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Etonogestrel (implant)

Subcutaneous long-acting hormonal implant (LARC)

ATC code: G03AC08

Updated · Methodology

Indications

A

Contraception

First line

Long-acting reversible contraception (LARC) for 3 years. Per SEGO 2023 and FSRH 2017, first-line for women of any age, including teens. Suitable with estrogen contraindications, breastfeeding, or forgetfulness. Insertion takes 1–3 minutes in office under local anesthesia.

Sources

  1. AEMPS: Ficha técnica de Etonogestrel + Etinilestradiol (anillo vaginal) (2024)
  2. World Health Organization: Medical Eligibility Criteria for Contraceptive Use, 5th edition (2015)

ICD-10: Z30.0 · ICD-11: QA21

A

Contraception during breastfeeding

First line

Contraception during breastfeeding. MEC 2015 category 1 from day 1 postpartum (category 2 if inserted in first 3 weeks – minimal theoretical risk, acceptable in practice). Etonogestrel does not reduce milk supply, RID about 0.2%. Ideal for women who don't want daily pill-taking.

Sources

  1. AEMPS: Ficha técnica de Etonogestrel + Etinilestradiol (anillo vaginal) (2024)
  2. WHO: Medical eligibility criteria for contraceptive use (2015)

ICD-10: Z30.0 · ICD-11: QA21

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Flexible 4 cm plastic rod with 68 mg etonogestrel. Releases 60–70 µg/day in year 1, 30–40 µg by year 3. Suppresses ovulation via LH suppression. Three-year duration. Pearl Index 0.05 – the most effective reversible method after sterilization. Independent of pill-taking or memory.

Safety

Contraindications

  • Hypersensitivity
  • Active VTE
  • Severe hepatic impairment, liver tumors
  • Breast cancer
  • Pregnancy
  • Unexplained uterine bleeding

Serious adverse effects

  • Implant migration
  • Difficult removal (US guidance needed)
  • Insertion-site reaction
  • Ectopic pregnancy if method fails

Common adverse effects

  • Cycle changes
  • Acne (15%)
  • Weight gain 1–3 kg
  • Headache
  • Breast tenderness
  • Decreased libido

Pregnancy: can you take Etonogestrel (implant)?

Remove if pregnant.

Breastfeeding: can you take Etonogestrel (implant)?

Hale L1 · Compatible

WHO MEC 2015 category 1 from day 1 postpartum. Etonogestrel does not reduce milk supply. RID about 0.2%, Hale L1. Ideal choice for breastfeeding women.

RID, infant dose via milk
0.2%
Maternal half-life
25.0 h
Maternal peak time
4 h
Peak milk concentration
0 mg/L
Milk-to-plasma ratio
0.4
Calculate RIDSafe feeding windowFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Insertion by a trained gynecologist via trocar into the inner upper arm. Takes 1–3 minutes. Any day of the cycle with a negative pregnancy test, or from day 1 postpartum. Removal at 3 years – ovulation returns within 3–7 days.

Monitoring

Expected cycle changes: amenorrhea (20%), irregular bleeding (50%), infrequent bleeding (35%), frequent bleeding (15%). If irregular bleeding is bothersome – try a course of ethinylestradiol or NSAIDs for 5–7 days.

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Frequently asked

What is Etonogestrel (implant) used for?

Etonogestrel (implant) is evaluated for the following indications with varying evidence strength: Contraception (evidence tier A), Contraception during breastfeeding (evidence tier A). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Etonogestrel (implant)?

Common side effects of Etonogestrel (implant) (≥ 1 in 100): Cycle changes, Acne (15%), Weight gain 1–3 kg, Headache, Breast tenderness, Decreased libido. See the Safety section for uncommon and serious reactions.

Is Etonogestrel (implant) safe during pregnancy?

Remove if pregnant.

Is Etonogestrel (implant) compatible with breastfeeding?

WHO MEC 2015 category 1 from day 1 postpartum. Etonogestrel does not reduce milk supply. RID about 0.2%, Hale L1. Ideal choice for breastfeeding women.

Who should not take Etonogestrel (implant)?

Etonogestrel (implant) is contraindicated in: Hypersensitivity; Active VTE; Severe hepatic impairment, liver tumors; Breast cancer; Pregnancy. Full list in the Safety section.

Other drugs in this group

Follitropin alfa, Levonorgestrel, Medroxyprogesterone acetate depot, Mifepristone, Norelgestromin + Ethinylestradiol (transdermal patch), Tongkat ali (Eurycoma longifolia), Drospirenone + ethinylestradiol, Ethinylestradiol