Nexplanon is now FDA-approved for up to five years, which means if your implant was placed under the old three-year label, you likely have more time than you thought. Even beyond the five-year mark, research suggests the implant continues releasing enough hormone to prevent pregnancy for some additional time, though it is no longer officially approved for use past that point.
The Approved Duration Changed in 2024
For years, Nexplanon carried a three-year label. In 2024, the FDA approved a supplemental application from Organon extending the approved duration to five years. This wasn’t a new implant or a reformulation. It was the same device, with new clinical data showing it works effectively for the longer period. If you had your implant placed before this label change, the implant itself hasn’t changed. You may be able to keep it for the full five years, though it’s worth confirming with your provider since your original insertion timing and records matter.
What the Research Shows Beyond Five Years
Clinical studies tracking people who kept the implant in past the original three-year label found zero pregnancies among implant users through five full years. In one key study, 223 participants continued using the implant for a fourth year and 102 continued into a fifth year, with no pregnancies in either group. The cumulative pregnancy rate at five years was 0.6 per 100 users, which is extremely low and comparable to other long-acting contraceptives.
The hormone the implant releases, etonogestrel, works primarily by suppressing ovulation. For ovulation to resume, blood levels of the hormone need to drop below a specific threshold (roughly 90 picograms per milliliter). Researchers measuring hormone levels in implant users found that median levels stayed well above that threshold at every yearly check through year five. This is why the implant continues working: there’s still enough hormone being released to block ovulation, even as the total amount in the rod slowly decreases over time.
No large studies have tracked users significantly beyond five years, so the exact point at which protection drops off isn’t well defined. The hormone doesn’t shut off like a switch. It tapers gradually, which means the transition from “protected” to “not protected” is a slow fade rather than a hard cutoff.
Does Body Weight Affect How Long It Lasts?
This has been a lingering question. The original three-year approval trial excluded people over 130% of their ideal body weight, which led to a label warning about potentially decreased effectiveness in people with higher BMI. The newer study that supported the five-year approval enrolled about 38% overweight or obese participants, and efficacy results were consistent across BMI categories, age groups, races, and ethnicities during that study period.
That said, the FDA noted the two-year extension study may not be long enough on its own to fully resolve the question for the later years of use. If you have a higher BMI and are approaching year four or five, the data is reassuring but not as robust as it is for people at lower weights. Some providers may recommend replacement a bit earlier in that situation.
What Happens If You Leave It In Too Long
Leaving the implant in past its approved duration doesn’t pose a safety risk. It won’t break down, migrate, or release harmful amounts of anything. The concern is purely about effectiveness: at some point, hormone levels will drop low enough that ovulation resumes and pregnancy becomes possible. Once that happens, fertility can return quickly. After removal, pregnancy is possible as early as the first week.
There are no well-documented “warning signs” that the implant is losing effectiveness. Some people report changes in bleeding patterns in later years, such as the return of more regular periods after a long stretch of light or absent bleeding. This could signal declining hormone levels, but it’s not a reliable indicator. You can’t feel when the implant stops working.
If you’re keeping the implant past five years and want to avoid pregnancy, using a backup method like condoms is a practical safeguard. If you’re past five years and not using backup, you’re in uncharted territory where pregnancy risk is low but no longer quantified by clinical data.
Scheduling Replacement or Removal
The simplest approach is to schedule removal or replacement before the five-year mark. If you’re approaching that date and can’t get an appointment right away, the gradual hormone taper means a few extra weeks or even a couple of months is unlikely to result in sudden loss of protection. But this isn’t something to stretch indefinitely.
Replacement can happen in a single visit: the old implant is removed and a new one inserted through a small incision in the same arm or the other. Most people return to normal activities the same day. If you decide not to replace it and want to avoid pregnancy, you’ll need another contraceptive method in place before removal, since fertility returns almost immediately.