Norplant does not protect you against STDs, including AIDS

Norplant is a birth control method that uses six tiny capsules that con- tain a progestin. They are placed just under the skin on the inside of the upper arm. In most women they are barely visible.

The capsules are porous, which means they allow small, regular amounts of progestin to pass into the body and prevent pregnancy.

They hold enough progestin to last for 5 years.

Before the capsules are inserted, the skin is made numb in that part of your arm. Then the capsules are inserted with an instrument like a fat ballpoint pen.

The most common side effect is irregular bleeding. This irregularity varies from woman to woman. Some have prolonged menstrual bleeding during the first months afterwards or untimely bleeding or spotting be- tween periods, no bleeding at all, or a combination of these.

With Norplant, there is nothing to remember and no prescription to refill every month. It is extremely effective, yet after it is removed, your periods start again and you can get pregnant almost right away.

Although having Norplant inserted is expensive, it costs less than 5 years of most other types of contraceptives.

Norplant does not protect you against STDs, including AIDS.

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know you are using a contraceptive. (5) Although the up-front cost is high, when compared to the expense of 5 years of other methods, it is much cheaper than most.

Norplant’s greatest disadvantage is that having it inserted and removed is expensive. In addition, the removal procedure can be uncomfortable, and the bleeding irregularities can be annoying to some women.

When Norplant is inserted, there is an initial surge of hormone that gradually diminishes until the capsules are delivering only a little bit of progestin every day. This means that only a tiny amount of hormone is necessary to produce a good contraceptive effect. The low dose of progestin and the absence of estrogen make Norplant a very safe contraceptive method.

Like the minipill, the progestin in Norplant prevents pregnancy

by thickening the cervical mucus so it is difficult for sperm to pen-

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FIGURE 9.1 Norplant Capsules in Place in Upper Arm.

Pictured larger than actual size

etrate. It also inhibits ovulation so eggs are not produced regularly, and it makes the womb inhospitable to a fertilized egg.

The Norplant tubes are made of the same silicone used for other medical devices such as some heart valves. Tubing made of this material has been used safely in surgical procedures since the 1950s.

The Norplant capsules are tiny and contain 100 times less silicone than do silicone gel breast implants.

The six capsules are placed under the skin through a single small puncture-type incision that is about 1/8 inch wide, using an instru- ment that resembles a fat ballpoint pen with a sharp tip (Figure 9.1).

The procedure generally takes 10 to 20 minutes and is done with a local anesthetic injected near the area. No stitches are required. If you are right-handed, the capsules are inserted in the left arm; if you are left-handed, the right arm is used. A health care provider who inserts Norplant should be specially trained before he or she per- forms this procedure.

The capsules can be removed at any time; fertility returns almost immediately afterwards. At the end of the fifth year, the method begins to become less effective, so if you want to continue with it, the old capsules must be replaced with new ones.

This system of long-lasting hormonal implants has been used in

other countries since 1983, and was approved in the U.S. in late 1990. More than three million women around the world have now used Norplant. Women like this method because they do not have to remember to take a pill every day or interrupt their lovemaking to insert something.

Norplant does not protect against sexually transmitted diseases.

EFFECTIVENESS AND REVERSIBILITY

Norplant is a highly reliable form of birth control, because there are no pills to forget or prescription to renew. Yet normal fertility returns very soon after the capsules have been removed.

Failure Rate

Although its hormone dose is extremely small, the failure rate for Norplant during the first 12 months after insertion is just under 1 percent. Over a 5-year period of use the failure rate is a bit more than 1 percent.

The implants begin releasing hormone directly into the blood- stream immediately after insertion. If you get the implants during the first 7 days of your menstrual cycle, no backup method is needed.

If the insertion takes place at any other time during your monthly cycle, you will need backup contraception during the first 24 hours.

Reversibility

When the Norplant capsules are removed, it is possible to con-

ceive quite soon, so you must start on another method of birth

control the same day if you do not want to get pregnant. This is in

contrast to women who discontinue oral contraceptives containing

estrogen and progestin, who sometimes find that several months or

more may elapse before they are ovulating regularly again and are

able to conceive.

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