Etonogestrel
progestogen · hormonal contraception
Our referenceBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
In pharmacological terms, Etonogestrel belongs to the “progestogen (hormonal contraception)” category. This hormone is part of hormonal contraception: taken every day, it prevents ovulation and makes the body unfavourable to pregnancy, reversibly.
For Etonogestrel, in practice: Component of a hormonal contraception. It is generally taken over the long term, within regular monitoring, and is not stopped on your own initiative.
Under which brands it is found
Etonogestrel is found in around 4 presentations listed in France. It is available under various brand names and as generics.
- Etonogestrel/Ethinylestradiol Viatris
- Etoring
- Nexplanon
- Nuvaring
Original brand-name products and generics deliver the same active substance; the choice between them is made with your doctor or pharmacist.
Our product for this treatment
Etonogestrel is one of the everyday treatments for which we have formulated a targeted supplement.
Layer Nutrition Contraception
Vitamin B6 helps you regulate your hormonal activity and reduce tiredness. Folate supports normal blood formation.
- Contributes to the regulation of hormonal activity (vitamin B6)
- Contributes to the reduction of tiredness (B6, folate, B12)
- Contributes to normal psychological function (B6, folate, B12)
B6 10 mg · Folate 250 µg · B2 4.2 mg · B12 50 µg
One bottle, one dose per day. Reduced price from the second box, free delivery from two boxes.
How etonogestrel works
Etonogestrel is a synthetic progestin, the active metabolite of desogestrel. In the Nexplanon implant, it is released continuously under the skin and prevents pregnancy through three actions that work together. It suppresses ovulation, so the ovary no longer releases an egg each cycle. It thickens the cervical mucus, the fluid that closes off the entrance to the uterus and blocks the passage of sperm. Finally, it alters the endometrium, the lining that covers the inside of the uterus.
Once in the bloodstream, etonogestrel circulates bound to transport proteins, about 32 % to SHBG (the globulin that binds sex hormones) and 66 % to albumin. The liver breaks it down using a specific enzyme, cytochrome P450 3A4, often shortened to CYP3A4. Its elimination half-life is around 25 hours, which explains the slow, steady release provided by the implant. This enzymatic pathway is also the key to the drug interactions described further on.
Why the implant is placed and how it is worn
The implant is indicated to prevent pregnancy, with an effectiveness that lasts up to five years. It is a single small rod, inserted under the skin on the inner side of the upper arm by a healthcare professional. It then releases etonogestrel continuously, without any surge. Insertion is ideally done within the first five days of the menstrual cycle, which ensures protection right away.
Its great advantage lies in how simple it is to use. There is no tablet to swallow every day, no strict schedule to keep, no constraint tied to meals. Contraception therefore no longer depends on the regularity of a daily dose. Removal, like insertion, is a matter for the healthcare professional: you do not handle the implant yourself, and any decision to stop is discussed during a consultation.
The effects to know about
The most common effect concerns bleeding. The menstrual pattern changes: irregular and unpredictable bleeding, light spotting between periods, or on the contrary a complete absence of periods. This change in bleeding is the leading reason for stopping the implant, since it led 11.1 % of users to have it removed in clinical trials. The other reasons for discontinuation remain far rarer: emotional lability and weight gain at 2.3 % each, headaches at 1.6 %, acne at 1.3 %, depression at 1.0 %.
Among the effects reported by at least 5 % of users are headaches, in nearly one woman in four (24.9 %), then vaginitis (14.5 %), weight gain (13.7 %), acne (13.5 %), breast pain (12.8 %), abdominal pain (10.9 %) and pharyngitis (10.5 %). Most of these effects remain tolerable and do not require removal of the implant. It is the discomfort linked to bleeding, more than these symptoms, that weighs most heavily in the decision to stop.
Weight, blood sugar and blood pressure
Weight gain comes up often in questions. In the American studies, it averaged around 1.3 kg after one year and around 1.7 kg after two years. These are averages: individual variation can be wider, in either direction. The order of magnitude remains modest over time.
On the metabolic side, the implant can induce slight insulin resistance and small changes in blood sugar, whose clinical significance is not established. The summary of product characteristics therefore recommends closely monitoring women who are prediabetic or diabetic, on the sugar side as well as the lipid side. As for blood pressure, hypertension that develops during treatment, or a rise that antihypertensive treatment fails to control, leads to removing the implant. These points fall under regular medical follow-up.
Interactions and monitoring
Since the liver breaks down etonogestrel via CYP3A4, anything that stimulates this enzyme speeds up its elimination and can lower contraceptive effectiveness. These inducers are numerous: rifampicin, rifabutin, phenytoin, barbiturates, carbamazepine, oxcarbazepine, topiramate, felbamate, griseofulvin, bosentan, efavirenz, aprepitant, rufinamide, as well as products containing St John's wort. This last plant, sold over the counter, deserves particular vigilance because it is often wrongly associated with the idea of harmlessness. Conversely, CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, ketoconazole or grapefruit juice can increase etonogestrel concentrations.
Breastfeeding is compatible with this contraception. Etonogestrel passes into milk in very small amounts, on the order of 178 ng/L at one month and 131 ng/L at four months, and no difference in milk volume or composition has been observed compared with a non-hormonal IUD. Expert opinion considers progestin-only contraceptives acceptable for a breastfeeding woman. Follow-up mainly consists of assessing how well the bleeding is tolerated, checking blood pressure and staying attentive to sugar metabolism in women at risk.
On the plate
A diet rich in micronutrients supports the body whatever the method of contraception. Folate, vitamin B9, is plentiful in lentils, chickpeas and spinach, as well as in broccoli. Vitamin B6 is found in bananas, salmon and sunflower seeds. Zinc is well represented in pumpkin seeds and red meat, while magnesium is concentrated in almonds, dark chocolate and again spinach. These four reference points cover a real share of daily needs.
One point of vigilance deserves to be stated precisely. The literature describing a drop in folate, B6, zinc and magnesium under contraception concerns combined pills, those that pair an estrogen with a progestin. The etonogestrel implant, for its part, delivers only a progestin alone, and this effect on micronutrients is neither established nor demonstrated with it. A targeted intake therefore does not correct a presumed deficiency: it simply completes a plate that, in practice, rarely reaches every reference point. That is the meaning of a supplement conceived in addition to your contraception, never in its place.
Sources
Related molecules
To explore in the « Hormones and contraception » family and its neighbours.
See the whole « Hormones and contraception » family · Back to the atlas
Frequently asked questions
What is etonogestrel?
Etonogestrel is a progestogen used as a hormonal contraceptive, notably as a subcutaneous implant placed in the arm. The leaflet for your contraceptive and your doctor or pharmacist explain how it works and how long it lasts.
What are the side effects of the etonogestrel implant?
The leaflet mainly lists changes in bleeding, headaches, breast tenderness and mood changes. For the full list and what applies to you, refer to the leaflet and speak with your doctor or pharmacist.
Does etonogestrel cause weight gain?
A change in weight is among the effects reported in the leaflet, but how much varies from person to person. If this concerns you, discuss it with your doctor or pharmacist rather than relying on a general figure.
Does the etonogestrel implant stop your periods?
The leaflet states that the frequency, duration and heaviness of bleeding can change, ranging from no periods at all (amenorrhoea) to irregular or prolonged bleeding. Your doctor can tell you what to expect in your situation.
What should you do about irregular or bothersome bleeding with the implant?
This irregular bleeding is common when you first start and often eases over time, according to the leaflet. If it persists or bothers you, see your doctor, who will assess what to do. Do not decide to have it removed on your own.
When is the implant removed, and does fertility return quickly?
Removal is decided with the professional who placed the implant, at the scheduled time or earlier depending on your situation. The leaflet states that ovulation usually returns quickly after removal. For your own case, refer to your doctor.
Does etonogestrel have any drug interactions?
The leaflet warns that some medicines, notably enzyme inducers (antiepileptics, certain antibiotics, St John's wort), can reduce its effectiveness. Tell your doctor or pharmacist about any ongoing treatment and read the leaflet before combining it with another product.
Can you use etonogestrel while breastfeeding?
Progestogen-only contraceptives such as etonogestrel are often considered during breastfeeding according to the leaflet, but the decision rests with your doctor. Discuss the timing of placement and follow-up with them.
Does the etonogestrel implant work right away?
How long it takes to become effective depends on when in your cycle it is placed and may call for extra precautions at first, as the leaflet indicates. Your doctor or pharmacist can tell you what to plan for in your case.
Does hormonal contraception affect your folate status?
Research on hormonal contraception links its use to lower folate status in some people (Palmery et al., Eur Rev Med Pharmacol Sci, 2013). This is an observed association, not a deficiency that is automatically caused. A blood test lets you assess your own situation with your doctor.
Which nutrients should you keep an eye on with etonogestrel-based hormonal contraception?
The same review links the use of hormonal contraceptives to variations in folate, vitamin B6 and magnesium status (Palmery et al., 2013). These observations suggest keeping an eye on these markers rather than concluding there is a systematic shortfall.
Which form is best, and where does the Layer CO01 reference fit in?
For folate, the active form (methylfolate) is preferred and, for B6, pyridoxal-5-phosphate; magnesium is best chosen in a well-absorbed form such as bisglycinate. Layer Nutrition's CO01 reference brings together this folate, vitamin B6 and magnesium angle documented around hormonal contraception.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.