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

Most common
headache (up to 6.3%)
vaginal candidiasis (up to 6.1%)
nausea (up to 4.6%)
menstrual cramps (up to 4.4%)

Nexplanon

Most common
irregular bleeding (up to 11.1%)
headache (up to 10%)
vaginitis (up to 10%)
weight increase (up to 10%)

Microgestin vs. Nexplanon Dosage

Microgestin

Dosage
Dosage Table
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

Dosage
Dosage Table
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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