Nexplanon and hair loss is a concern raised by some users of this popular contraceptive implant. Nexplanon releases etonogestrel, a synthetic progestogen, continuously for up to three years, offering highly effective contraception. Whilst most people tolerate it well, hair shedding or thinning is listed as an uncommon adverse reaction in the Nexplanon Summary of Product Characteristics. Understanding whether the implant is truly responsible — or whether other factors such as nutritional deficiencies, thyroid dysfunction, or stress are involved — is essential before making any decisions about your contraception.

Can Nexplanon Cause Hair Loss?

Yes — hair loss is listed as an uncommon adverse reaction to Nexplanon, but it is multifactorial and other causes such as thyroid dysfunction or iron deficiency should be excluded before attributing it to the implant.

Experiencing these side effects? Our pharmacists can help you navigate them →

Nexplanon is a small, flexible contraceptive implant inserted under the skin of the upper arm. It releases a synthetic progestogen called etonogestrel continuously over up to three years, providing highly effective contraception. Whilst Nexplanon is well tolerated by the majority of users, some individuals report changes to their hair, including increased shedding or thinning, during use.

Hair loss (medically referred to as alopecia) is listed as an uncommon adverse reaction in the Nexplanon Summary of Product Characteristics (SmPC), meaning it is estimated to affect between 1 in 1,000 and 1 in 100 users (≥1/1,000 to <1/100). It is important to note, however, that hair loss is a multifactorial condition, and in many cases there is no confirmed causal link between the implant and hair changes. Factors such as nutritional deficiencies, thyroid dysfunction, stress, and other hormonal fluctuations can all independently contribute to hair shedding.

Within general pharmacovigilance frameworks, hormonal contraceptives are recognised as a potential contributing factor to hair changes in susceptible individuals, but causality is not always straightforward to establish. If you notice significant or distressing hair loss after having Nexplanon fitted, it is worth discussing this with your GP or sexual health clinician rather than assuming the implant is definitively responsible. A thorough assessment can help identify or rule out other underlying causes before any decisions about contraception are made.

If you experience hair loss or any other suspected side effect whilst using Nexplanon, you can report it directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the Yellow Card Scheme at yellowcard.mhra.gov.uk. Reporting helps the MHRA monitor the safety of medicines and medical devices in the UK.

Not sure if this is normal? Chat with one of our pharmacists →

How Progestogen Hormones May Affect Hair Growth

Etonogestrel's mild androgenic activity may shorten the anagen (growth) phase and trigger telogen effluvium in susceptible individuals, though this mechanism is theoretical and not conclusively proven in large-scale trials.

To understand why Nexplanon might be associated with hair changes in some users, it helps to understand the normal hair growth cycle. Hair follicles cycle through three phases: anagen (active growth), catagen (transition), and telogen (resting and shedding). Hormones play a significant role in regulating these phases, and shifts in hormonal balance can disrupt the cycle.

Etonogestrel, the progestogen in Nexplanon, has a relatively low androgenic activity compared with some older progestogens. It is theorised — though not conclusively proven in large-scale clinical trials — that progestogens with even mild androgenic properties may, in susceptible individuals, influence androgen-sensitive hair follicles. This could potentially shorten the anagen phase and push more hairs into the telogen phase prematurely, a process known as telogen effluvium. The result is diffuse shedding, typically noticed two to four months after a hormonal change, rather than patchy or localised hair loss. These mechanistic explanations are plausible but should be understood as theoretical; the British Association of Dermatologists (BAD) and the Primary Care Dermatology Society (PCDS) note that telogen effluvium has many potential triggers beyond hormonal contraception.

Additionally, some individuals are genetically predisposed to androgenetic alopecia (pattern hair loss), and hormonal contraceptives may unmask or accelerate this tendency in susceptible people. It is worth noting that:

• Not all progestogens carry the same degree of androgenic activity

• Individual sensitivity to hormonal changes varies considerably

• Etonogestrel's androgenic activity is considered low, but not absent

The Faculty of Sexual and Reproductive Healthcare (FSRH) guidance on progestogen-only implants acknowledges that hormonal side effects, including hair changes, are reported by some users, but notes that the evidence base for a direct causal mechanism remains limited. Further research is needed to draw firm conclusions about the precise mechanism and frequency of this effect.

How Common Is Hair Loss With the Contraceptive Implant?

The Nexplanon SmPC classifies alopecia as uncommon, occurring in 1 in 1,000 to fewer than 1 in 100 users, though real-world reports suggest hair changes may be experienced more widely.

Establishing the true prevalence of hair loss associated with Nexplanon is challenging, partly because hair shedding is common in the general population regardless of contraceptive use, and partly because clinical trials do not always capture subjective or cosmetic side effects comprehensively. According to the Nexplanon SmPC, alopecia is classified as an uncommon adverse reaction, occurring in ≥1/1,000 to <1/100 users.

In real-world settings, anecdotal reports and online patient communities suggest that hair changes may be experienced by a broader group of users than clinical trial data implies. However, self-reported data must be interpreted cautiously, as confirmation bias and the absence of a control group make it difficult to attribute hair loss directly to the implant.

It is also worth considering that some individuals experience temporary hair shedding in the weeks or months following insertion of Nexplanon, which may reflect the body adjusting to a new hormonal environment rather than an ongoing side effect. In many cases, shedding stabilises or resolves without any intervention. Persistent or progressive hair loss that continues beyond three to six months of implant use warrants further investigation to exclude other causes, including:

• Iron deficiency — a common and treatable cause of diffuse hair loss; ferritin is the most sensitive marker

• Thyroid disorders — both hypothyroidism and hyperthyroidism can cause shedding

• Nutritional deficiencies — particularly low ferritin or folate, if suggested by clinical history

• Polycystic ovary syndrome (PCOS) — associated with androgenic hair changes

If you notice features such as scalp pain, tenderness, redness, scaling, or rapidly spreading patchy loss, seek prompt medical advice, as these may suggest a scarring alopecia or other condition requiring more urgent assessment. Understanding the broader context of an individual's health is essential before attributing hair loss solely to Nexplanon.

Managing Hair Loss While Using Nexplanon

The first step is to identify and treat concurrent causes via GP blood tests; gentle hair care, adequate nutrition, and — where appropriate — clinician-led topical minoxidil may also help.

If you are experiencing hair loss whilst using Nexplanon and wish to continue with this method of contraception, there are several practical steps that may help manage the condition. The first priority is to identify and address any concurrent causes. Your GP can arrange blood tests in line with UK primary care guidance; first-line investigations typically include a full blood count (FBC), serum ferritin, and thyroid-stimulating hormone (TSH). Additional tests — such as B12, folate, or coeliac serology — may be considered if your history or examination suggests a specific cause, but are not routinely recommended for all presentations of diffuse hair loss.

Correcting an underlying deficiency — for example, with iron supplementation where ferritin is low — can significantly improve hair shedding independent of any contraceptive change.

From a hair care perspective, gentle handling of the hair can reduce mechanical stress on already vulnerable follicles. This includes:

• Avoiding tight hairstyles such as ponytails or braids that place traction on the scalp

• Minimising heat styling with straighteners or blow dryers

• Using mild shampoos to reduce scalp irritation

• Ensuring adequate dietary protein and micronutrient intake, as hair follicles are metabolically active and nutritionally sensitive

In some cases, a dermatologist may consider topical minoxidil. In the UK, topical minoxidil is available over the counter and is licensed for the treatment of androgenetic alopecia (pattern hair loss) in adults. It is not a standard treatment for telogen effluvium, and any use outside its licensed indication should be clinician-led. Before starting minoxidil, discuss this with a pharmacist or clinician. Minoxidil should not be used during pregnancy or breastfeeding, and should be discontinued before attempting to conceive. The British Association of Dermatologists provides patient information on female pattern hair loss and its management.

Patience is also important — hair regrowth, when it occurs, is typically slow, and visible improvement may take three to six months or longer. Keeping a record of hair shedding patterns can be helpful when discussing progress with a clinician.

When to Speak to a GP or Sexual Health Clinician

Seek prompt advice if hair loss is rapid, severe, patchy, accompanied by systemic symptoms, or has persisted for more than three to six months without improvement.

Whilst some degree of hair shedding can be a normal and temporary response to hormonal changes, there are circumstances in which it is important to seek professional advice promptly. You should contact your GP or sexual health clinician if:

• Hair loss is rapid, severe, or distressing

• You notice patchy or localised hair loss, which may suggest alopecia areata — an autoimmune condition unrelated to contraception

• You notice scalp pain, tenderness, redness, scaling, or broken hairs, which may indicate a scarring alopecia requiring more urgent dermatology assessment

• Hair loss is accompanied by other symptoms such as fatigue, weight changes, skin changes, or irregular periods, which could indicate an underlying systemic condition

• Hair shedding has persisted for more than three to six months without improvement

• You are concerned about the psychological impact of hair loss on your wellbeing

Your GP can carry out a thorough assessment, including a detailed history and targeted blood tests, to help determine the most likely cause. If an underlying condition such as thyroid disease or iron deficiency is identified and treated, hair loss often improves without any need to change contraception.

If investigations are normal and hair loss is thought to be related to Nexplanon, your clinician can discuss the options with you in a balanced and non-pressured way. Referral to a dermatologist with an interest in hair disorders may be appropriate in complex or persistent cases. The NHS also provides access to psychological support if hair loss is significantly affecting your mental health or self-esteem, and your GP can facilitate this referral.

You can also report any suspected side effect from Nexplanon to the MHRA via the Yellow Card Scheme at yellowcard.mhra.gov.uk. This helps ensure that the safety of medicines continues to be monitored across the UK population.

Alternatives to Consider If Hair Loss Is a Concern

Non-hormonal options such as the copper IUD avoid androgenic effects entirely; combined pills containing low-androgenic progestogens may benefit some, but suitability must be assessed using FSRH UKMEC criteria.

If hair loss is significantly affecting your quality of life and is thought to be linked to Nexplanon, it is entirely reasonable to explore alternative methods of contraception. Removal of the implant is straightforward and can be carried out at any time by a trained clinician. Fertility typically returns quickly after removal, often within days to weeks.

When considering alternatives, it is helpful to think about whether a hormonal or non-hormonal method would be preferable. Options include:

• Combined oral contraceptive pill (COCP) — pills containing oestrogen alongside a progestogen with low androgenic activity (such as desogestrel or norgestimate) may be beneficial for hair in some individuals, as oestrogen supports the anagen phase. However, the COCP is not suitable for everyone, particularly those with a history of migraines with aura, certain clotting disorders, or cardiovascular risk factors. Suitability should be assessed using the FSRH UK Medical Eligibility Criteria (UKMEC).

• Levonorgestrel intrauterine system (IUS) — such as Mirena or Kyleena, which release progestogen locally within the uterus. Systemic levonorgestrel levels are lower than with oral methods, but systemic absorption does occur and hormonal side effects — including acne and, as noted in the Mirena and Kyleena SmPCs, alopecia — can still be reported by some users. The LNG-IUS may suit some individuals but is not guaranteed to resolve hair concerns.

• Copper intrauterine device (IUD) — a fully non-hormonal option that does not influence androgen levels or the hair cycle. It is highly effective and suitable for long-term use, and is a reasonable choice for those wishing to avoid hormonal methods entirely.

• Progestogen-only pill (POP) — desogestrel-based pills (such as Cerazette) have a similar hormonal profile to Nexplanon, so may not resolve hair concerns, but some individuals respond differently to oral versus implanted delivery.

Any decision about changing contraception should be made collaboratively with a clinician, taking into account your full medical history, contraceptive needs, and personal preferences. Relevant UK guidance includes NICE CG30 (Long-acting Reversible Contraception), NICE CKS Contraception, and FSRH clinical guidelines and UKMEC, all of which support a person-centred approach to contraceptive choice.

Frequently Asked Questions