Nexplanon is FDA-approved to prevent pregnancy for up to 5 years. The small, flexible rod sits just under the skin of your upper arm and slowly releases a hormone that stops ovulation, providing highly effective birth control without daily maintenance.
How the 5-Year Timeline Works
Nexplanon contains 68 mg of a synthetic hormone called etonogestrel. Rather than releasing it all at once, the implant delivers a steady, declining dose over time. In the first few weeks after insertion, it releases about 60 to 70 micrograms per day. By the end of year one, that drops to roughly 35 to 45 micrograms per day. By the end of year two, it’s down to 30 to 40 micrograms, and by the end of year three, it settles around 25 to 30 micrograms per day.
Even at these lower release rates, the hormone levels remain high enough to reliably suppress ovulation. The implant was originally approved for 3 years, but the FDA extended its approved duration to 5 years based on evidence that it continues working effectively through that full window. After 5 years, hormone levels may drop too low to guarantee protection, and the implant should be removed or replaced.
How Effective It Is Over 5 Years
Nexplanon is one of the most effective contraceptives available. In a large observational study called the NORA study, the Pearl Index (a standard measure of contraceptive failure) was just 0.04, meaning roughly 4 pregnancies per 10,000 women per year of use. When counting only pregnancies that occurred while the implant was still in place, the rate dropped to 0.02. Previous research on the implant has consistently found failure rates between zero under perfect conditions and 0.06 at the high end. For comparison, the pill has a typical-use failure rate of about 7 per 100 women per year.
There’s essentially no difference between “perfect use” and “typical use” with Nexplanon, because once it’s in your arm, there’s nothing to remember or do correctly. You can’t take it late, forget a dose, or use it wrong.
Does Body Weight Affect How Long It Lasts?
This is a common concern, and the prescribing information does mention that evidence is limited for people with higher body weight. Some earlier guidance suggested that people with overweight or obesity might consider replacing the implant sooner. However, a systematic review published in BMJ Sexual & Reproductive Health found no indication that the implant becomes less effective at higher body weights. The failure rates observed in people with overweight and obesity fell within the same range as those seen across all weight groups, at least through 3 years of use.
Data beyond 3 years in higher-weight users is still limited, so some clinicians may discuss earlier replacement as a precaution. But the available evidence does not support the idea that the implant fails sooner if you weigh more.
What Happens When It’s Time to Replace It
When your 5 years are up, a healthcare provider removes the implant through a small incision in your arm, typically under local anesthesia. The procedure usually takes just a few minutes. If you want to continue using Nexplanon, a new implant can be inserted during the same visit, in the same arm or the other one. Getting a new implant placed immediately means there’s no gap in protection.
If you decide not to replace it, fertility returns quickly. The hormone clears your system within days, and ovulation can resume within weeks. You’ll need a different method of birth control right away if you don’t want to become pregnant.
Signs You Shouldn’t Wait the Full 5 Years
Most people can safely keep Nexplanon for the full approved duration. But certain changes might prompt a conversation with your provider about earlier removal. Persistent or bothersome bleeding pattern changes are the most common reason people choose to have the implant taken out before it expires. Some people experience prolonged spotting, irregular bleeding, or no periods at all. None of these patterns are medically dangerous, but they can be frustrating enough to want a switch.
If you develop symptoms like severe arm pain near the implant site, difficulty feeling the rod under your skin, or signs of pregnancy, those warrant a prompt visit rather than waiting for your scheduled replacement date. An implant that can’t be located by touch may have migrated, and imaging can help confirm its position.