Microgestin vs. Nexplanon
See how Microgestin and Nexplanon compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Microgestin is a daily pill you take yourself, while Nexplanon is a matchstick-sized implant a clinician places in your arm that works for up to 3 years.
Microgestin costs far less per month out of pocket, but its effectiveness depends on remembering a pill every day.
Nexplanon removes the daily-adherence factor and lasts three years, but it requires a clinical procedure to insert and remove and has no generic option.
Microgestin vs. Nexplanon Drug Summary
Microgestin
Microgestin is a combination oral contraceptive containing norethindrone acetate and ethinyl estradiol, first approved in 1968. It is taken as one tablet daily to prevent pregnancy, and Fe pack versions include iron placebo tablets during the last week.
Nexplanon
Nexplanon is a progestin-only contraceptive implant containing etonogestrel, approved in 2011. A single small rod is inserted under the skin of the upper arm and prevents pregnancy for up to 3 years without any daily action.
Microgestin vs. Nexplanon Side Effects
Microgestin
Nexplanon
Microgestin vs. Nexplanon Dosage
Microgestin
Nexplanon
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg/20 mcg once daily | Days 1-21 |
| Maximum dose | 75 mg ferrous fumarate | Days 22-28 |
| Dose changes | 2 increases | Every 21 days |
| STAGE | DOSE | WHEN |
| Starting dose | 1 implant, 68 mg subdermal | Day 1 |
| Maximum dose | 1 implant, 68 mg subdermal | Same as starting |
| Dose changes | None | Fixed dose |
Microgestin
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg/20 mcg once daily | Days 1-21 |
| Maximum dose | 75 mg ferrous fumarate | Days 22-28 |
| Dose changes | 2 increases | Every 21 days |
Nexplanon
| STAGE | DOSE | WHEN |
| Starting dose | 1 implant, 68 mg subdermal | Day 1 |
| Maximum dose | 1 implant, 68 mg subdermal | Same as starting |
| Dose changes | None | Fixed dose |
Microgestin vs. Nexplanon Indications
Microgestin
Microgestin is FDA-approved solely to prevent pregnancy in women who choose oral contraception. It does not protect against sexually transmitted infections and must be taken daily to stay effective.
Prevents pregnancy when taken daily as directed
Not approved to prevent STIs, including HIV
Available in 21-day and 28-day (Fe) pack options
Comes in two dose strengths: 1/20 and 1.5/30
Nexplanon
Nexplanon is FDA-approved for long-acting reversible contraception, preventing pregnancy for up to 3 years after one insertion. It does not protect against STIs and is not approved for use beyond 3 years without replacement.
Prevents pregnancy for up to 3 years per insertion
Not approved to prevent STIs, including HIV
Not approved for use beyond 3 years without replacement
Requires no daily, weekly, or monthly action once placed
Microgestin vs. Nexplanon Pros and Cons
Microgestin
Microgestin is a well-established combination pill with decades of real-world use and a low monthly cost. Like all oral contraceptives, it requires consistent daily dosing and carries clotting risks that rise with age and smoking.
Pros
Oral tablet, no procedure needed to start or stop
Can be stopped immediately just by not taking the next pill
Long track record since original 1968 FDA approval
Roughly $20 to $50 per month versus $1,030 to $1,275 for Nexplanon
Cons
Must be taken at roughly the same time every day
Contraindicated in women over 35 who smoke
Real-world effectiveness depends heavily on adherence
Not appropriate for women with high thrombosis risk
Nexplanon
Nexplanon offers set-it-and-forget-it contraception that does not rely on remembering a daily pill. It requires a minor in-office procedure for placement and removal and carries a much higher list price with no generic alternative.
Pros
Set-and-forget contraception lasting up to 3 years
Effectiveness does not depend on daily user action
Contains no estrogen, an option for those who cannot use it
Radiopaque rod is visible on X-ray if localization is needed
Cons
Requires an in-office procedure to insert and remove
Roughly $1,030 to $1,275 per month versus $20 to $50 for Microgestin
No generic version currently available
Irregular bleeding is common and a leading reason for discontinuation
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