Nexplanon vs. Depo-Provera

See how Nexplanon and Depo-Provera compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Nexplanon is a matchstick-sized rod placed under the skin of the arm that prevents pregnancy for up to 3 years with no ongoing action needed.

  • Depo-Provera is an injection given every 3 months, either by a provider or, in the subcutaneous form, at home.

  • Both are progestin-only options, but Depo-Provera carries a boxed warning for bone density loss with long-term use that Nexplanon does not.

Nexplanon vs. Depo-Provera Drug Summary

Nexplanon

Nexplanon is a progestin-only contraceptive implant, a thin rod placed under the skin of the upper arm that prevents pregnancy for up to 3 years. It releases a steady low dose of etonogestrel and requires no daily or weekly action once inserted.

Depo-Provera

Depo-Provera is a progestin injection given every 3 months to prevent pregnancy. It contains medroxyprogesterone acetate and is delivered by injection into the muscle or, in a lower-dose version, under the skin.

Nexplanon vs. Depo-Provera Side Effects

Nexplanon

Most common
change in menstrual bleeding pattern (up to 11.1%)
headache (up to 10%)
vaginitis (up to 10%)
weight increase (up to 10%)

Depo-Provera

Most common
menstrual irregularities (up to 57%)
weight gain (up to 38%)
headache (up to 17%)
abdominal pain/discomfort (up to 11%)

Nexplanon vs. Depo-Provera Dosage

Nexplanon

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 implant, 68 mg Day 1
Maximum dose 1 implant, 68 mg Same as starting
Dose changes None Fixed dose

Depo-Provera

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 150 mg injection At the start
Maximum dose 150 mg injection Same as starting
Dose changes None Fixed dose

Nexplanon vs. Depo-Provera Indications

Nexplanon

Nexplanon is FDA-approved for long-acting reversible contraception. It is placed once and works continuously for up to 3 years without any action from the patient.

  • Prevention of pregnancy for up to 3 years

  • No daily, weekly, or monthly action required

  • Reversible by removal at any time

Depo-Provera

Depo-Provera is FDA-approved for prevention of pregnancy through repeat injections. It is not recommended as a long-term method beyond 2 years unless other options are inadequate, due to bone loss risk.

  • Prevention of pregnancy, given every 3 months

  • Available as intramuscular or subcutaneous injection

  • Not recommended for continuous use beyond 2 years

Nexplanon vs. Depo-Provera Pros and Cons

Nexplanon

Nexplanon offers the longest stretch of set-it-and-forget-it protection among hormonal methods, but it requires a brief in-office procedure for placement and removal. Its higher upfront list price can be a barrier without insurance coverage.

Pros

  • Lasts up to 3 years with no user action needed

  • No boxed warning for bone density loss

  • Fertility typically returns quickly after removal

Cons

  • Requires a minor in-office insertion and removal procedure

  • Rod may be visible or palpable under the skin

  • Higher list price, roughly $1,030 to $1,275 per month equivalent

  • Only available through providers trained under a REMS program

Depo-Provera

Depo-Provera offers a lower-cost option that avoids any visible device, but it carries a boxed warning for bone density loss with prolonged use. Return to fertility after stopping can also take longer than with other methods.

Pros

  • Lower cost, roughly $20 to $45 per month equivalent

  • No visible or palpable device

  • Subcutaneous version can be self-administered at home

Cons

  • Boxed warning for bone density loss with long-term use

  • Return to fertility can take several months after stopping

  • Requires a new injection every 3 months to stay effective

  • Not recommended for continuous use beyond 2 years

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