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
Mirena
Nexplanon vs. Mirena Dosage
Nexplanon
Mirena
| 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 |
| 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
| 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
| 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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