Nexplanon, also known as the birth control implant or subdermal implant, is a thin rod inserted under the skin of the upper arm that releases hormones to prevent pregnancy. It’s a convenient, low-maintenance contraception option. But you may be wondering: what’s it like to get Nexplanon inserted?

Here, we’ll go over the process of insertion and removal, and then discuss the most common side-effects and questions people tend to have when considering Nexplanon birth control.

What is Nexplanon?

Nexplanon is a subdermal implant placed under the skin of the upper arm that releases a hormone called progestin. Progestins are used in many forms of hormonal birth control, including the pill, patch, ring, injection, hormonal IUDs, and Nexplanon . Whereas the pill, patch and ring are composed of both estrogen and progestin, Nexplanon is estrogen free making it safe for women who can't take or wish to avoid estrogen eg. smokers, patients with migraines with aura, certain types of estrogen receptor positive breast cancers and women with high blood pressure.

Nexplanon works by preventing ovulation. It thickens the cervical mucus, which makes it harder for sperm to enter the uterus. It also thins the lining of the uterus. All of this makes pregnancy unlikely.

Once inserted, the implant stays in place until it is removed or replaced. In Canada, Nexplanon is authorized for use for the prevention of pregnancy for up to 3 years.

Nexplanon is more than 99.9% effective. This means that if 1000 women had the implant in place for one year, less than one of them would get pregnant.

How does Nexplanon insertion work?

The Nexplanon insertion process is quick and easy.

 Nexplanon is effective immediately  when implanted within the first 5 days after starting your menstrual cycle .  If insertion takes place anytime  after this time, ( when you are not on the first 5 days of your period ) you will be advised to use a backup method of birth control like condoms  or  or to avoid sex for 7 days following insertion

 The Nexplanon implant itself is a thin, flexible rod. It is 4 cm long and 2 mm in diameter. It is inserted into the inside of your upper arm on the non-dominant side. While you likely cannot see Nexplanon after it is inserted, you should be able to feel it beneath the skin.

The first step is a small injection to numb/ freeze the area of the arm where the implant will be inserted. You will feel a pinch or sting when the numbing shot is given, but afterward you will only feel dull pressure when the implant is placed . The doctor will then slide the device under the skin using a special needle called a cannula. You should not feel the implant being inserted. This process takes a few minutes.

You will need to protect the wound with an adhesive waterproof bandage for 5 days and wear  a pressure bandage for 24 hours to stop any bleeding and to prevent infection . You can go about  your normal activities afterwards but should avoid strenuous upper body activities as long as the wound is bruised and tender.

How does Nexplanon removal work?

Nexplanon should be removed no later than 3 years after the insertion date.

The Nexplanon removal process is similar to insertion. Before the implant is removed, your doctor will numb the area with freezing using a small needle.  Then they will make a small cut near one end of the implant and pull it out through the opening .

If you would like to insert a new implant, your doctor can usually insert it at the same time as removing the old one.

After removal, you’ll have the same two bandages on your arm – a pressure bandage for the first 24 hours, and an adhesive bandage for 5 days.

This video provides an overview of the Nexplanon insertion and removal process.

How does Nexplanon affect periods?

Nexplanon can cause changes in your menstrual cycle. It takes 3 to 6 months to adjust to progestin. For most users, Nexplanon makes their periods lighter. About 1 in 3 women will stop getting periods altogether while the implant is in place. 

Favourable changes on the period may include:

●      30 % of women  stop getting their period - this is called amenorrhea

●      30 % of women get infrequent periods ( less than 5 periods in a year)

Less favourable but not dangerous outcomes include :

●       Spotting or bleeding in between periods, longer or shorter duration of bleeding, unpredictable bleeding

●       Time between periods may vary

What are the side effects of Nexplanon?

Like other forms of hormonal birth control, Nexplanon may cause side effects in some users.

Nexplanon implant side effects include:

●       Headaches

●       Breast pain

●       Weight gain

●       Nausea

●       Ovarian cysts

●       Acne

●       Mood changes

●       Pain, bruising  or infection where the implant was inserted

Is Nexplanon right for me?

Nexplanon may be right for you if you are looking for a highly effective low-maintenance, estrogen free, hormonal birth control option. It is an excellent option for women who can not tolerate an IUD, had repeat IUD expulsions or simply prefer a non pelvic option for long acting reversible birth control.

Other long-acting reversible contraception options include non-hormonal copper IUD , and estrogen free , hormonal IUDs (Mirena or Kyleena) which are T shaped devices  placed inside the uterus,  Shorter acting contraception options include the birth control pill , patch and the contraceptive ring.  Each of these has different pros and cons. You can discuss these different options with your doctor and determine if you’d like to try Nexplanon.

It’s important to remember, though, that Nexplanon does not protect against STIs.

Summary

The process of Nexplanon insertion and removal is quick and easy. It is the only long acting reversible birth control that is placed in the arm. Once inserted, the implant is 99.9% effective at preventing pregnancy for up to 3 years. Side effects tend to be similar to other hormonal birth control options. 60% of women may find it has a positive effect on their menstrual cycle, or even stops it altogether. For all of these reasons, many women find Nexplanon to be a convenient long-acting birth control option.