Ask the Pharmacist

Q) I heard that there is a brand new form of birth control that is incredibly effective. What can you tell me about it?

A) Nexplanon is brand new to Canada but not necessarily to the world as it has been available for a number of other years in other countries. It is a unique method of contraception that involves the insertion of a single rod just below the skin of a patient’s upper arm. The rod is small, roughly the size of a matchstick. It is made of a soft and flexible plastic that very slowly releases etonogestrel, a type of progesterone.

As you may remember from biology class, progesterone and estrogen are two of the main female hormones. Etonogestrel enters the bloodstream from the implant and prevents pregnancy in two ways. First, it stops the release of eggs from the ovaries. Secondly, it induces changes in the mucus layer that lines the cervix making it more difficult for sperm to enter the uterus. The inserted rod can be felt under the skin but the procedure to insert it has been described as a relatively low-key deal taking way less than 10 minutes and causing pain to a level equivalent to a needle and lasting only a few seconds.

To females of a certain age, Nexplanon may remind them of another drug that was available close to 20 years ago. Norplant was a 5 rod insert that was used as a form of birth control in the 90’s but was pulled from both the American and Canadian markets in the early 2000’s amidst a swirl of ongoing controversies. Some women complained about side effects such as menstrual irregularities, headaches and nausea and there was a brief period when its sales were suspended due to allegations that it was not as effective as was claimed. These allegations were proven untrue, but were damaging to its brand image regardless.

As well, there were literally hundreds of lawsuits south of the border mostly pertaining to botched insertions and removals and claims about inadequate information being provided regarding Norplant’s risks. Given how litigious our southern neighbours are, it’s actually hard to say whether Norplant was withdrawn because it was a “bad” drug or was just no longer profitable to the manufacture given its checkered reputation. Regardless, the drug had its fans and there was mounting pressure over the years on the Canadian government to approve its successor by a number of sexual health advocates. This might be because Nexplanon is indeed different from other currently available options making it an important alternative for some females.

One advantage of Nexplanon is it is super effective. It is more than 99% effective and there is no way you can mess it up. You get it inserted and can forget about it for three years. With typical use;

· less than 1 in 1,000 females will get pregnant per year on Nexplanon
· 2 in 1,000 females with IUD’s such as Mirena (these are devices inserted into the uterus that give off hormones similar to Nexplanon)
· 8 in 1,000 females with a copper IUD or
· 90 in 1,000 females with the pill, patch or ring

The 90 in 1,000 reflects just how often people delay or forget to take their next dose and the consequences of those mental lapses.

A second advantage is its convenience. There are no more trips to the pharmacy, no ring to pull out, or pill to find. People won’t be able to even notice the implant under your skin unless you tell them where to look. You can feel it, but it shouldn’t hurt to touch it and is less noticeable than an IUD inserted into your vagina. As well, implants tend to help many, although certainly not all, with menstrual irregularities which can be very helpful for those with brutal cycles. Nexplanon helps cut down on cramps, can make the period lighter and in fact, about 1/3 stop getting their periods at all after a year.

Nexplanon is also very flexible when it comes to family planning. Once the insert is removed, fertility is restored to normal virtually instantly. But perhaps its greatest advantage is that it doesn’t involve the use of the hormone estrogen that so many other forms do.

There are many women who cannot take estrogen for many reasons such as a history of migraines, a history or risk of being diagnosed with an estrogen dependent form of cancer and many others. There are also females who find that the estrogen content of most birth control pills/ patches and rings gives them unpleasant side effects that they’d rather avoid such as weight gain.

However, there are downsides to Nexplanon as a contraceptive as well. These include potential side effects such as headaches, acne, mood swings, breast tenderness and nausea which are also common with most of the other prescription forms of contraception.

The side effect that is most likely to lead to a woman discontinuing Nexplanon is irregular breakthrough bleeding (aka spotting) particularly in the first 6 to 12 months of therapy. While eventually many women wind up without a period, the adjustment phase for some women is bad enough that about 1 in 10 quit therapy due this type of side effect.

There is also a very slight chance that the implant can “move” from where it was surgically implanted and may therefore need to be reinserted which means you may be “unprotected” until this happens and necessitates another visit to the doctor’s office.

The cost for Nexplanon is about $310 for three years of protection which compares very favourably to the various pills, the patch and the ring (although IUD’s are the most cost effective option if they are left in for the full duration of their effect). Certainly, Nexplanon will not be the main option of contraception for most females but it does provide a unique alternative that may better fit the needs of a not insignificant number of ladies. For more information about this or any other health related questions, contact your pharmacist.