Nexplanon is FDA-approved to prevent pregnancy for up to five years. This is a recent update: before 2023, the approved duration was three years, so if you’ve seen conflicting information online, that’s likely why. The implant is a small, flexible plastic rod about the size of a matchstick that sits just under the skin of your upper arm and slowly releases a progestin hormone to prevent pregnancy.
Why the Duration Changed From Three to Five Years
Nexplanon works by steadily releasing a hormone into your bloodstream. That release rate naturally decreases over time. In the first few weeks after insertion, the implant releases roughly 60 to 70 micrograms per day. By the end of year one, that drops to about 35 to 45 micrograms. By year three, it’s down to approximately 25 to 30 micrograms per day.
Even at those lower levels, the hormone concentration remains high enough to reliably suppress ovulation. The FDA reviewed clinical trial data specifically covering years four and five and found zero pregnancies among participants during that period. The failure rate for those two additional years was statistically comparable to other long-acting methods like IUDs. That data is what supported extending the approved duration from three years to five.
How Effective It Is Over Five Years
Nexplanon is one of the most effective forms of birth control available. Across the full five-year span, clinical trial data showed a Pearl Index of 0 for years four and five, meaning no pregnancies occurred among study participants during that window. For context, a Pearl Index of 0 is as close to perfect as contraceptive data gets. The upper bound of the confidence interval still placed effectiveness well within the range of other top-tier long-acting methods.
One practical advantage of the implant is that there’s almost no room for user error. Unlike pills, patches, or rings, you don’t have to remember to do anything after insertion. That’s a major reason why its real-world effectiveness matches its clinical trial effectiveness so closely.
Does Body Weight Affect How Long It Lasts?
This has been a common concern. The original three-year approval trial excluded women who were more than 130% of their ideal body weight, so the label included a warning about potentially decreased effectiveness in heavier users. Newer studies specifically enrolled a significant proportion of overweight and obese participants (about 38% of one key trial), and the results were consistent across weight categories. Effectiveness did not differ based on BMI, age, race, or ethnicity in the data the FDA reviewed.
That said, the FDA noted that the newer study only covered two additional years, and longer-term data in higher-weight users would strengthen the evidence further. The current labeling reflects this nuance. If you have concerns about your weight and the implant’s longevity, it’s a reasonable conversation to have with your provider, but the existing data is reassuring.
What Happens When It Expires
At the five-year mark, the implant should be removed. It doesn’t stop working overnight at exactly five years, but its hormone output continues to decline, and there isn’t sufficient data to confirm reliable protection beyond that point. Leaving it in past the approved duration means you can’t count on it for contraception.
If you want to continue using Nexplanon, a new implant can be placed during the same appointment as your removal. There’s no waiting period required. Your provider can take the old one out and insert a fresh one through the same small incision or a nearby site, keeping you continuously protected without a gap.
Fertility After Removal
The implant does not cause any lasting delay in fertility. Once removed, the hormone clears your system quickly. Ovulation can return within days, and pregnancy is possible as early as one week after removal. If you’re having the implant taken out and don’t want to become pregnant right away, you’ll need another form of contraception immediately.
Removal and Replacement Timing
You don’t need to wait until the implant “runs out” to have it removed. If you want to stop using it for any reason, whether that’s side effects, a desire to get pregnant, or switching to a different method, it can come out at any point during the five years. The removal procedure is quick, typically taking just a few minutes under local anesthesia. Your provider makes a small incision near the tip of the rod and slides it out.
If you’re approaching the five-year mark and want uninterrupted protection, schedule your replacement appointment before the expiration date rather than after. This avoids any window where you might be unprotected.