CDC Recommendations for Initiation Timing and Backup Contraception with Nexplanon

Immediate Contraceptive Protection (No Backup Needed)

Inserting Nexplanon within the first 5 days of menstrual bleeding provides immediate contraceptive protection without the need for additional backup methods. 1
Insertion at the time of a surgical abortion also confers immediate protection, eliminating the requirement for backup contraception. 1
Post‑partum women who are < 6 months postpartum, amenorrheic, and are fully or nearly fully breastfeeding (≥ 85 % of feeds) receive immediate protection from Nexplanon without backup contraception. 1

If Nexplanon is inserted on day 6 or later of the menstrual cycle, the patient must abstain from intercourse or use a barrier method (e.g., condoms) for the next 7 days. [1][2]
When switching from another contraceptive method and more than 5 days have elapsed since the start of menstrual bleeding, a 7‑day period of backup contraception is required. [1][2]
Amenorrheic women who are not postpartum must use backup contraception for 7 days after insertion. 1
Post‑partum women who are not breastfeeding and are ≥ 21 days after delivery without a return of menses also need a 7‑day backup period. 1
The CDC notes that the 7‑day backup recommendation provides a conservative safety margin for clinical practice, even though pharmacokinetic data show rapid hormone levels. [1][2]

Nexplanon may be inserted at any time when the clinician is reasonably certain the patient is not pregnant; waiting for the next menstrual period is unnecessary. [1][2]
If pregnancy status is uncertain, the benefits of immediate insertion generally outweigh potential risks; the implant should be placed and a pregnancy test scheduled for 2–4 weeks later. 1
Delaying insertion until the next menstrual period is a common pitfall that creates an unnecessary gap in contraceptive coverage. 1

When switching from an intrauterine device (IUD) and more than 5 days have passed since the start of bleeding, clinicians may either retain the IUD for an additional 7 days after Nexplanon insertion or advise the patient to use abstinence or barrier methods for 7 days before removing the IUD. [1][2]

The Centers for Disease Control and Prevention recommends Nexplanon as a highly effective contraceptive method, with fewer than 1 woman out of 100 becoming pregnant in the first year of typical use 3
Nexplanon can be inserted immediately during menstruation, providing immediate contraceptive protection without requiring backup methods 3, 4
When inserted within the first 5 days of menstrual bleeding, no additional contraceptive protection is needed 4, 5

No examinations or tests are needed before initiation of an implant in healthy women, according to the Centers for Disease Control and Prevention 5, 6
A baseline weight and BMI measurement might be useful for monitoring over time 5, 6
The patient should be informed that Nexplanon does not protect against STIs; consistent and correct use of condoms reduces the risk of STIs 3, 4

Depo-Provera can also be started immediately during menstruation with no need for backup contraception, but it requires injections every 3 months and has more significant bone mineral density concerns 7, 8