If you have a Nexplanon implant or are considering one, there is news worth knowing: as of January 2026, the FDA extended how long a single Nexplanon can stay in place from three years to five. That is two extra years of protection from the same small device in your arm, with no change in how it works. For a lot of my patients, this makes an already convenient method even more so.
Let me walk through what Nexplanon is, how it works, the new five-year approval, the side effects that come up most in my office, and what insertion and removal actually involve. My goal is to give you the straight version, without the anxiety that so often surrounds birth control decisions.
What is Nexplanon?
Nexplanon is a birth control implant: a thin, flexible rod about the size of a matchstick that a clinician places just under the skin of your upper arm. Once it is in, it releases a steady low dose of a hormone that prevents pregnancy, and you do not have to think about it day to day. It is what we call a long-acting reversible contraceptive, or LARC, meaning it works for years but can be removed at any time if you want to stop or become pregnant.
The implant contains a progestin called etonogestrel. It contains no estrogen, which matters because it makes the implant an option for many women who cannot take estrogen-containing birth control, such as those with certain migraines, clotting risks, or who are breastfeeding.5
How does Nexplanon work?
Nexplanon prevents pregnancy in three ways. Its main action is to stop ovulation, so no egg is released to be fertilized. It also thickens cervical mucus, which makes it harder for sperm to reach an egg, and it thins the lining of the uterus. Together these make it more than 99 percent effective at preventing pregnancy, which puts it in the same tier as an IUD and ahead of the pill in real-world use, largely because there is nothing to remember to take.
It is fully hormonal but estrogen-free, a progestin-only method, and it starts working quickly.7 If it is placed during the first five days of your period, it protects you right away; placed at another time, you use backup contraception for the first week.
The 2026 change: now approved for five years
Here is the update that prompted this article. On January 16, 2026, the FDA approved extending the labeled duration of Nexplanon from three years to up to five years.1,2 The decision was based on a clinical study of women who continued their implant into years four and five: no pregnancies occurred during that extended period, and no new safety concerns emerged.2,3,6
What this means in practice is straightforward. If you are getting a Nexplanon now, one device can protect you for up to five years before it needs replacing. If you already have one placed under the old three-year guidance, this is worth a conversation with your clinician about whether the extension applies to your situation. The device itself has not changed; the evidence for how long it keeps working has, with a Pearl Index of 0.0 reported across years four and five.10
How effective is it, and how long until it works?
At more than 99 percent effective at preventing pregnancy, the implant sits among the most reliable methods there is.4 In the five-year extension study of 399 women, there were no pregnancies during years four and five.2,9 Because it removes the daily-adherence problem that lowers the real-world effectiveness of pills, its typical-use effectiveness stays very close to its perfect-use effectiveness, which is not true of many other methods.
It works fast. Placed in the first five days of your cycle, it is effective immediately; placed later, give it seven days with a backup method.
Side effects: what actually happens
Every effective birth control method has trade-offs, and the honest picture of Nexplanon is that most side effects are manageable and many women have none that bother them. The ones patients ask about most:
| Concern | What the evidence and experience show |
|---|---|
| Irregular bleeding | The most common side effect. Bleeding patterns change, often becoming irregular, lighter, or absent. This is the top reason some women choose to remove it, though it is not harmful |
| Weight gain | Frequently asked about. Studies have not shown a consistent, clearly causal link; some women report weight change, but the evidence for the implant causing meaningful weight gain is weak |
| Mood changes | Some women report mood changes or low mood; if this happens and is significant, it is worth discussing removal or an alternative |
| Acne | Can occur or improve; individual response varies |
| Headaches | Reported by some users, usually mild |
| Insertion-site effects | Temporary bruising, tenderness, or mild pain at the site after placement |
On weight in particular, because it is the question I hear most: the data do not support the idea that Nexplanon reliably causes weight gain. Some women do notice a change and others do not, and it is hard to separate the implant from the ordinary weight changes of life. I never dismiss a patient's experience, but I also do not want fear of weight gain to steer someone away from an otherwise excellent method based on evidence that is not there.
How your periods may change
This is the change to expect and plan for. Nexplanon commonly alters bleeding patterns, and there is no single way it goes. Some women stop having periods entirely, which is safe and for many a welcome effect. Others have lighter or less frequent bleeding, and some have irregular spotting or unpredictable bleeding, especially in the first six to twelve months. The bleeding changes are the most common reason women give for removing the implant. When women know to expect some unpredictability early on, many find it easier to stay with the method long enough for things to settle.
Insertion and removal
Insertion is a quick office procedure. The clinician numbs a small area of your upper arm with local anesthetic and uses a special applicator to place the rod just under the skin. It takes a few minutes, and most women feel pressure rather than pain. Afterward you may have some bruising or tenderness for a few days.
Removal is also done in the office. The clinician numbs the area, makes a tiny incision, and removes the rod, usually in a few minutes. You can have it removed at any time, and your fertility returns quickly afterward, typically within weeks, which is one of the advantages of the implant over some other long-acting methods. Under the 2026 safety program, both insertion and removal are done by clinicians trained in the technique, which reduces the small risk of a difficult removal.
How it compares to other methods
| Method | How long | Hormone | Notes |
|---|---|---|---|
| Nexplanon (implant) | Up to 5 years | Progestin only (no estrogen) | Arm implant; fast return to fertility; can stop periods |
| Hormonal IUD (e.g., Mirena) | Up to 8 years | Progestin only | In the uterus; often lightens periods |
| Copper IUD | Up to 10 years | None (hormone-free) | In the uterus; can make periods heavier |
| Depo-Provera shot | Every 3 months | Progestin only | Injection; slower return to fertility |
| The pill | Daily | Varies | Requires daily adherence; typical-use effectiveness lower |
When patients weigh Nexplanon against an IUD, the choice often comes down to where they want the device (arm versus uterus), how they feel about the insertion, and their bleeding preferences. Both are excellent, highly effective options, and the best choice is simply the one that fits your body, your history, and your life.
Cost
Under the Affordable Care Act, most insurance plans in the United States cover FDA-approved contraceptives, including the implant, at no out-of-pocket cost.8 Without insurance, the device and insertion can run into the hundreds of dollars, but family planning clinics and programs often provide it at reduced or no cost. If cost is a barrier, that is worth raising with your clinician or a local clinic, because there are usually options.
What I tell patients
Five years now, not three. A single implant is approved to protect you for up to five years, so if you have one or are getting one, factor the new timeline into your planning.
Expect your bleeding to change. Irregular or absent periods are the norm, not a problem. Knowing this in advance is what helps many women stay with a good method instead of giving up too early.
The weight-gain fear is largely unsupported. The evidence does not show Nexplanon reliably causes weight gain. Do not let that worry alone rule it out.
It is estrogen-free. That makes it a good option if you cannot take estrogen, including many who are breastfeeding or have clot or migraine concerns.
It is reversible and fast to reverse. It can come out anytime, and fertility returns quickly, so it is not a permanent commitment.
Choose trained hands. Insertion and removal are simple, but they should be done by someone trained in the technique, which the 2026 program now formalizes.
Frequently asked questions
How long does Nexplanon last now?
As of January 2026, the FDA approved Nexplanon for up to five years of use, extended from the previous three years. The decision was based on a study showing no pregnancies and no new safety concerns during years four and five. A single implant can now stay in place for up to five years before it needs to be replaced.
Does Nexplanon cause weight gain?
The evidence does not show that Nexplanon reliably causes weight gain. Some women report weight changes and others do not, and studies have not established a consistent causal link. Weight can change for many reasons unrelated to the implant, so fear of weight gain alone is not a strong reason to avoid an otherwise effective method.
Is Nexplanon hormonal? Does it have estrogen?
Nexplanon is hormonal but contains no estrogen. It releases a progestin called etonogestrel. Because it is estrogen-free, it is often an option for women who cannot use estrogen-containing birth control, including many who are breastfeeding or who have certain migraines or clotting risks.
How effective is Nexplanon?
Nexplanon is more than 99 percent effective at preventing pregnancy, among the most reliable methods there is. Because there is nothing to remember daily, its real-world effectiveness stays very close to its ideal effectiveness. In the five-year extension study, no pregnancies occurred during years four and five.
Does Nexplanon stop your period?
It can. Nexplanon commonly changes bleeding patterns: some women stop having periods entirely, which is safe, while others have lighter, irregular, or unpredictable bleeding, especially in the first six to twelve months. Changes in bleeding are the most common side effect and the top reason some women choose removal, though they are not harmful.
How is Nexplanon inserted and removed?
Both are quick in-office procedures done with local anesthetic. For insertion, a clinician places the small rod just under the skin of the upper arm with a special applicator, taking a few minutes. For removal, the clinician numbs the area, makes a tiny incision, and removes the rod. Fertility returns quickly after removal, usually within weeks.
How much does Nexplanon cost?
Under the Affordable Care Act, most US insurance plans cover the implant at no out-of-pocket cost. Without insurance, the device and insertion can cost several hundred dollars, but family planning clinics and programs often offer it at reduced or no cost. If cost is a concern, ask your clinician or a local clinic about options.
References
- Organon. Organon Announces US Food and Drug Administration Approval of Supplemental New Drug Application Extending Duration of Use of NEXPLANON (etonogestrel implant) 68 mg Radiopaque. News release, January 16, 2026. organon.com
- US Food and Drug Administration. Nexplanon (etonogestrel implant) prescribing information: extended duration of use up to 5 years; efficacy during years 4-5 (NCT04626596). Revised January 2026. accessdata.fda.gov
- ClinicalTrials.gov. A Study to Evaluate the Contraceptive Efficacy and Safety of Extended Use of the Etonogestrel Implant (NCT04626596). 2020-2025. clinicaltrials.gov
- American College of Obstetricians and Gynecologists. Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Practice guidance on implant effectiveness exceeding 99%. acog.org
- Centers for Disease Control and Prevention. US Medical Eligibility Criteria for Contraceptive Use (US MEC): etonogestrel implant. 2024. cdc.gov
- Contemporary OB/GYN. FDA approves 5-year use for etonogestrel implant 68 mg contraceptive. January 2026. contemporaryobgyn.net
- American College of Obstetricians and Gynecologists. Progestin-Only Hormonal Birth Control: Pill and Injection, and progestin-only method considerations. acog.org
- Office of Population Affairs, US Department of Health and Human Services. Contraceptive coverage under the Affordable Care Act. opa.hhs.gov
- Neurology Advisor (reporting on FDA/Organon). Nexplanon Approved for Pregnancy Prevention for Up to 5 Years: study of 399 women, no pregnancies in years 4-5, intermenstrual bleeding most common adverse reaction. February 2026. neurologyadvisor.com
- Epocrates. FDA OKs Nexplanon for pregnancy prevention for up to 5 years: Pearl Index 0.0 (95% CI, 0.00-0.69) in years 4-5. January 2026. epocrates.com
This article is educational and does not constitute medical advice or establish a physician-patient relationship. Contraceptive decisions should be individualized with a qualified clinician who knows your history. Consult your own provider about whether Nexplanon is right for you and about the timing of insertion or removal.