Nexplanon vs. Mirena

See how Nexplanon and Mirena compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Nexplanon is a single-rod arm implant approved for 3 years, while Mirena is an intrauterine device approved for up to 8 years.

  • Both require a clinician for insertion and removal and do not depend on the patient remembering a daily or weekly dose.

  • Mirena is also FDA-approved to treat heavy menstrual bleeding, a use Nexplanon does not have.

Nexplanon vs. Mirena Drug Summary

Nexplanon

Nexplanon is a progestin-only contraceptive implant that prevents pregnancy for up to 3 years. It is a single matchstick-sized rod placed under the skin of the upper arm by a clinician. Once inserted, it works continuously with no daily or weekly action needed.

Mirena

Mirena is a hormonal intrauterine device that releases levonorgestrel into the uterus to prevent pregnancy for up to 8 years. It is a T-shaped device placed by a clinician and is also approved to treat heavy menstrual bleeding for up to 5 years. Like Nexplanon, it requires no daily action once in place.

Nexplanon vs. Mirena Side Effects

Nexplanon

Most common
headache (up to 16.3%)
vaginitis (up to 14.5%)
weight increase (up to 13.7%)
acne (up to 13.5%)

Mirena

Most common
unscheduled uterine bleeding (up to 31.9%)
abdominal/pelvic pain (up to 22.6%)
amenorrhea (up to 18.4%)
headache/migraine (up to 16.3%)

Nexplanon vs. Mirena Dosage

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

Mirena

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose ~21 mcg/day LNG release Day 24
Maximum dose ~7 mcg/day LNG release If needed
Dose changes 2 increases As tolerated

Nexplanon vs. Mirena Indications

Nexplanon

Nexplanon is approved only for preventing pregnancy, not for treating any other condition. It releases a steady dose of etonogestrel that suppresses ovulation for up to three years. Because it sits under the skin, it avoids the uterine placement and cervical dilation Mirena requires.

  • Long-term pregnancy prevention (up to 3 years)

  • Does not require daily or weekly action

  • Inserted and removed by a trained clinician

  • Reversible with rapid return to fertility after removal

Mirena

Mirena is approved for both pregnancy prevention and for treating heavy menstrual bleeding in women who also want contraception. It releases levonorgestrel directly into the uterus, so hormone levels in the rest of the body stay low. This dual approval sets it apart from purely contraceptive options like Nexplanon.

  • Long-term pregnancy prevention (up to 8 years)

  • Treatment of heavy menstrual bleeding (up to 5 years)

  • Placed and removed by a clinician in-office

  • May reduce or stop periods over time

Nexplanon vs. Mirena Pros and Cons

Nexplanon

Nexplanon involves a quick in-office procedure using local anesthetic in the upper arm, avoiding the pelvic insertion Mirena requires. It provides three years of continuous contraception without any pelvic exam or cervical dilation. Removal is also a simple arm procedure rather than an intrauterine retrieval.

Pros

  • No pelvic exam or cervical dilation needed

  • Simple arm placement under local anesthetic

  • Radiopaque rod is visible on X-ray if needed

  • Does not raise ectopic pregnancy risk if it fails

Cons

  • Only approved for 3 years before replacement

  • Available only through a restricted REMS program

  • Can be felt or seen as a small ridge under the skin

  • No FDA-approved use for heavy menstrual bleeding

Mirena

Mirena requires placement inside the uterus, a slightly more involved procedure than Nexplanon's arm insertion, but it lasts up to 8 years and can also treat heavy periods. Its intrauterine position keeps hormone levels reaching the rest of the body very low. Removal is done in-office by a clinician trained in IUD extraction.

Pros

  • Longest approved duration of any hormonal option, 8 years

  • Also FDA-approved to treat heavy menstrual bleeding

  • Hormone stays mostly localized to the uterus

  • May significantly lighten or stop periods over time

Cons

  • Insertion involves cervical dilation and a pelvic exam

  • Small risk of uterine perforation or device expulsion

  • Any pregnancy that occurs is more likely to be ectopic

  • Higher reported rates of pelvic pain and discharge

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