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What OB-GYNs want you to know about the birth control that lives in your arm

Nexplanon is more than 99% effective and lasts for up to three years.

Two hands holding the birth control product. Credit: Reviewed / Getty Images / flocu / celsopupo

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From birth control pills to IUDs to condoms, you have many choices of safe and highly effective forms of pregnancy prevention available. One you may be less familiar with: the birth control implant, Nexplanon. When inserted beneath the skin of the upper arm, this match-sized device is more than 99% effective at preventing pregnancy for up to three years. But how does it work and what are its side effects? We dug into the details of arm-based pregnancy protection, and why you might prefer it.

What is a birth control implant?

A graphic design showing where the birth control product goes.
Credit: Reviewed / Getty Images / bortonia / Inna Miller

The implant goes on the bicep.

Nexplanon is a thin plastic rod, about the size of a match, that contains a synthetic version of the pregnancy hormone progesterone. When inserted under the skin of your upper arm, it slowly releases the hormone, effectively protecting you from pregnancy for years without any maintenance.

Older brands include Implanon, Norplant, and Jadelle, but they all work in similar ways. Nexplanon replaced Implanon, which is no longer being manufactured because of its tendency to move after insertion, and the risk of being planted too deeply (ouch!). Nexplanon comes in a preloaded applicator to minimize insertion errors.

How does Nexplanon work?

Like other forms of birth control that use hormones, such as a hormonal intrauterine device (IUD) or the pill, Nexplanon releases progestin into the body to prevent pregnancy. Progestin works by thickening cervical mucus, making it more difficult for sperm to reach and fertilize an egg. Progestin can also prevent ovulation, or the release of an egg from the ovaries. Without an egg to fertilize, you can’t get pregnant.

How effective is Nexplanon?

The implant is more than 99% effective at preventing pregnancy. After the implant is placed in your arm, you can leave it there until it expires, which means it can’t be forgotten or used incorrectly, making it highly effective. But don’t forget about it too long: After three years, Nexplanon starts losing its efficacy, so you’ll want to follow up with your doctor a few months before its expiration date to make sure it gets removed or replaced on time.

If you get the implant inserted during the first five days of your period, you’re protected immediately. But if you get it placed after that timeframe, it takes a week to start working. You’ll want to use a backup method of birth control during those seven days, such as condoms or spermicide.

How long does Nexplanon last?

Nexplanon is currently approved to be effective for three years, but research is underway to determine its efficacy up to five years after insertion. If you’re unsure about when you should have yours replaced, consult your doctor.

What are the implant’s potential side effects?

Apart from soreness and possibly swelling for a few days after insertion, Nexplanon can cause spotting and irregular periods, especially during the first six months. Some people experience heavier periods after getting the implant, but most report lighter periods, including less cramping and PMS. And one in three people with the implant stop getting their period entirely, according to Planned Parenthood.

“As long as you can tolerate this potential side effect [of irregular periods], the implant is a great option for most women,”” says Dr. Carolyn Ross, MD, OB-GYN, and medical advisor for Stix, a vaginal health company.

Like other forms of birth control, additional potential side effects may include headaches, breast tenderness, or weight gain. Other more serious risks include ovarian cysts or an injection site infection. It’s also possible that the implant could move or migrate after insertion, which is why Nexplanon contains a small amount of barium sulfate, which makes it radiopaque, or visible via MRI, so your healthcare provider will be able to check if it has accidentally moved. Scar tissue around the implant could also make removal more difficult.

How much does Nexplanon cost?

Getting the birth control implant inserted costs between $0 and $1,300, and removal can be an additional $300 if you don’t have insurance. However, most insurance plans cover all forms of birth control, so you might be able to get Nexplanon for free. If you don’t have insurance, you can still get the implant at low- or no-cost through clinics like Planned Parenthood.

What do the insertion and removal procedures feel like?

A hand holding the implant.
Credit: Reviewed / Getty Images / celsopupo

It may sting a little.

Before getting the implant inserted, your doctor or nurse will give you a shot to numb the tricep of your non-dominant arm. They will then use a special tool to inject the implant under the skin. Most people feel a pinch with the numbing shot but don’t feel the actual insertion. After the implant is placed and the numbing shot wears off, your arm will likely feel sore for a day or two. You’ll wear a pressure bandage for 24 hours and switch to a small bandage for three to five days following the procedure. Your arm may feel tender, swollen, or bruised for the next few days.

To remove the implant, your doctor or nurse will start by numbing your arm. They will then make a small incision, 3 to 4 inches long, to access and remove the implant. It’s unlikely the removal will leave a scar, but possible. Similar to insertion, you may experience tenderness, swelling, or bruising at the removal site. Your doctor will also provide aftercare instructions to keep the site clean while it heals.

As with most other forms of birth control, your ability to become pregnant returns almost immediately after removal; Nexplanon says it takes about a week for this to happen. Be sure to use other contraception if you don’t want to become pregnant.

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