The birth control implant, brand name Nexplanon, is considered one of the most effective reversible contraceptive methods available. It provides protection from pregnancy for up to three years with a 0.01% chance of pregnancy.

Nexplanon is a type of birth control known as a long-acting reversible contraceptive (LARCs). LARCs don’t require routine maintenance, like remembering to take the pill every day, and they are, therefore, typically more effective at pregnancy prevention because there is less opportunity for human error.

For comparison, the pill is 99% effective when taken correctly but with typical use it’s only 91% effective. Long-acting methods are much more reliable. Here’s what you should know about the birth control implant.

Nexplanon costs around $900 without insurance

Without insurance, the cost of one Nexplanon implant is around $900. But most health insurance plans will cover it. You may, however, be responsible for costs associated with the insertion and removal procedures.

By comparison, an IUD may cost up to $1,300 and the pill can cost $20-50 per pack. But because of the Affordable Care Act, most birth control methods are fully covered and cost $0 out of pocket.

To see if you're covered for Nexplanon, or any other form of birth control, contact your health insurance provider.

Nexplanon is an implant that goes in your arm

Nexplanon is a flexible plastic rod that is about the size of a matchstick. A healthcare provider will use a device called an applicator to insert the rod in the upper, inner side of your non-dominant arm.

Nexplanon can be inserted at any time, but it is immediately effective if it is inserted during the first five days of your menstrual cycle. If insertion is timed correctly, the implant will provide protection against pregnancy right away. To determine if Nexplanon is right for you, your healthcare provider will ask about your medical history - including birth control use, pregnancy history, and other medications.

Nexplanon insertion is a quick and painless procedure

Getting a Nexplanon inserted is a relatively quick process. Here's what to expect during a typical insertion procedure:

  • You will lie flat and rest your non-dominant arm facing upward.
  • Your health care provider will locate a space on your arm between the muscles to insert the device.
  • They will then clean the area and apply a local anesthetic, usually lidocaine.
  • The device will be inserted directly beneath your skin, which should take less than 20 seconds.
  • The skin where the implant is located may be slightly raised, but is not usually visible. You should be able to feel the rod just beneath the skin if you palpate the area, but it should not disturb your regular movement or range of motion of your arm.
  • Your provider will apply a small bandaid over the site of the implant that you should wear for 3-5 days and a pressure bandage around the arm that you should wear for 24 hours after the procedure.

The procedures should not be painful, but you may experience soreness or bruising a day or two after the device is inserted or removed.

If you are experiencing consistent pain or have a fever following your insertion or removal of Nexplanon you should contact your health care provider right away as it may be a sign of allergic reaction or improper placement.

See a doctor if you can't find your implant

To avoid damage to any nerves or blood vessels, the implant should only go about 2 millimeters beneath the surface. The skin should feel slightly raised where the device was located.

If this area becomes irritated you should contact your doctor immediately as you may be allergic to something in the rod.

"If the device becomes inserted too far into the skin it can become difficult to remove and may even require surgery," says Parin Patel, MD and assistant professor in the Department of Obstetrics and Gynecology at the University of Texas Medical Branch in Galveston, Texas.

One way the device can become too deep is if you gain weight over the course of the time the device is in your arm. You should contact your healthcare provider if at any point while using the Nexplanon in your arm you can no longer locate it.

How Nexplanon prevents pregnancy

Nexplanon is a progestin-only, hormonal birth control option. It uses a synthetic form of progestin, called etonogestrel.

Etonogestrel works to prevent pregnancy in three ways:

  1. It inhibits the release of luteinizing hormones which kick-start ovulation.
  2. It thickens the lining of the cervix, making it harder for sperm to reach the uterus.
  3. It disrupts the lining of the uterus, making it more difficult for an egg to attach.

The hormones stored in the device are slowly and continuously released into the bloodstream over the course of the three years that the device is inserted.

After the first six weeks the daily dose of hormones you receive slightly decreases, but it is still enough to prevent pregnancy. Most side effects will be most severe the first few months.

Irregular bleeding is the most common side effect

Unscheduled sporadic bleeding is a common issue for women that use the birth control implant. "In my experience, irregular bleeding is the most common reason that women have it removed," Patel says. With Nexplanon, you often will stop having regular periods and instead may have intermittent spotting.

Unlike some forms of hormonal birth control, where irregular bleeding may decrease overtime, irregular bleeding will most likely continue over the course of the three years it is effective.

Other common side effects of the implant include

  • Headaches
  • Acne
  • Hair loss
  • Nausea
  • Weight changes
  • Loss of libido

These are all side effects associated with the hormone progestin."Some people get all the side effects, some people experience none at all, everyone responds differently to hormones," says Patel.

Although it is extremely unlikely that you will become pregnant while using Nexplanon, if you do, there is a slightly higher risk of having an ectopic pregnancy, which is when an egg develops outside of the uterus and cannot develop normally, ending in a miscarriage.

According to the manufacturers of Nexplanon, you should not get the implant if you have any of the following:

  • History of blood clots
  • Liver disease or tumor
  • Undiagnosed irregular bleeding
  • Think you may be pregnant

When it's time to remove your birth control implant

The birth control implant typically lasts three years. It's important that you replace it after that period of time, or switch to another form of birth control if you're sexually active and do not wish to become pregnant.

It's usually your responsibility to set up an appointment to replace your Nexplanon. You may receive a card from your healthcare provider to remind you when to replace your Nexplanon. Store this card in a safe place and take it with you to your health care appointments. Additionally, you can make note of the card's due date and schedule it on your digital calendar where you can set yourself reminders.

You can also have the device removed at any time over the three years. There is a quick return to fertility once the device is removed, so use a backup birth control method if you do not replace it and do not want to become pregnant. The implant does not provide protection against sexually transmitted infections. The best way to prevent STIs with the implant is to also use condoms.

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