Understanding Contraceptives: Norplant

Norplant is an implanted contraceptive that consists of a synthetic form of the hormone progesterone. It has been available since the FDA approved Norplant in 1990, and adds another alternative to the array of contraceptive options available to women today.

How It Is Used
Norplant can only be prescribed by a health care professional. It is composed of six small plastic capsules that are about the size of matchsticks and are filled with levonorgestrel (synthetic progesterone). These tiny capsules are inserted under the skin of the upper arm through a tiny cut (about 1/8 inch long) that the physician makes. The arm may feel sore for a few days after the insertion of the capsules, but it usually heals quickly.

Norplant is usually started within seven days of the start of a woman’s menstrual period. The capsules can be removed at any time by making another small cut to pull the capsules out through and the effect is quickly reversible, with most women able to become pregnant within a year of its removal.

How Does It Work?
The hormone progesterone is produced by the ovaries during the second half of the menstrual cycle, and is also released during pregnancy. Progesterone has several effects, including causing thinning of the lining of the uterus (endometrium) to make it more difficult for a fertilized egg to implant, and causing the mucous in the cervix to thicken (which helps prevent the entrance of sperm). It also suppresses ovulation, or the maturing and releasing of eggs. Without ovulation, pregnancy cannot occur. The small capsules filled with progestin release the hormone slowly, at a steady rate, for up to five years of protection from pregnancy.

Effectiveness
Norplant is 99.9 % effective, making it more effective than the pill, IUD,diaphragm, or condoms. It’s protection begins within 24 hours of insertion, and it can prevent pregnancy for up to five years, or until the tube is removed from under the skin. Norplant 2 provides protection from pregnancy for up to three years. One advantage of this form of contraception is that the woman does not need to remember to take a daily pill, or to use a barrier form of contraception. But it cannot offer any protection from sexually transmitted diseases such as chlamydia or HIV.

Certain medications can interfere with the effectiveness of Norplant, including some anti-seizure medications and rifampin.

Side Effects
Side effects can include changes in menstrual periods, such as light or irregular periods or increased bleeding; breast tenderness, hair less, acne, depression, weight changes, headache, dizziness, and decreased libido (sexual interest). Many of these side effects lessen after several months.

The implant may be seen or felt in some women, especially those who are muscular or thin. Some darkening of the skin over the implant site can also occur, and is reversible once the implant is taken out. A woman can feel the implants under her skin, but they usually are not noticeable to others. In rare cases, some scarring or infection at the insertion site can occur, and the capsules may migrate or break up, making extraction difficult.

It is important for a woman to notify her doctor if she experiences heavy or prolonged bleeding, missed periods, severe headaches or blurred vision, abdominal pain, or redness and swelling at the insertion site.

Other Benefits
Progesterone offers some protection against uterine cancer and pelvic inflammatory disease. It can also be taken by a mother who is breastfeeding, since progesterone does not affect the quantity or quality of breast milk. Tiny amounts of the hormone are passed to the nursing infant, but at this point it is believed to not cause any ill effects.

Norplant should not be used by a woman if she has abnormal uterine or vaginal bleeding, blood clots, breast cancer, some forms of high blood pressure or liver disease or growths. If a woman has problems with gallbladder disease, irregular or light periods, heart disease, high blood pressure, or seizure disorders, she should notify her medical care provider for their recommendations.

If a woman suspects she may be pregnant, she should not use it.

Norplant is one of several contraceptive options available to women today. Before making a final decision, a woman should discuss factors such as lifestyle, effectiveness, cost, ease of use, and possible side effects with her physician.