, 2025 · Methodology
List Price
$1,100
With Insurance
$0 (ACA-mandated Tier 1 coverage in most plans)
How It Works
Nexplanon releases etonogestrel — a synthetic progestin derived from 19-nortestosterone — continuously from a subdermal rod placed in the upper arm. It works through three simultaneous mechanisms: suppression of ovulation (the primary mechanism — LH surge is blocked, preventing egg release), thickening of cervical mucus (creating a physical barrier to sperm), and thinning of the uterine endometrium. The ovulation suppression mechanism alone is sufficient for contraceptive efficacy in most users, but efficacy does diminish by year 3 as etonogestrel levels decline — which is why the labeling specifies replacement at 3 years (or 2 years in heavier patients, where lower etonogestrel serum levels are documented). The endometrial thinning mechanism is the one that generates ethical and religious objections for some users — it is important that this mechanism be disclosed during informed consent, as surveys suggest many patients are not informed about it. The systemic progestin exposure also affects the hypothalamic-pituitary-ovarian axis: prolonged suppression of LH and FSH alters the hormonal environment beyond just contraception, affecting mood, libido, and in some cases bone density in long-term adolescent users.
Why the side effects happen
The irregular bleeding — affecting up to 65% of users with non-regular cycle patterns — occurs because continuous progestin thins the endometrium unevenly and unpredictably, removing the cyclic hormonal fluctuation that normally coordinates the menstrual cycle. The result is an atrophic, fragile endometrium that bleeds at irregular intervals that cannot be predicted. This is not dangerous but is the primary driver of discontinuation. The mood and depression connection flows from the CNS progestin receptor effects described above — synthetic progestins are not equivalent to endogenous progesterone in their receptor binding profile and downstream neurological effects. The clinical trial dataset was not designed to detect mood changes (single-question assessment vs. validated instruments), which explains the discrepancy between the 6% trial rate and the 40% increased antidepressant prescription rate found in the Skovlund 2016 Danish cohort.
When Will I Feel It?
Contraceptive protection begins within 24 hours if inserted at the right time in the cycle. Full systemic etonogestrel levels are reached within days. Fertility returns within 1–4 weeks of removal.
If inserted during days 1–5 of the menstrual cycle: immediate contraceptive protection. If inserted at any other time: use backup contraception for 7 days. Etonogestrel begins releasing immediately at insertion.
Therapeutic etonogestrel serum levels reached. LH suppression established. Cervical mucus thickening confirmed. Insertion site bruising typically peaks and begins to resolve.
Bleeding pattern adjustment period. Most irregular bleeding occurs during this window. If bleeding is tolerable, Organon and most guidelines suggest waiting 90 days before considering removal — patterns often stabilize.
Etonogestrel levels decline significantly by year 3 — from ~60–70 mcg/day at insertion to ~25–30 mcg/day. Efficacy remains >99% through year 3 in normal-weight women. Heavier women should replace at 2 years due to lower serum levels.
Etonogestrel levels fall rapidly — typically to undetectable within days. Ovulation and fertility return within 1–4 weeks. Fertility is not permanently affected by implant use.
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Common Side Effects
While taking this medication, you may experience the following common side effects. We've included tips on how to manage them.
Irregular, unpredictable bleeding
Up to 65%This is the most common reason for early removal. In trials, only 17% of women had regular menstrual cycles; 20% had no periods (amenorrhea); 33% had infrequent, prolonged, or frequent bleeding. Patients should be counseled on this before insertion — not after. A 90-day trial is typically needed before the bleeding pattern stabilizes.
Headache
14%Usually mild; track frequency and severity. New-onset severe headache (especially with visual changes) after insertion warrants medical evaluation — though migraine with aura on progestin-only methods is not a contraindication as it is with estrogen-containing methods.
Acne
12%Progestins can increase androgenic activity — can worsen pre-existing acne. In patients for whom acne is already a concern, discuss this risk before insertion.
Breast tenderness
10%Usually resolves within the first 2–3 months as hormone levels stabilize.
Mood changes / depressed mood
6% in clinical trials — widely believed to be underreportedThe pivotal trials used single-question mood assessment rather than validated psychiatric instruments (PHQ-9, etc.). A large Danish cohort study (Skovlund et al. 2016) found progestin-only implant users had a 40% higher rate of first antidepressant prescription compared to non-hormonal contraception users. If you develop new depressive symptoms after insertion, connect this to the timing and discuss with your provider. Removal resolves the hormonal exposure.
Anxiety / nervousness / emotional lability
Listed in prescribing information; underreported in trialsEtonogestrel modulates progesterone receptors in the amygdala and limbic system — areas central to fear response and emotional regulation. Synthetic progestins suppress allopregnanolone, a GABA-A receptor positive modulator with natural anxiolytic effects; reducing allopregnanolone can increase anxiety vulnerability. The same Skovlund 2016 Danish cohort that found increased antidepressant use also found increased anxiolytic prescriptions in hormonal contraception users. If new anxiety begins or worsens after insertion, note the timing — this is mechanistically plausible, not coincidental.
Weight change
Variable — reported in 12% but contestedSome studies show weight gain, others show no significant change compared to non-hormonal users. The mechanism proposed is appetite increase via progestin. The reported rate varies significantly by study population and methodology.
Insertion site bruising / tenderness
Common (>20% short-term)Expected and typically resolves within 7–10 days. Report any signs of infection (increasing redness, warmth, pus, fever) to your provider immediately.
Serious Adverse Effects
- • Implant migration — the device can migrate from the insertion site into the arm or, rarely, into the vasculature or thoracic cavity (pulmonary artery migration documented in Nexplanon's prescribing information); requires imaging (X-ray, ultrasound, or MRI) to locate before removal; may require surgical or cardiothoracic intervention in extreme cases
- • Difficult removal — estimated 1–5% of insertions require complex removal due to deep placement, migration, or fibrous encapsulation; may require surgical dissection under general or regional anesthesia. Providers trained only in insertion (without sufficient removal experience) may be ill-equipped to manage complications
- • Nerve injury at insertion — the medial cutaneous nerve of the forearm runs near the insertion site; improper technique can cause persistent numbness, tingling, or pain
- • Ectopic pregnancy — Nexplanon is highly effective at preventing pregnancy, but when pregnancy does occur (rare), it is more likely to be ectopic than with unprotected intercourse. Any symptoms of pregnancy (or pelvic pain) while the implant is in place require immediate evaluation
- • Insertion into a blood vessel — documented in post-marketing reports; results in loss of contraceptive coverage and vascular complications
- • Depression and mood disorders — large epidemiological data (Skovlund et al. 2016 Danish cohort) shows significantly increased antidepressant use and depression diagnosis in hormonal contraception users vs. non-hormonal users; implant users among the highest-risk subgroup
Drug Interactions
Major Interactions (Avoid)
Moderate Interactions (Caution)
Food Interactions
When to Contact Your Doctor
This medication requires ongoing medical supervision. The following situations warrant a prompt conversation with your prescribing physician — do not wait for your next scheduled appointment.
Contact soon if you notice
- Implant migration — the device can migrate from the insertion site into the arm or, rarely, into the vasculature or thoracic cavity (pulmonary artery migration documented in Nexplanon's prescribing information); requires imaging (X-ray, ultrasound, or MRI) to locate before removal; may require surgical or cardiothoracic intervention in extreme cases
- Difficult removal — estimated 1–5% of insertions require complex removal due to deep placement, migration, or fibrous encapsulation; may require surgical dissection under general or regional anesthesia. Providers trained only in insertion (without sufficient removal experience) may be ill-equipped to manage complications
- Nerve injury at insertion — the medial cutaneous nerve of the forearm runs near the insertion site; improper technique can cause persistent numbness, tingling, or pain
- Ectopic pregnancy — Nexplanon is highly effective at preventing pregnancy, but when pregnancy does occur (rare), it is more likely to be ectopic than with unprotected intercourse. Any symptoms of pregnancy (or pelvic pain) while the implant is in place require immediate evaluation
- Device is no longer palpable under the skin — imaging required before any removal attempt
Also discuss if you want to
- Review whether this medication is still appropriate for you
- Consider dosage adjustments based on response
- Explore lifestyle or non-drug alternatives
- Understand stopping or tapering options
- Plan monitoring labs and follow-up
In the US, call 911 or go to the nearest emergency room for severe symptoms. Poison Control: 1-800-222-1222.
Special Populations
Safety classifications for specific groups — discuss with your provider before use.
Nexplanon should not be inserted in a patient with known or suspected pregnancy. There is no evidence of teratogenicity if accidentally exposed in early pregnancy. If pregnancy occurs during implant use (rare) — test immediately, as ectopic pregnancy risk is elevated relative to intrauterine pregnancy.
The irregular bleeding pattern of Nexplanon is particularly complex to manage in perimenopausal women, where irregular cycles are already occurring from declining ovarian function. In this population, distinguishing implant-related bleeding from perimenopausal bleeding — and from pathological causes — requires more frequent clinical evaluation. The effect of chronic progestin exposure on perimenopausal bone density, cognition, and cardiovascular risk is not well characterized.
FDA approved and AAP-endorsed as a first-line contraceptive for adolescents — yet the Skovlund 2016 Danish cohort showed the highest relative risk of antidepressant use and new depression diagnoses in the youngest age group. Adolescents prescribed Nexplanon are in the highest-risk demographic for progestin-related mood harm, and they are receiving it as a first-line recommendation. The long-term neurodevelopmental effects of continuous synthetic progestin exposure during adolescent brain development have never been adequately studied. There are no long-term prospective studies examining the impact on developing hypothalamic-pituitary-ovarian axis maturation, cognitive development, or mood disorder trajectory in this population. This is a significant informed consent gap.
Nexplanon is a contraceptive — not indicated after confirmed menopause. Occasionally used off-label for menstrual management in perimenopausal women, but this is not an FDA-approved indication and the evidence base for this use is limited.
Limited data, but etonogestrel's primary metabolism is hepatic. Renal impairment alone is not a contraindication — progestin-only methods are generally preferred over estrogen-containing methods in patients with renal disease.
Etonogestrel is hepatically metabolized. WHO Medical Eligibility Criteria Category 3–4 for severe liver disease and hepatic tumors: avoid use. Mild or compensated liver conditions are generally acceptable (Category 2).
FDA Adverse Event Reports
Patient-filed reports from the FDA FAERS database · refreshed daily
Community Reports
User-reported experiences — anonymous & anecdotal
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Global Prescribing & Pricing
LARC use is higher in the UK and France as a proportion of contraceptive choices; the US has had rapidly increasing LARC uptake since the CHOICE project, partly driven by Organon provider education programs
United States
$0 (ACA-covered) · $370–730/year without insurance/mo
LARC uptake driven by CHOICE project data, AAP guidance, and Organon provider training programs; immediate postpartum insertion promoted in safety-net settings
ACA mandates $0 copay for all FDA-approved contraceptives including Nexplanon and the insertion procedure. No restriction on which provider can insert — provider quality varies with training depth. Open Payments shows substantial Organon training and speaking payments to OB/GYN physicians.
ACA Tier 1 — typically $0 copay including procedure
United Kingdom
Free (NHS)/mo
The subdermal implant is one of the most widely used LARCs in the UK — NHS promotes it as the most effective reversible method; proactive national LARC strategy since 2005 NICE guidance
NICE CG30 (2005, updated): recommend LARC as first-line discussion for all women. Training is delivered through NHS-accredited FSRH (Faculty of Sexual & Reproductive Healthcare) programs — not manufacturer-sponsored. This separation of training from manufacturer reduces Organon's direct prescribing influence in the UK compared to the US.
NHS — completely free including device, insertion, and removal
France
Fully reimbursed (Sécurité Sociale)/mo
Nexplanon widely used; French National College of Gynecology guidelines recommend LARC discussion at first contraceptive visit; strong midwife insertion training programs
Social Security reimburses Nexplanon at 100% for women under 26; 65% for older women. Training delivered through professional medical societies independent of manufacturer, limiting Organon's direct educational influence.
100% for under-26; 65% reimbursement for others
Australia
PBS-listed — low patient cost (~$30)/mo
TGA-approved; PBS subsidy makes it affordable; Royal Australian and New Zealand College of Obstetricians training programs are provider-led, not manufacturer-sponsored
PBS subsidy with a modest patient co-payment; Therapeutic Goods Administration regulates advertising restrictions — Organon cannot directly market to the public. Insertion training managed through RANZCOG/FPAA professional programs.
PBS subsidized — low copay
Germany
Covered for women under 22 (GKV); ~€200–400/3 years for older women/mo
Lower LARC uptake than UK/France; GKV (statutory insurance) covers contraception only up to age 22; above that, patients pay out of pocket — which increases cost sensitivity and affects uptake
Advertising restrictions limit Organon's direct-to-provider marketing; prescribing habits more influenced by gynecologist professional societies than manufacturer reps. The out-of-pocket cost above age 22 creates an equity gap that significantly limits access.
GKV covered under age 22 only
The UK demonstrates what LARC promotion looks like without manufacturer-led training: the NHS achieved comparable LARC uptake rates to the US using NHS-accredited FSRH training programs, with no Organon representative involvement. This creates a cleaner separation between clinical recommendation and commercial interest. In the US, Organon's direct payment to providers for training, combined with procedural billing incentives, creates a structural conflict of interest that does not exist in the UK or Australian models.
Clinical Trials & Funding
Understanding who funds research helps contextualize results. Industry-funded trials are not automatically invalid — they undergo the same FDA review — but declared conflicts and sponsor effects are worth knowing. All linked trials can be verified on ClinicalTrials.gov.
Funding Sources
The pivotal trials establishing Nexplanon's efficacy were funded by Organon — the manufacturer. These were non-comparative, single-arm studies with no placebo or alternative-method control arm. Efficacy (>99%) is extremely well established and not meaningfully disputed. The CHOICE Project, frequently cited to show high LARC satisfaction and continuation rates, was funded primarily by the Susan Thompson Buffett Foundation (a pro-contraception access organization) and conducted at Washington University in St. Louis. The CHOICE methodology used a convenience sample of motivated, volunteer participants — a population with fundamentally different baseline motivation than the average contraception user — which inflates satisfaction and continuation metrics.
Declared Conflicts of Interest
Organon runs an extensive "Nexplanon Certified Provider Training" program — a direct-to-physician education and certification model that creates documented financial relationships between the company and the clinicians most likely to insert the device. These payments appear in the Open Payments (Sunshine Act) database under Organon Global. Beyond training fees, the device creates a structural financial incentive unique to procedural contraception: providers bill separately for the insertion procedure (CPT 11981, typically $200–500) and the removal procedure (CPT 11982, typically $150–400). A provider who inserts Nexplanon earns two procedure fees per patient over three years — an inherent financial alignment toward LARC recommendation that does not exist with pills, patches, or rings. Pharmaceutical sales representatives actively visit OB/GYN offices and residency training programs; many residents receive their first insertion training through Organon-sponsored programs, embedding prescribing habits at the earliest stage of clinical practice.
Key Efficacy Results
CHOICE: Higher continuation and satisfaction vs. short-acting methods — but in a volunteer, motivated population. Pivotal trials: Pearl Index <0.05 (pregnancy rate), confirming >99% efficacy. Depression study (Skovlund et al.): progestin-only methods showed significantly increased antidepressant use and depression diagnosis rates vs. non-hormonal contraception users — Nexplanon users had one of the highest relative risks in the cohort.
Referenced Studies
Each study carries a Cochrane RoB-2 risk-of-bias badge — tap the badge for details.
Evidence & Transparency
Cochrane RoB-2 (Risk of Bias)
Badges reflect an editorial assessment using Cochrane's RoB-2 tool domains: randomization, intervention deviation, missing data, outcome measurement, and selective reporting. These are not certified Cochrane reviews. Learn more ↗
CMS Open Payments
Manufacturer payment disclosures are reported via the CMS Sunshine Act. Disclosure is legally required and does not imply bias or misconduct. Language uses "may," "suggests," or "appears" — never definitive clinical claims. CMS Open Payments ↗
Live Clinical Trials
Live from ClinicalTrials.gov · refreshed every 4 hours
Currently enrolling, active, and recently completed studies involving Etonogestrel 68mg Subdermal Implant. Data is pulled directly from the U.S. National Library of Medicine.
Recent Research
Live from PubMed · peer-reviewed literature · refreshed every 4 hours
Most recently indexed clinical trials and systematic reviews mentioning Etonogestrel 68mg Subdermal Implant in PubMed.
Source Documentation
Structured citations for referenced clinical trials
Each referenced trial is listed with its registry ID, funding source, and bias assessment. Use the copy button to generate a formatted citation.
| Trial | Registry ID | Cite |
|---|---|---|
| CHOICE Project — NEJM 2012 | PMID:22682688 | |
| Nexplanon Removal Complications — A Systematic Review | PMID:32312907 | |
| Progestin-Only Contraception and Depression Risk (JAMA Psychiatry 2016) | PMID:28259903 |
Bias ratings use Cochrane RoB-2 methodology. Editorial assessment — not a certified Cochrane review.
Our MethodologyMedical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Stopping This Medication Safely
Etonogestrel does not cause pharmacological dependence. Once the implant is removed, hormone levels fall within days and fertility typically returns within 1–4 weeks. The only barrier to stopping is the need for a removal procedure — which carries its own complexity if the device has migrated or been placed too deeply.
What Published Research Shows About Stopping This Medication
This summarizes what published research documents — it is not personal medical advice. Any changes to your medication require discussion with your prescribing physician.
- ·Research and clinical guidelines confirm removal can be requested at any time without a medical reason
- ·If palpable, outpatient removal typically takes ~5–10 minutes under local anesthesia
- ·If non-palpable, imaging (ultrasound, X-ray) is required to confirm location before removal
- ·If deep or migrated, referral to a provider with advanced removal experience is documented as the appropriate pathway
- ·Unusual arm pain, numbness, tingling, or swelling warrants evaluation before attempted removal — these may indicate migration or nerve involvement
- ·Research documents fertility returning within 1–4 weeks of removal; ovulation can occur before the first period
Warning Symptoms — Contact Your Doctor If You Experience:
- Device is no longer palpable under the skin — imaging required before any removal attempt
- New arm pain, numbness, or tingling — possible migration or nerve involvement
- Severe pelvic pain or missed period — evaluate for ectopic pregnancy immediately
- Signs of insertion site infection (increasing redness, warmth, pus, fever) — seek care within 24 hours
- Sudden chest pain or shortness of breath — in the rare event of vascular migration, this is an emergency
Never change or stop a medication without consulting your prescribing physician.
Questions for Your Doctor
Questions to Ask
- 1.I've read that irregular bleeding affects up to 65% of users for the full three years — can you tell me specifically what my bleeding pattern might look like and when I should come back if it's bothering me?
- 2.Are you a Nexplanon Certified Provider through Organon's training program? How many insertions and removals have you personally performed?
- 3.I have a history of depression — given the Skovlund 2016 Danish cohort data showing increased antidepressant use in implant users, should we be monitoring my mood formally after insertion?
- 4.If I need removal and the implant is difficult to locate or has migrated — what is your experience with complex removals, and when would you refer me to a specialist?
- 5.I'm on [medication] — has anyone reviewed whether it affects how etonogestrel is metabolized?
Lab Tests to Request
- Pregnancy test before insertion (required)
- Arm X-ray or ultrasound if implant cannot be palpated at removal attempt — do NOT attempt removal without imaging confirmation of location first
- PHQ-9 (depression screen) at 3 and 6 months post-insertion if mood symptoms develop
- Blood pressure check (progestin-only methods do not have the same hypertension risk as combined methods, but baseline is useful)
- STI screening if clinically indicated — Nexplanon does NOT protect against sexually transmitted infections
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Frequently Asked Questions About Nexplanon®
- What is Nexplanon® used for?
- Nexplanon® (Etonogestrel 68mg Subdermal Implant) is a Progestin Subdermal Contraceptive Implant manufactured by Organon (formerly Merck Women's Health). FDA-approved indications include: Contraception (up to 3 years); Off-label: dysmenorrhea, menorrhagia, endometriosis symptom management — not FDA approved for these uses.
- What are the common side effects of Nexplanon®?
- Common side effects of Nexplanon® include: Irregular, unpredictable bleeding (Up to 65%); Headache (14%); Acne (12%); Breast tenderness (10%); Mood changes / depressed mood (6% in clinical trials — widely believed to be underreported).
- How much does Nexplanon® cost?
- Nexplanon® list price is approximately $1,100. With insurance it typically costs $0 (ACA-mandated Tier 1 coverage in most plans); without insurance approximately $800–1,300 (device) + $200–500 (insertion) + $150–400 (removal) = ~$1,150–2,200 total.
- Who funded the clinical trials for Nexplanon®?
- The pivotal trials establishing Nexplanon's efficacy were funded by Organon — the manufacturer. These were non-comparative, single-arm studies with no placebo or alternative-method control arm. Efficacy (>99%) is extremely well established and not meaningfully disputed. The CHOICE Project, frequently cited to show high LARC satisfaction and continuation rates, was funded primarily by the Susan Thompson Buffett Foundation (a pro-contraception access organization) and conducted at Washington University in St. Louis. The CHOICE methodology used a convenience sample of motivated, volunteer participants — a population with fundamentally different baseline motivation than the average contraception user — which inflates satisfaction and continuation metrics.
- How strong is the clinical evidence for Nexplanon®?
- Key studies: Pivotal Implanon efficacy trials (Organon, 1998–2006); CHOICE Project (St. Louis, 2007–2013). CHOICE: Higher continuation and satisfaction vs. short-acting methods — but in a volunteer, motivated population. Pivotal trials: Pearl Index <0.05 (pregnancy rate), confirming >99% efficacy. Depression study (Skovlund et al.): progestin-only methods showed significantly increased antidepressant use and depression diagnosis rates vs. non-hormonal contraception users — Nexplanon users had one of the highest relative risks in the cohort. Potential conflicts of interest: Organon runs an extensive "Nexplanon Certified Provider Training" program — a direct-to-physician education and certification model that creates documented financial relationships between the company .
- Are there non-drug alternatives to Nexplanon®?
- Consult your healthcare provider about lifestyle, dietary, or behavioral alternatives to Nexplanon®. Options vary by condition and individual health history.
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