Does Nexplanon Lower Sex Drive? What the Implant Studies Actually Show

Nexplanon and sex drive come back to two separate counts. Most women who use the etonogestrel implant do not report a desire drop, and the women who do are largely the ones who have it removed. In prospective series, loss of libido was counted in 2 of 80 women and in 1 of 61 breastfeeding women. Pooled questionnaire scores were unchanged at three months and higher at six. In one cross-sectional survey 19.8% named loss of libido. In a cohort of 199 women, 17.1% had the implant removed inside 12 months, and among those removals 50.0% named decreased libido. The average hides both groups.

Figures from Gezginc et al. 2007 (PMID 17853166), Ali et al. 2025 (PMID 41174678) and Ruiz de Vinaspre-Hernandez et al. 2024 (PMID 38323032). Counted side effects and removal reasons, none measured with a desire questionnaire.

Is it the Nexplanon, or is it me?

You typed something into a search bar at midnight: Nexplanon libido, etonogestrel implant sexual side effects, birth control implant and low sex drive. That search is why this page exists.

Nexplanon (the etonogestrel implant) is a 4 cm radio-opaque rod placed under the skin of the non-dominant arm, giving up to 3 years of contraception, the description Chapa and colleagues (2017) give in a case report.

Hormonal contraception and desire is a contradictory literature in general. Casado-Espada and colleagues (2019), a narrative review of hormonal contraceptives and sexual problems in women, says the influence of these drugs on sexual function is not clear and reports results going both ways. A broad page about the pill cannot answer a question about a rod in your arm.

This page goes one device deep: the implant, counted four ways, with every denominator printed next to every percentage. For the wider picture, read our guide to birth control and low libido, our Mirena page on the hormonal IUD, where the pooled device analysis is charted, and the page on progesterone and sex drive.

What the side-effect counts say

Gezginc and colleagues (2007) followed 80 women at one centre. Bleeding ran amenorrhoea in 33 (41.25%), infrequent bleeding in 19 (23.75%) and frequent bleeding in 14 (17.5%). Breast tenderness hit 18.75%, acne 10%, headache and dizziness 3.75%. Depressive mood disorders, pelvic pain and loss of libido were each mentioned by 2 women, so 2.5%. Twenty implants came out and no reasons are printed, so the 2.5% is a side effect reported at follow-up, with the removal count on its own line.

Duvan and colleagues (2010) followed 61 postpartum women who chose the implant while breastfeeding. Amenorrhoea affected 20 (32%), prolonged bleeding 13 (21%), frequent bleeding 4 (6.5%) and infrequent bleeding 2 (3.2%). Weight gain hit 10 women (16%), anxiety 6 (9.8%), breast tenderness and headache 4 each (6.5%). Loss of libido was recorded in 1 woman, 1.6%. Twenty-four implants were removed, 39%, with the reasons left unbroken.

Ali and colleagues (2025) interviewed 101 implant users in Sulaimaniyah, Iraq. Weight gain came in at 24.8%, headache 23.8%, loss of libido 19.8%. A total of 54.5% had removed the implant or intended to within 3 years, mostly for menstrual irregularities (43.6%). This is self-report with no validated desire scale, and intended removals are counted with real ones.

Sergent and colleagues (2004) surveyed one French family planning service: 182 insertions, and 108 women answered. Mean use ran 16 months, range 2 to 24, with 29 removals (27%). Menstrual disturbance affected 83% and weight gain 37%. Headache, acne, breast pain, mood and decreased libido were named the main reasons for removal, with no counts printed.

Brache and colleagues (2002), reviewing implant trial events, lists headaches and acne as the most frequent events reported as probably related, with loss of libido, fatigue and hair loss listed as possibly related and much less frequently reported. In Chen and colleagues (2018), 20 women carried an implant as back-up to the pill; three chose removal at the end, one for decreased libido, one for mood changes, one for weight gain and acne.

What the questionnaires say

Ghorbani and colleagues (2021) pooled 19 studies with 710 participants across progestin contraceptive methods. For the implant, the sexual function score showed no effect three months after insertion (weighted mean difference 1.85; 95% CI -0.34 to 4.04; p = .098) and a positive effect at six months (3.48; 95% CI 2.78 to 4.19; p = .001). Our Mirena page charts both. The pooled base is 710 participants, the abstract's publication bias sentence is ambiguously worded, and no I squared value is printed.

Trigo and colleagues (2022) compared 213 sexually active women in Brazil who had used a copper IUD, a levonorgestrel intrauterine system or an etonogestrel implant for at least a year. On the desire item, copper IUD users scored 4.20 against 3.63 in implant users (p = .009). Total sexual function scores ran 27.48 against 25.07 (p = .029). Dysfunction-range shares were 47.8% on the implant, 47.2% on the levonorgestrel system and 33.8% on the copper IUD, with no difference between groups. General health scored lowest on the implant at 58.33 (p = .034). Nothing was measured before insertion, so we see a level and no change.

Higgins and colleagues (2016) followed 159 completers of 200 enrolled women across three long-acting methods for 3 months, the implant making up 34%. Function and satisfaction scores did not change over time. By 3 months, 40% (n = 64) reported positive changes in their sex life and 17% (n = 27) reported negative ones, the negatives largely increased vaginal bleeding.

Sanders and colleagues (2018) followed 193 women for a year, and 10% discontinued. Scored changes in function and satisfaction showed no association with discontinuation. Women who felt their method detracted from their sex life removed it at an adjusted hazard ratio of 8.04 (95% CI 1.53 to 42.24), controlling for method type, bleeding changes and other covariates. The authors flag the small number who stopped, the interval is wide, and industry research funding is disclosed.

Di Carlo and colleagues (2014), a preliminary Italian study of Nexplanon, reports no negative effect on libido and sexual function, with a temporary dip in vitality, mental health, social functioning and emotional role functioning in the first three months. No scores and no sample size are printed. Sansone and colleagues (2018) followed 25 women with an endometrioma pattern plus pain: sexual function rose above baseline at 6 and 12 months, desire included at 6 months. All of them started with pain, so part of that gain is pain relief.

The hormone story

Hofmeyr and colleagues (2024) analysed serum from 398 of 615 women in the ECHO randomized trial at one South Africa site. At six months, median free testosterone was 14 pmol/L on the implant, 12 on the copper IUD and 11 on the injection, putting the implant 29% above the injection (p < 0.001). Sex hormone binding globulin, which binds testosterone and pulls it out of circulation, measured 23.35 on the implant against 49.1 on the IUD (p < 0.001). Median total testosterone was 0.66 nmol/L on the implant against 0.86 on the IUD. The authors note that this contrasts with reports of reduced androgens and impaired sexual function with the etonogestrel implant. No sexual outcome was measured here, and the arm studied used the levonorgestrel implant, a different device.

Casado-Espada and colleagues (2019) gives the general picture: hormonal methods seem to lower circulating androgen, estradiol and progesterone levels and to inhibit oxytocin functioning, and use could alter pair-bonding behaviour and increase sexual jealousy. Results are contradictory across studies, and author disclosures list fees and grants from multiple drug companies.

Mood is the other half of this. Skovlund and colleagues (2016) followed 1,061,997 Danish women aged 15 to 34 years. The rate ratio for first use of an antidepressant was 1.23 (95% CI 1.22 to 1.25) for combined pills, 1.34 (95% CI 1.27 to 1.40) for progestogen-only pills, 1.6 (95% CI 1.55 to 1.69) for the etonogestrel vaginal ring and 1.4 (95% CI 1.31 to 1.42) for the levonorgestrel intrauterine system. The abstract prints no implant figure, mood itself was never measured, and an association is a long way from a cause. Mood and desire pull on each other, which is why depression and low libido belongs in this conversation.

The women who had it removed

Ruiz de Vinaspre-Hernandez and colleagues (2024) is the study that makes the two stories hard to reconcile. Of 199 women who received the etonogestrel implant at sexual and reproductive health centres in Spain between September 2019 and September 2020, 17.1% discontinued before 12 months. Among that 17.1%, unsatisfactory bleeding was the main reason at 97.1%, joined by cessation of sexual intercourse (58.8%), worsening mood (58.8%), weight gain (55.9%) and decreased libido (50.0%). Three factors raised removal risk: living with a partner, being aged 25 to 34 years, and not receiving comprehensive structured counselling from the midwife. Reasons came from routine follow-up, and no baseline desire measure existed.

Sergent and colleagues (2004) named the same reasons in that French service: headache, acne, breast pain, mood and decreased libido, with 27% removals and no counts per reason.

Chapa and colleagues (2017) published the sharpest end of that spectrum. A 21-year-old woman who was not depressed reported new trouble finishing one month after insertion, meaning she could no longer reach climax. Oral bupropion and sildenafil, both used off-label, did nothing for it. One week after implant removal, 4.5 months after insertion, the ability returned on its own. One woman, no questionnaire, nothing measured before insertion.

Vegunta and colleagues (2024) reviewed contraceptive literature built on validated sexual health questionnaires and concludes that adverse sexual effects often lead to dissatisfaction and discontinuation, and that sexual health belongs in contraceptive counselling and follow-up with shared decision making. Our page on why desire and sensation drop on the pill gives you words for that conversation.

What has been counted, in order

Seven studies have looked at the etonogestrel implant and desire, and they disagree because they asked different questions. Four counted side effects in women who already had the rod in their arm. One asked women how their sex life felt three months after insertion. One pooled 19 studies into a questionnaire score. One followed 199 women through a year and wrote down why each implant came out. The counted desire complaints run from 1 woman in 61 to about 1 in 5, and the pooled score goes up. Read these cards in date order and the spread starts to make sense: studies that count every user find a small number, and the study that only asks women who already decided to leave finds half.

The implant in the studies: what each measured, and whose number it is.

Study	Design	Who	Finding	Whose number
Gezginc 2007	Prospective series	80 implant users	Loss of libido 2.5%	Every user's, counted without a questionnaire
Duvan 2010	Prospective series	61 breastfeeding implant users	Loss of libido 1.6%	Every user's, breastfeeding only
Ali 2025	Cross-sectional survey	101 implant users	Loss of libido 19.8%	Every user's, self-report
Ruiz de Vinaspre-Hernandez 2024	Prospective cohort	199 implant users	17.1% removed inside 12 months, decreased libido named by 50.0% of those	The removal group's
Ghorbani 2021	Meta-analysis	19 studies, 710 women	Implant score +1.85 at three months (95% CI -0.34 to 4.04) and +3.48 at six (95% CI 2.78 to 4.19)	A pooled average's
Trigo 2022	Cross-sectional	213 long-acting users for at least a year	Desire item 3.63 on the implant against 4.20 on the copper IUD	A between-method comparison's, no baseline
Chapa 2017	One case	A 21-year-old woman	Trouble finishing from one month after insertion, back one week after removal	One woman's

What actually helps, graded honestly

Counselling comes first. In the cohort of 199 women, missing comprehensive structured counselling from the midwife was one of the factors that raised removal risk, alongside living with a partner and being aged 25 to 34 years. It is the only lever in this evidence that was measured before the rod went in, which puts it at the top of the list.

What you believe the method is doing to your sex life predicts removal better than a questionnaire does. Women who perceived that their method detracted from their sex life had significantly higher removal rates over the year: adjusted hazard ratio 8.04, 95% CI 1.53 to 42.24. That interval is very wide, the authors flag the small number of women who discontinued, and the paper discloses funding from contraceptive manufacturers. Read it as a signal about expectation. Our page on low libido in women covers how to work through a drop that has several causes at once.

Removal worked in the one case where desire was followed closely. A 21-year-old woman reported trouble finishing from one month after insertion, and it returned on its own one week after removal, 4.5 months after insertion. One woman, no score taken before insertion.

Switching method is the lever the reviews name. Where a contraceptive-related sexual problem is suspected, the recommendation is to stop that method with an alternative considered, and the alternatives named include the levonorgestrel intrauterine system, copper intrauterine contraception, etonogestrel implants, permanent sterilization of either partner when future fertility is not wanted, and a contraceptive ring.

Bleeding and mood ride along with the desire complaint. In that removal group, 97.1% named unsatisfactory bleeding and 58.8% worsening mood, so all three belong in one conversation. If you are breastfeeding, touched out after kids is worth reading beside this article, and a drop that moves month to month has its own pattern in sex drive across the menstrual cycle. None of this is a solo decision: the implant is prescription contraception, and staying, switching and removing are all clinician conversations.

Does it wear off on its own?

On the pooled numbers, averages move up over time. Across 19 studies and 710 women, the implant's sexual function score showed no effect at three months (mean difference 1.85, 95% CI -0.34 to 4.04) and a positive effect at six months (mean difference 3.48, 95% CI 2.78 to 4.19). A preliminary study of healthy women using the etonogestrel implant found a temporary dip in energy, mood, social functioning and emotional role functioning in the first three months that appeared to disappear by six months, and no negative effect on libido. In an ECHO trial ancillary study of the levonorgestrel implant, sexual function showed little difference at 3 and 12 months. In the one case report, trouble finishing cleared one week after removal. Nobody has measured desire month by month on the etonogestrel implant alone, so the honest answer is that averages recover and individuals vary.

What to bring to your clinician

One conversation covers most of this. Bring dates, numbers and the words you use. Your clinician cannot weigh the implant against your sex life from a two minute question at the end of an insertion visit, and the studies above show how much depends on what gets asked.

1. The timeline since insertion: the month you noticed the drop, the month the rod went in, and anything else that changed in the same window. In the one case report, trouble finishing started one month after insertion.
2. The bleeding pattern, because it travels with the desire complaint. Unsatisfactory bleeding was named by 97.1% of the women who removed the implant inside 12 months.
3. The mood picture. Worsening mood was named by 58.8% of that same removal group, and a Danish registry of 1,061,997 women links hormonal contraception to first use of an antidepressant, with a rate ratio of 1.34 for progestogen-only pills (95% CI 1.27 to 1.40) and no implant figures printed in the abstract. That is an association, and mood itself was never measured.
4. The removal conversation and the alternatives on the table: the levonorgestrel intrauterine system, copper intrauterine contraception, another etonogestrel implant, a contraceptive ring, and permanent sterilization of either partner when future fertility is not wanted.
5. Whether you had structured counselling and what you were told to expect about bleeding and mood. Missing that counselling raised removal risk in the 199-woman cohort.
6. The supplement question, bottle in hand, so your clinician can read the ingredient list and the label caution with you.

The everyday levers, and where a botanical fits

Start with who this section is not for. Blood-pressure medication and heart, kidney and lung disease are common enough, and they are exactly what our own label warns about: "avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients". For some readers that sentence is the whole answer. Talk to your clinician first and bring the label.

A few ordinary things move desire, and the free ones do more work than the internet admits.

• Bleeding and mood, first. The conversation about your bleeding pattern and your mood outranks every supplement on this list. In the 199-woman cohort, 97.1% of the women who removed the implant named unsatisfactory bleeding and 58.8% worsening mood.
• Sleep, in quantity and quality. A year of broken nights flattens wanting in anyone. Sleep, libido and testosterone covers that.
• Movement you can sustain, the kind you are still doing in month four. Exercise and libido covers the wider picture.
• Time with a partner, or on your own, with nothing expected at the end. Desire needs room in a calendar, and a week with no space in it starves it.
• A botanical supplement, if you want one, as the smallest lever here.

NUUD is a botanical supplement built around desire in general. It does nothing for contraception, for hormones, or for the side effects of Nexplanon or any implant, and it has no role in managing any medical condition. The formula is anchored by the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption, on a timeline of roughly 30 to 60 minutes. If you take blood-pressure medication or have a heart, kidney or lung condition, the label says no, and your clinician decides the rest. If your clinician has read that label and has no objection, that is what our women's libido gummies are for. There is a men's version.

Nothing is wrong with you

Two answers circulate, and both are useless. One is the shrug: it settles, everybody feels it, give it time. The other is the forum certainty that the implant kills libido, posted by strangers who have never seen your bleeding pattern, your sleep or your marriage.

Here are the numbers in plain words. In a series of 80 users, 2 women reported a loss of libido. In a series of 61 breastfeeding users, 1 did. A survey of 101 users put it at 19.8%. Among the 17.1% of women who removed the implant inside 12 months, half named decreased libido. The pooled questionnaire score went up at six months.

A desire drop travels with other things. Unsatisfactory bleeding was named by 97.1% of that removal group and worsening mood by 58.8%. A new baby, a year of broken sleep, pain, a household running on logistics: all of it flattens wanting, and none of it shows on an ultrasound.

Saying my drive is nowhere to be found is not drama. It is the reason you want to want it again, and to feel normal again. Both are reasonable asks, and both belong in the room with your clinician.

Keep reading

• Birth control and low libido
• Does birth control kill your libido?
• Does Mirena affect sex drive?
• Does progesterone increase sex drive?
• Low libido in women
• Why is my libido so low?

Frequently asked questions

Does Nexplanon lower sex drive?
Usually no. In a series of 80 implant users, 2 women reported loss of libido, 2.5%. In a series of 61 breastfeeding users, 1 woman did, 1.6%. A meta-analysis of 19 studies and 710 women found the implant's sexual function score unchanged at three months and higher at six months. In a cohort of 199 women, 17.1% removed the implant within 12 months, and 50.0% of that removal group named decreased libido. Most women do not report a drop. The women who report one are the ones who ask for removal.

How common is low libido on the implant?
It depends on who was asked and how. Counted side effects in prospective series came out at 2.5% among 80 implant users and 1.6% among 61 breastfeeding users. A cross-sectional survey of 101 implant users found loss of libido in 19.8%, self-reported on a structured questionnaire with no validated sexual function scale. In a study of 213 long-acting method users, the desire item scored 3.63 on the implant against 4.20 on the copper IUD, while the share scoring in the dysfunction range showed no difference between groups.

Does sex drive come back after Nexplanon removal?
In the one case report, yes, and quickly. A 21-year-old woman reported trouble finishing beginning one month after insertion, and it returned on its own one week after removal, 4.5 months after insertion (Chapa and colleagues, 2017). Off-label bupropion and sildenafil did not restore it. That is one woman with no measurement before insertion. In the Spanish cohort, decreased libido was a removal reason for 50.0% of the 17.1% who removed the implant, and nobody measured their desire afterwards. No trial has measured desire after removal.

Is the implant worse than an IUD for sex drive?
Lower on desire in the one head-to-head study, with no clear difference overall. In 213 women using a long-acting method for at least a year, the desire item scored 3.63 on the implant against 4.20 on the copper IUD, and the dysfunction-range shares showed no difference between groups. That study took no measurement before insertion. Pooled across 19 studies, the implant score was higher at six months and the levonorgestrel intrauterine system showed no significant change to 12 months. An ECHO ancillary study found little difference at 3 and 12 months.

Can I take a botanical supplement with Nexplanon?
Ask your clinician first. Our label says to avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. No interaction studies exist for this formula with any contraceptive. NUUD is a botanical supplement built around desire in general. It does nothing for contraception, for your hormones, or for the side effects of Nexplanon, and it changes nothing about how well the implant prevents pregnancy.

References

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12. Sanders JN, Higgins JA, Adkins DE, Stoddard GJ, Gawron LM, Turok DK. The Impact of Sexual Satisfaction, Functioning, and Perceived Contraceptive Effects on Sex Life on IUD and Implant Continuation at 1 Year. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2018;28(5):401-407. https://pubmed.ncbi.nlm.nih.gov/30131221/
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14. Hofmeyr GJ, Singata-Madliki M, Batting J, Balakrishna Y, Morroni C. Effects of depot medroxyprogesterone acetate, the copper IUD and the levonorgestrel implant on testosterone, sex hormone binding globulin and free testosterone levels: ancillary study of the ECHO randomized clinical trial. BMC women's health. 2024;24(1):167. https://pubmed.ncbi.nlm.nih.gov/38459552/
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This article is for general education and is not medical advice. Contraception is managed by a licensed clinician, and Nexplanon (the etonogestrel implant) should only be removed or changed with your clinician. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing the side effects of any contraceptive, any hormonal condition, or any other disease, and these statements have not been evaluated by the Food and Drug Administration. Talk with your doctor before starting any new supplement, and do not stop or change any medication or contraceptive without your doctor.