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Nexplanon

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Updated April 11, 2014

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Nexplanon

Nexplanon

Photo Courtesy of Merck

What Nexplanon Is:

Nexplanon is the newer form of the contraceptive implant, Implanon. It is a progestin-only contraceptive that contains 68 mg of etonogestrel.

Nexplanon is about the size of a matchstick and is made of a soft, flexible, medical polymer. This single-rod implant is inserted by a specially trained medical professional under the skin of your upper arm. You will be given a local anesthetic first, and the whole insertion only takes a few minutes.

The FDA has approved Nexplanon for the prevention of pregnancy for up to three years. It must be removed after this time (it will not dissolve), but you can choose to have it taken out at any time before the three years are over. You can also have a new Nexplanon inserted after having your old one removed. If Nexplanon is not removed after three years, the little bit of etonogestrel that will still be released may cause fertility problems or ectopic pregnancy.

How Nexplanon Works:

Nexplanon continually releases a low dose of the progestin etonogestrel over the 3-year period. The amount of progestin slowly decreases over time. During the first six weeks, 60 to 70 micrograms of the progestin is released per day. By the end of the first year, approximately 35-45 micrograms are released each day. This decreases to about 30-40 micrograms per day at the end of the second year and then around 25-30 micrograms a day by the end of the third year. After three years, Nexplanon will not release enough hormone to protect against pregnancy.

How Nexplanon is Different from Implanon:

Nexplanon differs from Implanon in two ways. First, Nexplanon is radiopaque. This means that the implant can be seen in an x-ray, computed tomography (CT scan), ultrasound scan or magnetic resonance imaging (MRI). There was some concern over increased failure rates with Implanon in the UK during January 2011; at that time, it appeared that Implanon was not as effective because doctors were not inserting it properly and had no real way (other than to physically feel the rod under the skin) to verify that the Implanon rod was inserted. With Nexplanon, doctors can now confirm that the implant has been properly inserted as well as easily locate it before removal.

Nexplanon also has a different applicator than Implanon, so the insertion procedure is a little different. The new preloaded applicator is designed to reduce the risk of insertion errors (such as implanting Nexplanon too deeply). The Nexplanon applicator is also designed to be operated with one hand. The Implanon applicator made it more difficult to determine if the rod had actually been inserted into the arm. The way the applicator was designed, it was also possible that the Implanon rod could fall out if the applicator was not properly held.

Advantages of Nexplanon:

  • Discreet and private
  • Does not require ongoing maintenance or the need to remember to use birth control
  • One of the most effective, reversible contraceptives available
  • A good alternative option for women who can't use estrogen-based birth control
  • Can be used while breastfeeding (after 4 weeks)
  • Allows for sexual spontaneity (nothing needs to be inserted or put on prior to sexual intercourse)
  • Nexplanon is immediately effective if inserted between the first and fifth day of your menstrual period
  • Because of its low and steady hormone delivery, Nexplanon may have fewer hormonal ups and downs than daily or weekly birth control methods
  • Fertility quickly returns once you stop using Nexplanon; pregnancies have been reported to occur as early as 7 to 14 days after Nexplanon has been removed

Nexplanon Side Effects:

The most common side effect of Nexplanon is changes in your menstrual bleeding pattern. These could include changes in frequency, intensity, or duration of bleeding. Bleeding irregularities were the most common reason that women stopped using Nexplanon. About 1 in 5 women reported not having a period at all, while another 1 in 5 women reported frequent and/or prolonged bleeding. The bleeding pattern experienced during the first three months is broadly predictive of future bleeding patterns for many women who use Nexplanon.

Other side effects may include:

  • Headache (24.9% reported in clinical trials)
  • Vaginitis (14.5%)
  • Weight increase (13.7%)
  • Acne (13.5%)
  • Breast pain (12.8%)
  • Abdominal pain (10.9%)
  • Pharyngitis [sore throat] (10.5%)

Other side effects that have also been reported include increased appetite, emotion lability (unstable and/or quick emotional changes, which include depressed mood, nervousness, and decreased libido), dizziness, nausea, hot flush, hair loss, fatigue, increased blood pressure and implant site pain or reaction.

Possible Nexplanon Complications:

Serious problems with Nexplanon are rare, but make sure to report any complications to your doctor right away.

  • Insertion Complications: Some women may experience bruising, local irritation, pain, itching, paresthesias (i.e., tingling, burning, pricking or numbness), bleeding, hematoma, scarring, or infection after having Nexplanon inserted. If Nexplanon is inserted too deeply, neural or vascular injury may occur.

  • Removal Complications: Removal of Nexplanon could be difficult if the implant is not where it should be, if it was improperly inserted, inserted too deeply, it has broken or if it has become dislodged. In such cases, you may need to have Nexplanon removed surgically.

  • Ectopic Pregnancy: If you happen to become pregnant while on Nexplanon, there is a slightly higher chance (as compared to women who are not using birth control) that your pregnancy will be ectopic.

  • Medication Interaction: Certain medicines may make Nexplanon less effective (like ones that induce liver enzymes), so you may need to use a back-up contraceptive method. Make sure to tell your doctor about any medicines you are taking or plan to use.

Who Can Use Nexplanon:

This is a safe birth control option for most healthy women. It is important to discuss your full medical history with your doctor before using Nexplanon.

You may still be able to use Nexplanon even if you have certain risk factors as long as you remain under close medical supervision. But Nexplanon may not be the right method for everyone. Nexplanon use is not recommended if you:

  • Are pregnant or think you may be pregnant
  • Have liver disease
  • Have unexplained vaginal bleeding
  • Have or have had breast cancer
  • Have a history of severe depression
  • Have or had serious blood clots in your legs (deep venous thrombosis), lungs (pulmonary embolism), eyes (retinal thrombosis), heart (heart attack), or head (stroke)

Nexplanon may not be your most optimal choice if you have or had diabetes, high cholesterol or triglycerides, headaches, seizures/epilepsy, gallbladder or kidney disease, high blood pressure, or an allergic reaction to anesthetics or antiseptics.

The effectiveness of Nexplanon in women who weighed more than 130% of their ideal body weight is not known. Concentrations of etonogestrel are inversely related to body weight and decrease with time after implant insertion. Because of this, it is thought that Nexplanon may be less effective in overweight women. Heavier women who use Nexplanon should discuss with their doctor the consideration of earlier replacement (since the progestin levels during the third year may not adequately protect against pregnancy).

How to Obtain:

You need a medical prescription to obtain Nexplanon. Plan for two doctor's visits: first, you will most likely need to have a medical evaluation, which includes a blood pressure check and possibly a pelvic exam. At this time, your doctor should discuss with you the pros and cons of Nexplanon and will make an appointment for you to return for the insertion of the implant. Make sure you find a trained healthcare professional to insert (or remove) Nexplanon. Doctors must be trained and qualified through special training programs in order to buy Nexplanon as well as insert and remove it.

Nexplanon Costs:

Given the newness of this method, prices vary from area to area. The cost also depends on insurance, copays, and your doctor/family planning clinic. Though this method may have a higher upfront cost, when compared to other birth control methods, you could save much more money over time.

Effectiveness:

Nexplanon is 99.9% effective when inserted correctly. This means that out of every 100 women who use Nexplanon in one year, less than 1 will become pregnant with typical use as well as with perfect use.

Nexplanon may be less effective in overweight women and for those who are taking medications that induce liver enzymes.

STD Protection:

Nexplanon offers no protection against sexually transmitted infections.

Sources:

Merck. HIGHLIGHTS OF PRESCRIBING INFORMATION: NEXPLANON (etonogestrel implant). http://www.merck.com/product/usa/pi_circulars/n/nexplanon/nexplanon_pi.pdf Accessed November 9, 2011.

Merck. FDA-Approved Patient Labeling: NEXPLANON (etonogestrel implant). http://www.merck.com/product/usa/pi_circulars/n/nexplanon/nexplanon_ppi.pdf Accessed November 9, 2011.

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