WHO’s new contraception guidelines, published on 23 September 2026, support the etonogestrel implant for up to five years, following five-year licences in the US and UK. The change could mean fewer procedures and lower costs for women and health systems, although the US approval came with new training rules for clinicians.
On 23 September 2026, the World Health Organization published new guidelines on expanding contraceptive options. They cover extended use of the etonogestrel implant, a small rod placed under the skin of the upper arm. In its news release the same day, WHO said it supports implant use for up to five years.
WHO writes its guidelines to help ministries of health decide what to include in national programmes. Each country can now weigh a longer duration, two years beyond the original three-year label. WHO says this could mean fewer replacement procedures, fewer clinic visits and lower costs.
The same guidelines recommend extended use of combined oral contraceptive pills, for up to six months or continuously for up to one year. They also add mifepristone as an emergency contraception option, taken within five days of unprotected sex. WHO says it “aims to support countries in updating their policies and plans” to reflect the changes. Our report on the WHO guidelines covers the full package.
What a longer duration means in lower-income countries
WHO estimates that 164 million women who want to delay or avoid pregnancy aren’t using contraception, according to its family planning fact sheet. That figure comes from 2021 data, the latest available. For many of these women, each clinic visit costs time and money.
FP2030, the global family planning partnership, published an evaluation of the Implants Access Program in 2020. It found that volume guarantees with manufacturers cut implant prices by about 50%. Procurement rose tenfold between 2010 and 2018, with case studies in Kenya, Nigeria and Uganda.
A five-year duration lets programmes stretch each device over a longer period. The FP2030 evaluation linked better supply chain visibility to fewer stock-outs, and a longer-lasting device reduces how often each woman needs a new one. National programmes will still need to update their own guidelines and train staff before the change reaches clinics.
Two regulators moved first
In January 2026, the US Food and Drug Administration (FDA) extended the implant’s labelled duration from three to five years. The UK’s Medicines and Healthcare products Regulatory Agency approved the same change in May 2026. The UK’s College of Sexual and Reproductive Healthcare (CoSRH) confirmed in a May 2026 statement that the product information and patient leaflet now reflect five years.
Both approvals rest on a single US trial. It enrolled women who had already used the implant for 36 months and followed them through years four and five. According to manufacturer Organon, 399 women aged 18 to 35, with a mean age of 27, took part. No pregnancies occurred in the extra two years, and the trial reported no new safety findings.
The trial included women across a wide range of body weights, with body mass index from 17.2 to 64.3. Earlier trials supporting the three-year licence had excluded women above 130% of ideal body weight, according to Organon UK. Women with higher body weight now have trial evidence specific to them.
In 2022, the US Society of Family Planning advised clinicians to counsel patients that the implant’s effectiveness is maintained beyond its labelled duration. It gave that recommendation its highest evidence grade. The new approvals bring the official label in line with that practice.
The US trial had no comparison group and took place in one country. Participants were 35 or younger, so the data say less about women in their late 30s and 40s. CoSRH notes the young study population in its statement.
Training rules for US clinicians
The FDA paired its approval with a Risk Evaluation and Mitigation Strategy (REMS), a programme that restricts how a medicine is supplied. Its purpose is to reduce complications from incorrect insertion and removal. Deep insertion can damage nerves or blood vessels, and a misplaced implant can be hard to remove.
Under the REMS, which began on 23 February 2026, only certified clinicians can obtain the implant. Organon told clinicians to complete certification by 23 August 2026 to keep access. From that date, clinicians without certification lost the ability to order the implant until they certified, according to the California Medical Association. Pharmacies and distributors must also register.
Anita Nelson, Professor of Obstetrics and Gynecology at Western University of Health Sciences, said in Organon’s January release that “The REMS program builds on existing training requirements”. Certification involves an online knowledge test and enrolment form. Clinicians without current training must first complete Organon’s online and in-person programme, according to the Reproductive Health Access Project.
The Reproductive Health Access Project compared the implant REMS with restrictions on mifepristone. It said the pattern “elicits a concern that there may be increasing and unnecessary barriers to reproductive health care”. It noted that the FDA introduced the REMS despite a low overall rate of complications.
Checking an implant you already have
Women with an etonogestrel implant can check its insertion date and ask their clinician whether it can stay in for five years. The trial behind the approvals studied exactly this group: women who kept an existing implant beyond three years. In the UK, the patient leaflet now reflects the five-year duration, according to CoSRH, so women can check it there too. In the US, only clinicians certified under the REMS can now obtain the implant.
Women over 35 can ask how the evidence applies to them, since trial participants were younger. Anyone who can’t feel their implant under the skin should seek advice, as Organon’s safety information says it should be palpable after insertion. The implant doesn’t protect against HIV or other sexually transmitted infections.
WHO’s new guidelines frame the five-year implant as one option among several. “Choice is a gender equality issue,” said Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing. “Contraception isn’t one-size-fits-all.” She added: “Real choice means the confidence and control to choose a method, change it, or stop it.”
This article is for information only and does not replace advice from a qualified health professional.
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