The birth control implant is now FDA approved for up to five years, including implants already in place, and some IUDs are effective longer than their labels say. Here’s what the evidence shows and how to talk with patients about LARC extended use.
The scenario:
A 20 y.o. patient (they/them) had a birth control implant (Nexplanon®) placed three years ago this month. They are happy with their method and want to keep using an implant for birth control.
Is the implant FDA approved for five years?
As of January 2026, the U.S. Food and Drug Administration (FDA) approved the implant for up to five years, up from three. That includes implants already in place, but patients counseled before the change may still think theirs expires at three years. The new label matches high-quality evidence that the implant is highly effective at preventing pregnancy for up to five years.
The same approval added a Risk Evaluation and Mitigation Strategy (REMS) program for implant insertion and removal training.
What is the evidence to support extended use of IUDs and implants?
The implant’s FDA label now matches the evidence: up to five years. For intrauterine devices (IUDs), the evidence still goes further than the label in some cases. The copper 380 mm2 IUD is FDA approved for 10 years, and data show it remains highly effective for 12. Miudella®, a newer copper IUD, is FDA approved for three years, and while extended-use data for it isn’t yet available, it’s likely to go through a similar process of extended use approval.
The levonorgestrel (LNG) 52 mg IUDs (Mirena® and Liletta®) are FDA approved for eight years; the LNG 19.5mg IUD (Kyleena®) is approved for five years and the LNG 13.5mg IUD (Skyla®) is approved for 3. None of the hormonal IUDs are currently approved for extended use beyond their FDA label.
Providers can recommend the use of approved medications in ways that are best for their patients, even if it is outside of the approved labeling, sometimes referred to as “off-label.” Evidence-based, off-label medications are used this way all the time. Methotrexate, for example, is FDA-approved for choriocarcinoma but widely studied and used to medically manage an ectopic pregnancy. Misoprostol for labor induction is also widely studied but “off-label.”
Extended use of IUDs is supported by the American College of Obstetricians and Gynecologists (ACOG) and the Society of Family Planning (SFP)
How long does each IUD and implant work?
IUD and Implant Duration: FDA-Approved vs. Evidence-Based
FDA-approved (years) | Evidence-based (years) | |
|---|---|---|
| Implant (Nexplanon®) | 5† | 5 |
| Copper 380 mm² IUD (Paragard®) | 10 | 12 |
| Copper IUD (Miudella®) | 3 | 3 |
| Levonorgestrel (LNG) 52 mg IUD (Mirena® or LILETTA®) | 8 | 8 |
| LNG 19.5 mg IUD (Kyleena®) | 5 | 5 |
| LNG 13.5 mg IUD (Skyla®) | 3 | 3 |
How should I discuss extended use with patients?
When placing a copper IUD, you can explain how the FDA label and the evidence on duration may differ. For implant users counseled before January 2026, let them know their implant is now approved for five years from the day it was placed. At each visit, talk with your patient about how long they want to continue using their method, which is another chance to revisit how long it works. For patients who were over 30 when their copper 380 mm2 IUD was placed, SFP says continued use until menopause can be considered.
For patients who’ve reached the FDA-approved duration and want to keep their method, you can let them know it’s safe and effective to continue up to its evidence-based duration.
Removing and replacing it is just as reasonable if that’s what they prefer. If a patient wants their IUD or implant out, remove it promptly, for any reason, at any time.
Here’s how that conversation might sound as an ASA Cycle (Affirm, Share, Ask) with a patient whose implant is at three years:
- Affirm: “A lot of people were told their implant lasts three years, so it makes sense to check in about it.”
- Share: “The FDA now approves it for five years, including implants already in place, like yours.”
- Ask: “How do you feel about keeping it for now?”
Back to our scenario – Do you remove and replace their implant today?
It depends on what they want!
After three years, R.D.’s implant is still effective, and it’s FDA approved for two more years. If R.D. wants to keep their implant, they can. If they were told at placement that it lasts three years, they may feel more comfortable replacing it today, and that’s a reasonable choice too.
Key Points
- As of January 2026, the implant is FDA approved for up to five years, including implants already in place.
- LNG 52 mg IUDs have been FDA approved for eight years since November 2022.
- Data support effectiveness of the copper 380 mm2 IUD (Paragard®) to 12 years, beyond its 10-year FDA approval.
- Extended use of IUDs is evidence-based and supported by major medical organizations, including ACOG and SFP.
- Continuing beyond FDA labeling is reasonable, but so is removing and replacing the method if that’s what the patient prefers.