Nexplanon is FDA-approved to prevent pregnancy for up to 5 years. That makes it one of the longest-lasting reversible contraceptives available. Once the five-year mark arrives, the implant needs to be removed, though a new one can be placed during the same visit if you want to continue using it.
How the Five-Year Timeline Works
Nexplanon is a small, flexible rod inserted just under the skin of your upper arm. It releases a steady stream of a synthetic hormone that prevents ovulation. In the first few weeks, the implant releases about 60 to 70 micrograms per day. That rate gradually tapers: by the end of year one, it drops to roughly 35 to 45 micrograms per day, and by the end of year three, it’s down to about 25 to 30 micrograms per day. Even at those lower levels, the hormone concentration remains high enough to reliably suppress ovulation.
The five-year approval is relatively recent. For years, Nexplanon was labeled for three years of use. The FDA extended that to five years based on a clinical trial that enrolled 399 women who had already been using the implant for three years and tracked them through years four and five. Zero pregnancies occurred during that extended window, giving a Pearl Index of 0.0 pregnancies per 100 women-years of use. In plain terms, the implant worked just as well in years four and five as it did earlier on.
Effectiveness Compared to Other Methods
Nexplanon is the most effective reversible contraceptive on the market. A large observational study tracking real-world use found a Pearl Index of 0.02 for pregnancies that occurred while the implant was in place, which translates to roughly 2 pregnancies per 10,000 women per year. Under perfect conditions in clinical trials, the failure rate has been reported as zero. Even when accounting for pregnancies that happened within a week of removal, the rate only rises to 0.04 per 100 women-years.
For comparison, IUDs have typical-use failure rates between 0.1 and 0.8 percent per year depending on the type. The pill, patch, and ring all hover around 7 percent with typical use because of the room for human error. With Nexplanon, there’s nothing to remember or manage once it’s in your arm, which is why real-world effectiveness so closely mirrors clinical trial numbers.
Does Body Weight Affect How Long It Lasts?
This is a question many people have, and the answer has evolved. The original three-year approval trial excluded women who were more than 130 percent of their ideal body weight, so the label once carried a warning about potentially decreased effectiveness in people with higher BMIs. More recent data has pushed back on that concern. In the study supporting the five-year approval, 38 percent of participants were classified as overweight or obese, and the efficacy results were consistent across BMI categories, age groups, and racial and ethnic backgrounds. No subgroup showed a meaningful drop in protection.
That said, the FDA has noted that longer-term data specifically in higher-weight individuals would strengthen the case for fully removing the original label warning. For now, the clinical evidence available shows the implant working reliably regardless of body weight through its approved five-year lifespan.
What Happens at the Five-Year Mark
The implant must come out by the end of year five. Removal is a quick office procedure: your provider numbs the area, makes a small incision, and slides the rod out. The whole process typically takes just a few minutes, though it can occasionally take longer if the implant has shifted or is deeply placed.
If you want to keep using this method, a new implant can be inserted immediately, through the same small incision if the location is appropriate. There’s no gap in contraceptive coverage when you swap one for another in the same visit. If you don’t replace it right away, you’ll need to start another form of contraception immediately, because fertility returns fast.
Fertility After Removal
Unlike some long-acting methods that can take weeks or months to “wear off,” Nexplanon’s effects reverse quickly. It’s possible to get pregnant right away after removal. Ovulation can return within days to weeks, so there’s no built-in buffer period. If you’re having the implant removed because you want to conceive, that’s good news. If you’re switching methods or taking a break, plan your next contraceptive step before the removal appointment so there’s no unprotected window.