Nexplanon vs. Skyla

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

Key Takeaways

  • Nexplanon is a matchstick-sized arm implant and Skyla is a small T-shaped device placed in the uterus, and both prevent pregnancy for up to 3 years.

  • Nexplanon is inserted under the skin of the upper arm in a brief office procedure, while Skyla requires a pelvic exam and cervical insertion.

  • Both can cause irregular bleeding and acne, but Skyla carries added IUD-specific risks like perforation and expulsion that Nexplanon does not.

Nexplanon vs. Skyla Drug Summary

Nexplanon

Nexplanon is a progestin-only contraceptive implant containing etonogestrel, used to prevent pregnancy for up to 3 years. It is a single flexible rod inserted just under the skin of the upper arm during a short in-office procedure. Once placed, it requires no daily, weekly, or monthly action from the patient.

Skyla

Skyla is a levonorgestrel-releasing intrauterine system (IUS), a small T-shaped device placed inside the uterus to prevent pregnancy for up to 3 years. A clinician inserts it in a single office visit through the cervix. It is the lowest-dose hormonal IUD currently marketed and was specifically studied in women who have not given birth.

Nexplanon vs. Skyla Side Effects

Nexplanon

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

Skyla

Most common
vulvovaginitis (up to 20%)
abdominal/pelvic pain (up to 19%)
acne/seborrhea (up to 15%)
ovarian cyst (up to 13%)

Nexplanon vs. Skyla 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

Skyla

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 13.5 mg IUS, one insertion At the start
Maximum dose 13.5 mg IUS, one insertion Same as starting
Dose changes None Fixed dose

Nexplanon vs. Skyla Indications

Nexplanon

Nexplanon is FDA-approved for long-acting reversible contraception. A single rod is placed under the skin of the upper arm and works continuously for up to 3 years without any action needed from the patient.

  • Prevents pregnancy for up to 3 years

  • Single-rod implant placed in the upper arm

  • No daily, weekly, or monthly dosing

  • Reversible by removal at any time

Skyla

Skyla is FDA-approved to prevent pregnancy for up to 3 years using a small intrauterine device that releases levonorgestrel locally. It is placed once by a clinician and does not require any ongoing action from the patient afterward.

  • Prevents pregnancy for up to 3 years

  • T-shaped device placed inside the uterus

  • No daily, weekly, or monthly dosing

  • Reversible by removal at any time

Nexplanon vs. Skyla Pros and Cons

Nexplanon

Nexplanon avoids any pelvic procedure, since it is placed and removed through a small incision in the arm. Its radiopaque design lets clinicians locate it on imaging if it becomes difficult to find, and it carries no risk of uterine perforation.

Pros

  • Insertion and removal done through the arm, not the pelvis

  • Radiopaque rod can be located by X-ray if needed

  • No risk of uterine perforation or expulsion

Cons

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

  • Contraindicated in people with a history of blood clots

  • Menstrual bleeding changes are the leading cause of discontinuation

Skyla

Skyla delivers a lower, more localized dose of hormone directly in the uterus rather than systemically through the skin. It carries IUD-specific risks like perforation and expulsion that an arm implant does not, and insertion requires a pelvic exam rather than a simple arm procedure.

Pros

  • Lowest hormone dose among levonorgestrel IUDs

  • Hormone acts locally in the uterus rather than throughout the body

  • Specifically studied for safety and fit in women who have not given birth

Cons

  • Insertion requires a pelvic exam and cervical procedure

  • Carries a risk of uterine perforation and device expulsion

  • Increases risk of ectopic pregnancy if pregnancy occurs with device in place

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