Nexplanon is FDA-approved to prevent pregnancy for up to 5 years. The small, flexible rod is inserted just under the skin of your upper arm, where it steadily releases a synthetic hormone called etonogestrel to suppress ovulation. When the 5-year window closes, you’ll need to have it removed or replaced.
How the Implant Works Over 5 Years
Nexplanon contains 68 mg of etonogestrel sealed inside a tiny polymer rod about the size of a matchstick. Once it’s placed under your skin, the rod releases hormone in a slow, tapering pattern. During the first several weeks, it releases about 60 to 70 micrograms per day. By the end of year one, that drops to roughly 35 to 45 micrograms. By the end of year two, it’s around 30 to 40 micrograms, and by year three it settles to about 25 to 30 micrograms per day.
Even at these lower release rates, the hormone levels remain high enough to reliably prevent ovulation. The implant also thickens cervical mucus, making it harder for sperm to reach an egg. These two mechanisms together are what make it one of the most effective contraceptives available.
Why You Might See “3 Years” in Older Sources
For years, Nexplanon’s label said it was approved for 3 years of use. That was the original approval based on the clinical data available at the time. A newer clinical trial specifically studied whether the implant remained effective during years four and five, and the FDA updated the approved duration to 5 years based on the results. If you see a source citing 3 years, it’s using outdated information. The current label is 5 years.
Effectiveness by the Numbers
The implant is more than 99% effective at preventing pregnancy, making it one of the most reliable birth control methods in existence. Unlike the pill, patch, or ring, there’s virtually no gap between “perfect use” and “typical use” because it doesn’t require you to do anything after insertion. You can’t forget to take it or use it incorrectly. Once it’s in your arm, it works continuously.
Clinical data also shows that the implant’s effectiveness holds across different subgroups, including variations in age, race, and ethnicity. The original 3-year approval trial excluded women above 130% of their ideal body weight, which led to a label warning about potentially reduced effectiveness in heavier women. A more recent study enrolled a significant proportion of overweight and obese participants and found consistent efficacy results across BMI categories, though the FDA has noted that longer-term data in this group would strengthen the evidence further.
What Happens After 5 Years
Once you reach the 5-year mark, the implant needs to come out. Hormone levels drop to undetectable within about a week of removal, which means ovulation can resume quickly. There’s no lingering delay to your fertility. Your body returns to whatever baseline fertility is normal for you, and pregnancy is possible soon after removal.
If you want to continue using the implant, a new one can be inserted during the same office visit. Your provider numbs the area, removes the old rod through a small incision, and places the new implant in the same location while the area is still numb. The whole process typically takes just a few minutes. Afterward, you’ll wear a pressure bandage for 24 hours and a smaller adhesive bandage for 3 to 5 days.
Removing It Before 5 Years
You don’t have to keep Nexplanon for the full 5 years. It can be removed at any point if you want to get pregnant, switch methods, or stop for any reason. The removal process is the same regardless of timing: a provider numbs your arm, makes a small cut, and slides the rod out. Fertility returns within days, not weeks or months.
Some people choose early removal because of side effects, particularly changes in bleeding patterns. Irregular bleeding or spotting is the most common reason people have the implant taken out before it expires. Others remove it simply because their plans change. Whatever the reason, there’s no medical advantage to waiting until the implant “runs out” if you want it gone sooner.
Tracking Your Timeline
Your provider will give you a card with the insertion date and the date by which the implant should be removed or replaced. Keeping that card is the simplest way to stay on top of your timeline. You can also set a reminder on your phone for a few months before the 5-year mark, giving yourself time to schedule an appointment without any lapse in coverage. If you’re replacing one implant with another, continuous protection picks up immediately with no gap.