Nexplanon must be replaced by the end of its fifth year. The FDA approved the implant for up to 5 years of continuous pregnancy prevention, and the device needs to be removed once that window closes. You can have a new implant inserted during the same appointment if you want to continue using it.
The Current 5-Year Timeline
The FDA-approved label is straightforward: Nexplanon prevents pregnancy for up to 5 years, and the implant must be removed by the end of that fifth year. If you want uninterrupted contraception, a new implant can go in at the same visit, right after the old one comes out.
If you got your Nexplanon before 2024, you may have been told it lasts 3 years. That was the original approved duration. The FDA extended approval to 5 years based on clinical evidence showing the implant remains effective for that longer period. If your implant is still within the 5-year window and you haven’t had it replaced yet, it’s still working.
How the Implant Works Over Time
Nexplanon is a small flexible rod inserted under the skin of your upper arm. It releases a steady stream of a synthetic hormone that prevents ovulation. The release rate is highest in the first few months, around 60 to 70 micrograms per day, and gradually tapers. By the end of the first year, it drops to roughly 35 to 45 micrograms per day. By the end of year two, it’s around 30 to 40 micrograms. By year three, it settles to about 25 to 30 micrograms per day.
That declining curve is by design. Even at the lower end, the hormone levels stay well above the threshold needed to suppress ovulation. This is why the implant remains highly effective even in its later years, though it does eventually reach a point where replacement becomes necessary to maintain reliable protection.
Effectiveness in Years 4 and 5
The evidence supporting the extended timeline is strong. In a multicenter trial of 390 people who kept their implants beyond three years, no pregnancies occurred during years 4 and 5. The five-year pregnancy rate was 0.6 per 100 woman-years, which is comparable to the rate seen with the implant in its earlier years.
A separate prospective study tracked 291 people using the implant into years 4 and 5, accumulating 444 woman-years of follow-up data. Again, zero pregnancies occurred. These results are what gave the FDA the confidence to extend the approved duration from 3 years to 5.
Does Body Weight Affect the Timeline?
A common concern is whether the implant runs out of hormone faster in people with a higher body weight. Research from the Society of Family Planning measured hormone levels in normal weight, overweight, and obese implant users and found no meaningful difference. After adjusting for how long the implant had been in place, BMI had no association with hormone levels.
Every participant in that study, regardless of weight, had hormone levels above the threshold needed to prevent ovulation. The lowest individual reading recorded was still well above the cutoff. So the 5-year replacement schedule applies the same way regardless of your body size.
What Replacement Involves
The removal and reinsertion process is typically done in a single office visit. Your provider numbs the area around the implant with a local anesthetic, makes a small incision, and slides the old rod out. If you’re getting a new one, it goes into the same arm, often through the same incision or a nearby spot. The whole process usually takes under 20 minutes.
Some bruising and tenderness at the site is normal for a few days afterward. There’s no gap in contraceptive coverage when a new implant is placed at the same visit, so you don’t need backup contraception.
What Happens if You Leave It Too Long
If you keep the implant past 5 years, there’s no guarantee it will continue suppressing ovulation reliably. The hormone output continues to decline, and at some point it drops below the level needed to prevent pregnancy. The implant itself won’t cause harm if left in place, but it can no longer be counted on for contraception. If you’re past the 5-year mark and haven’t had it replaced, use another method of birth control until you can get to your provider.
Setting a calendar reminder around the 4.5-year mark gives you a comfortable window to schedule the appointment without cutting it close.