Definition & Overview

Nexplanon, manufactured by Merck, a leading American pharmaceutical company, is a subdermal female contraceptive that is 99% effective for up to 3 years. Once implanted underneath the skin, the contraceptive prevents pregnancy by releasing low doses of progestin hormone called etonogestrel into the bloodstream. The hormone stops the ovaries from releasing an egg and effectively blocks sperm from reaching the egg at the same time.

Nexplanon is a thin tube about 1.6 inches (4 cm) in length. It is packaged with an applicator, comprising of a needle and a protection cap. Only clinicians trained in its application should insert the device as there is a special technique that should be followed to reduce possible risks and complications.

The contraceptive does not require any type of maintenance, but will need to be removed before the end of a 3-year period. Should birth control still be required after removal, a new contraceptive can be implanted. If a new contraceptive is not implanted after removing the old device, it is possible for the woman to become pregnant within a week.

Using Nexplanon comes with a variety of risks and complications. It should not be used by people with certain medical conditions, which will be discussed in detail later on in this article.

Who should undergo and expected results

Women who do not wish to become pregnant but engage in unprotected sex should consider getting Nexplanon. However, it's important to remember that the device only provides protection against pregnancy. It does not provide any protection against sexually transmitted diseases.

As mentioned earlier, Nexplanon is highly effective and lasts for up to 3 years. Women who wish to conceive before the end of the 3-year period should have the device removed. Once removed, the effects of the contraceptive are significantly reduced and the woman can become pregnant within a week.

How the procedure works

Only professionals trained in the special Nexplanon insertion technique should perform the procedure. If the procedure is performed incorrectly, it can lead to a variety of complications, such as the device not being effective or the device itself flows into the bloodstream and ends up in the chest.

Prior to the procedure, the doctor will perform an interview and physical assessment to ensure that the patient is qualified to receive the implant. The doctor will also explain the risks and complications.

If the patient is qualified and fully aware of the risks, the procedure will commence with the doctor applying a numbing agent on the inner part of the non-dominant arm.

After removing the protective cap, the doctor will gently push the needle towards the skin at a 30-degree angle. Once the needle punctures the skin, the applicator is moved so that it is horizontal to the skin and the rest of the needle is gently inserted in its entirety.

After the needle is fully inserted, the applicator is placed in the locked position and removed together with the needle, leaving the contraceptive underneath the skin. The area is gently palpated to ensure that it can be felt before applying a dressing. Both the doctor and the patient should be able to feel the contraceptive under the skin. If not, then there is a possibility that the contraceptive was placed too deep or may not have been inserted at all. Either condition will lead to complications.

Possible risks and complications

Nexplanon is a hormonal contraceptive and should not be used by women with certain physical or medical conditions. Women who are pregnant or who have not yet completed a full month of breastfeeding should avoid using the contraceptive as a small amount of the hormone can be passed into the breast milk.

Additionally, women who have blood clotting problems, liver disease, unexplained vaginal bleeding, or are sensitive to progestin should avoid using the contraceptive. Those who have diabetes, high cholesterol, kidney problems, hypertension, or any other type of medical condition should inform their doctor prior to receiving the implant.

Most complications with Nexplanon are experienced during insertion. If the implant cannot be felt after the procedure, it should be considered as a failed insertion.

Although it rarely happens, there have been cases where the implant was discovered in the pulmonary artery. If the implant cannot be felt, the doctor will need to find the implant by performing an x-ray or other imaging tests. If the implant is found in the chest, surgery will be required to remove it.

Other conditions that are usually related to the insertion or removal of the implant are pain or swelling at the site, scarring or keloid formation, infections, the implant is removed without assistance and injury to the nerves or blood vessels during insertion.

You should seek immediate medical attention if you experience any of the following after a Nexplanon implant procedure:

  • Pain or swelling in the legs
  • Severe chest pains
  • Shortness of breath
  • Severe headaches
  • Speaking difficulties
  • Weakness in the upper or lower extremities
  • Partial or complete blindness
  • Abdominal pains
  • Loss of appetite
  • A general feeling of weakness
  • Sleeping problems
  • Heavy menstrual bleeding
  • Feeling that the implant is bent or broken inside the arm


If, at any time, you discover that you can no longer feel the device, you should consult your doctor. In the meantime, it is best to use an alternate contraceptive until the device has been located and the problem solved.

References:

  • Isley, M. Journal of Pediatric and Adolescent Gynecology, December 2010.
  • Mommers, E. American Journal of Obstetrics & Gynecology, November 2012.
  • Planned Parenthood: "Birth Control Implant (Implanon and Nexplanon)."
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