Hormonal Birth Control Pelvic Health

Hi friends!
Dr. Kelly here—your friendly, Double Board-Certified Pelvic Floor PT—tackling a question I received last week in the clinic:

"How does hormonal birth control, specifically Nexplanon, affect my pelvic health?"

And actually, the person asked specifically about if Nexplanon had a link to urinary incontinence.  I didn’t know, so I had to look it up.  Let’s unpack that together.

As always, this blog is intended for general education—not personalized medical advice (hi, lawyers 👋). While all references are listed at the end of the blog, when making your own personal medical decisions, please talk to your direct medical team to determine what’s right for you.  

❓What Is Nexplanon?

Nexplanon is a long-acting, reversible contraceptive (LARC) in the form of a tiny implant placed just under the skin of your upper arm. It releases etonogestrel, a type of progestin, and is over 99% effective at preventing pregnancy for up to three years.

It works by:

• Stopping ovulation (no egg released = no fertilization),
• Thickening cervical mucus (so sperm can’t travel easily), and
• Thinning the uterine lining (to reduce the chance of implantation).

It's safe, effective, and fully reversible—removal can be done any time by a trained healthcare professional.

💬 Common Questions I Get as a Pelvic PT

1. Does Nexplanon hurt?

This is one question I cannot answer scientifically, so I will have to resort to “what I know from what clients and providers have told me” (so essentially heresy…but educated heresy).

Clients who have the implant report mild to moderate discomfort during the procedure, that subsides within a few weeks. Medical providers who perform the procedure say they use a local numbing agent to improve comfort during implantation.  But the key is that every person’s pain tolerance is different, and even our own personal pain tolerances vary depending on what’s happening in our lives.  If you are concerned about pain during the procedure, discuss this fear with your doctor, and have a plan in place.  You can also reach out to community forums, etc, and ask other humans about their experiences with local providers and implantation, to choose the best provider for you. 

2. Can Nexplanon help with pelvic pain?

This is a great (and complicated) question, especially from people navigating endometriosis or adenomyosis. 

If you have a uterus, your uterus is lined with a tissue called “endometrium”.  This endometrium is what sheds each month during your period.  Endometriosis & Adenomyosis are conditions where there is “uterine lining-like” tissue growing outside the uterus—sometimes on organs like the bladder or bowel—so when hormones trigger a period, the “uterine lining-like” tissue reacts…so we essentially have a period on the inside of our abdomen.  

Ouch.

So can hormonal contraceptives like Nexplanon help?
Yes—with some caveats.

Suppressing the menstrual cycle (which Nexplanon often does, and oral contraceptives can be set up to do) can reduce monthly inflammation, as well as reduce movement of organs during that inflammation, in both the actual uterine lining, as well as in the “uterine-lining-like” tissues, which may help decrease pain.    A 2021 study by Niu et al. found that etonogestrel implants did significantly reduce pelvic pain in people with endometriosis and adenomysos. But—and this is key—it’s not a cure.

Once periods return, or the implant is removed, the underlying inflammation, lesions, and adhesions are still there, often the pain returns. That’s why excision surgery is still considered the gold standard treatment for endometriosis.

That said, if you’re not ready for surgery or looking to manage symptoms while maintaining contraceptive coverage, Nexplanon, or other hormonal contraceptives, could be a helpful option.

If you have pelvic pain unrelated to endometriosis or adenomyosis, there is no present literature supporting hormonal contraceptives in improving that pain.

3. Is Nexplanon safe if I have a family history of cancer?

This is definitely one to take to your primary care provider or OB-GYN—especially one who understands up-to-date evidence on hormones and cancer risk.

Here’s what the current science says:
A 2025 study by Tuesley et al. found that Nexplanon carries a slightly increased risk of breast cancer, similar to other hormonal contraceptives. This risk tends to return to normal after stopping the medication.

The American College of Obstetricians and Gynecologists (ACOG) recommends individualized risk-benefit discussions for anyone with a personal or family history of hormone-sensitive cancers.

And if you’re not sure where to start? I highly recommend following physicians like Dr. Rachel Rubin or Dr. Kelly Casperson—both are experts in hormones and sexual health.  You can work with them directly, or by following their work, you will learn about more questions to ask, as well as how to find appropriate providers near you.  

4. Can Nexplanon cause urinary incontinence?

Ah, the question that kicked off this blog. Seriously. Someone asked me this last week in the clinic, and honestly…I didn’t know the answer at first. So I went digging.

🔍 According to current research (as of summer 2025), there’s no known link between Nexplanon and urinary incontinence.

But I did find a very interesting 2009 study that I want to geek out with you over:

In 2009, Iliadou et al,  looked at over 10,000 women and found that those using oral contraceptives (the pill) had a significantly reduced risk of:

• Stress incontinence (leaks with coughing, sneezing, jumping),
• Urge incontinence (sudden, strong "gotta go" feelings),
• Mixed incontinence (combo of both).

Even when they adjusted for age, pregnancy, and body weight, these benefits held up.

They also looked at users of levonorgestrel-releasing IUDs (like Mirena), and found no significant increase or decrease in urinary issues.  And Nexplanon is a etonogestrel-releasing agent, which is different than Mirena…so while this is interesting….it leads us back to the question:

“Can Nexplanon cause incontinence?”

Short answer: No.
There is no current evidence that links Nexplanon to increased incontinence, and based on my clinical experience, I’ve never seen it happen in practice either.

But it was a great question, that sparked a great blog post.

👩‍⚕️ Final Thoughts from Dr. Kelly

So that’s your pelvic PT rundown on Nexplanon—what it is, how it works, and what we know (and don’t know) about its effects on the pelvic floor.

As always, this blog is meant to empower you with science-backed information, so you can have real, informed conversations with your care team.

Got questions? Have your own experience to share?
Email us at [email protected]—we’d love to hear from you.

Until next time,

XOXO

Dr. Kelly 💋

Find a Pelvic PT Near You

Schedule an Appointment in-person or online!

Follow on Instagram

For every four online courses sold, one is donated to someone in need through our People Before Profits program. LEARN MORE 

📚 References:  (It’s True, You Can Look it Up!)

• Iliadou A, Milsom I, Pedersen NL, Altman D. Risk of urinary incontinence symptoms in oral contraceptive users.Fertil Steril. 2009. PMC4442795
• Niu X et al. Effects of Etonogestrel implants on pelvic pain in adenomyosis or endometriosis. Medicine. 2021. DOI: 10.1097/MD.0000000000024597
• Rocca ML et al. Safety and Benefits of Contraceptives Implants: A Systematic Review. Pharmaceuticals. 2021.
• Rosenthal MA, McQuillan SK. What do I need to know about the etonogestrel-releasing implant? Paediatr Child Health. 2021.
• Tuesley KM et al. Progestin-based contraceptives and cancer risk. J Natl Cancer Inst. 2025. DOI: 10.1093/jnci/djae282