Birth Control & Family Planning

Nexplanon Birth Control Implant: How It Works, Side Effects and Removal

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

The birth control implant, sold in the U.S. as Nexplanon, is a thin, flexible rod about the size of a matchstick that sits under the skin of your upper arm. It releases a progestin hormone and prevents more than 99% of pregnancies, which makes it the most effective reversible method there is. In January 2026 the FDA approved it for up to 5 years of use, and you can have it taken out whenever you want.

People who choose it usually say the same thing: they liked the idea of not thinking about birth control at all. The trade-off is that your bleeding pattern becomes a bit of a wildcard. Here's the whole picture.

How it works

The implant releases a steady, low dose of etonogestrel, a type of progestin. It works mainly by:

• Stopping ovulation, so no egg is released
• Thickening cervical mucus, which blocks sperm

It has no estrogen. So many people who can't use estrogen, like those with migraine with aura or a history of blood clots, may still be able to use it. Your clinician will check the CDC's Medical Eligibility Criteria for your situation.

How well it works

Fewer than 1 in 100 implant users get pregnant in a year. Because there's nothing to remember, typical use and perfect use are nearly the same. Compare that with the pill, patch and ring, where typical use leads to about 7 pregnancies per 100 users a year, mostly from missed doses and late refills.

How long it lasts

For years, Nexplanon was approved for 3 years. In January 2026 the FDA extended that to up to 5 years, based on a study of users in years 4 and 5. If you already have one, ask your clinician whether yours can stay in for the full 5 years. Put the removal date in your phone calendar the day you get it.

Insertion: what the appointment is like

It's a quick office visit:

1. Your clinician confirms you're not pregnant and goes over your health history.
2. The inside of your non-dominant upper arm is cleaned and numbed. The numbing shot stings for a few seconds; that's usually the worst part.
3. A preloaded applicator slides the rod just under the skin. You'll feel pressure, maybe a push, but not sharp pain.
4. You and the clinician both feel the rod to make sure it's there.
5. A small bandage and a pressure wrap go on for about a day.

The insertion itself takes about a minute. The FDA now requires clinicians who insert and remove Nexplanon to complete certified training, so it's fine to ask, "Are you trained to place the implant?"

Afterward: expect a bruise, sometimes a surprisingly big and colorful one, and some soreness for a few days. Many people schedule it so they don't have a heavy gym day or a long commute with a backpack strap on that arm right after.

When it starts working

If it's placed within the first 5 days after your period starts, it works right away. Any other time, use condoms or skip sex for 7 days.

Side effects, honestly

Bleeding: the big one

The most common side effect is a change in bleeding, and it's hard to predict:

• Some people get infrequent periods or none at all
• Some get frequent or long-lasting spotting
• The first 3 months often hint at what's coming, but the pattern can change

Bleeding changes aren't harmful, but they're the top reason people have the implant removed early. If spotting is driving you crazy, don't just put up with it. Ask your clinician about short-term treatments; CDC guidance lists options that help some people.

Other possible side effects

• Headaches
• Acne
• Breast tenderness
• Mood changes
• Weight changes (studies haven't shown a clear link for most users)
• Bruising, soreness or irritation where it was placed

Rare risks

• Infection at the insertion site
• Being placed too deep, which can make removal harder
• Very rarely, the implant moving from where it was placed

Implant vs. IUD

If you'd rather skip a pelvic exam or you're nervous about IUD insertion pain, the implant is a strong choice. If you want predictably lighter periods, a hormonal IUD may suit you better. More comparisons in our birth control options guide.

After having a baby

According to CDC guidance, the implant can go in any time after childbirth, including before you leave the hospital, and it's safe while breastfeeding. Ask your prenatal provider whether your birth hospital offers placement before discharge; it saves an extra appointment in those blurry newborn weeks. See birth control after giving birth.

Removal

Also an office procedure. The area is numbed, a tiny cut is made, and the rod is gently pushed out. If you want to keep going, a new implant can often go in through the same spot at the same visit. Fertility returns quickly after removal.

Medicines that can interfere

Some medicines lower hormone levels from the implant and make it less effective, including certain seizure medicines, rifampin for tuberculosis, some HIV medicines, and the supplement St. John's wort. Tell your clinician and pharmacist about everything you take. If you need one of these long-term, an IUD may be a better fit.

Can teens get it?

Yes. ACOG and the American Academy of Pediatrics consider the implant and IUDs first-line options for adolescents because they're safe and highly effective. In New York, minors can consent to their own birth control, according to the state Attorney General's office.

Cost in New York

The implant is covered by New York Medicaid, and New York law requires state-regulated insurance plans to cover FDA-approved contraception without cost sharing. If you have a self-funded employer plan regulated under federal law, check your plan documents or ask HR.

When to call your provider

Call if you:

• Can't feel the implant in your arm anymore
• Notice the rod looks bent or broken
• Have redness, warmth, pus or worsening pain where it was placed
• Have very heavy or long bleeding
• Have pregnancy symptoms or a positive test
• Notice signs of a blood clot, a severe headache, yellowing skin or eyes, or a new breast lump

Find an implant provider near you

Insertion and removal must be done by a trained clinician. Many OB/GYNs, nurse practitioners and family planning clinics offer it. When you call, ask whether they keep implants in stock, so you can get it placed the same day. Search the directory to find someone near you.

Frequently asked questions

Sources

• FDA — Nexplanon (etonogestrel implant) prescribing information
• CDC — U.S. Medical Eligibility Criteria for Contraceptive Use, 2024
• CDC — U.S. Selected Practice Recommendations for Contraceptive Use, 2024
• ACOG — Long-Acting Reversible Contraception: Implants and Intrauterine Devices (Practice Bulletin 186)

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.