“We’re all on Nexplanon,” says a recent ad for “the birth control that goes in your arm,” featuring actress Vanessa Hudgens. Seconds later, the ad warns that “if at any time you can’t feel the implant, contact your doctor right away… removal of the implant may be very difficult or impossible if the implant is not where it should be.”
Perhaps you remember the old slogan for Nexplanon, which used to be the clever “Armor Up.” Remember the ads, with the stylishly dressed young women in the workplace, flexing their biceps and telling us that they‘ve “armored up” against an unplanned pregnancy? Now, Nexplanon wants to show us that everyone—from moms to gamers to students to actresses (and not just women striving for the corner office)—are “all on Nexplanon.”
It’s true that more and more women are turning to long-acting reversible contraceptives (LARCs) such as Nexplanon. Like the IUD, the Nexplanon implant is increasingly favored by patients and healthcare providers for its ease of use and compliance. The idea behind Nexplanon and other LARCs is to function as a “set it and forget it” method of birth control, promising women up to three years of protection against unplanned pregnancy without having to worry about taking a daily pill.
The trouble is, ever since women have been getting birth control implants in their arms, there have been reports that the matchstick-sized devices have the rare but serious chance of moving from the arm to other places in a woman’s body. In 2016, the FDA updated the Nexplanon label to include warnings about the device’s ability to migrate, noting that a “deep” insertion is more likely to lead to issues with locating or removing the implant.
Nexplanon also shares hormonal birth control’s more common side effects such as headache, depression, weight gain, mood swings, breast pain, acne, nausea, loss of libido, and painful periods (among others)—as well as the less common but far more serious side effects of blood clots, strokes, and heart attacks.
How does Nexplanon work?
Similar to hormonal IUDs, Nexplanon prevents pregnancy by continuously releasing a steady, low dose of a synthetic form of the hormone progesterone, known as a progestin. Nexplanon’s particular progestin is known as etonogestrel, which prevents pregnancy through various functions, including preventing ovulation, thickening cervical mucus, and changing the lining of the uterus (etonogestrel can also be found in combination with ethinylestradiol, a synethetic estrogen, in vaginal rings such as the NuvaRing).
Nexplanon should be removed after three years, but if it is lost and/or cannot be retrieved, it may continue affecting the body even after the three-year mark. During the COVID-19 pandemic, some women have had difficulty finding providers to remove their expired Nexplanon implants. However, providers are assuring women that the device is probably still pumping out enough synthetic hormone one to two years after its expiration date to continue preventing pregnancy (although many providers advise condom use after an implant expires). The continued effects of the implant past its expiration may seem like a boon to some, but for those whose device has moved, making it difficult or impossible to retrieve (or if it has become lost, and impossible to retrieve, as has happened in some rare cases) the extended effects can be troubling.
Nexplanon’s risk of moving and informed consent
As it turns out, Nexplanon‘s issues with migrating are nothing new. Nexplanon is actually an updated version of a device called Implanon (which gained FDA approval in 2006), which was also a matchstick-sized hormonal LARC placed in the arm to prevent pregnancy for up to three years. With the FDA’s approval of Nexplanon in 2011, Implanon has gradually been phased out, but for many years was the subject of class action lawsuits from women “who allege they were not properly warned about the risks associated with using Implanon,” and from some for whom the device is irretrievable.
One of the issues with Implanon was not only that it had the potential to migrate to areas outside the arm—including the pulmonary artery, a vital blood vessel found in the lungs—but it was also impossible to find via x-ray. To fix this problem, Nexplanon was developed to contain barium, which makes it radio-opaque. This means that if Nexplanon does move (as it still has the potential to do, despite the updates made to the original version), it can be located via x-ray. So, in a way, the updates to Nexplanon were developed with a specific awareness in mind of the implant’s potential to get lost inside a woman’s body.
When Nexplanon moves and can’t easily be found
Nexplanon migration is an uncommon occurrence, and an updated applicator is meant to keep healthcare providers from inserting Nexplanon too deeply (again, a deep insertion is believed to make migration more likely). However, migration to other areas of the body is still possible (including within blood vessels, and even blood vessels within the lungs), and it can be extremely serious. In fact, the FDA-approved label for Nexplanon notes that if the device cannot be located, chest x-rays may be required to ensure that the device is not located within the pulmonary artery.
Some women report they were not aware of Nexplanon’s ability to migrate when they had it inserted. One woman shared with the New York Post her ordeal having to undergo mandatory surgery to go “fishing” and “digging” for the implant after her Nexplanon merely moved to a different part of her arm. “I was angry,” says Tenayah Dawson, who was told she needed an MRI to locate her implant because it had moved. “I was like, what do you mean it moved? I was really concerned. It moved? How can it move?” Dawson says it took over an hour of surgery for her doctor to find and remove the device.
A way to prevent pregnancy that doesn’t require being “on” anything
The good news is there are family planning methods that don’t involve inserting foreign objects into your body. Fertility Awareness-Based Methods, more informally called fertility awareness methods (FAM) or natural family planning (NFP) have gained in popularity since the FDA approved the digital health app Natural Cycles as an effective form of birth control.
Fertility awareness methods are modern, scientifically-based methods of family planning. They are 100% natural (they work with your body’s natural processes of fertility, not against them), have zero side effects, and can be just as effective as the Pill, the implant, and the IUD. As a proud, longtime user of the Sympto-Thermal Method of NFP, I’ll take a thermometer in my mouth any day over a matchstick in my arm—especially one that could end up in my lungs. If you feel the same, it’s time to start learning about your fertility awareness options today. Because, as it turns out, for women to reach the goal of scientifically proven and effective family planning, we don’t have to sacrifice our health—or be “on” anything.
*Nexplanon is a registered trademark of Merck.
This article was originally published on January 12, 2019 as written by Grace Emily Stark. It has since been updated by Natural Womanhood to offer more resources. Last updated October 22, 2020.