When you have Norplant inserted, your practitioner will prob- ably give you a booklet for writing down the date the capsules were inserted, by whom and where, and when they should be removed.
You should store this somewhere for future reference. If you keep a calendar, you can record this information and then carry it forward to your new calendar every year so you know when you must have your implants removed.
Norplant capsules should be removed after 5 years because after this time they gradually become less effective. They also can be taken out at any earlier time and for any reason.
As with the insertion, you should make sure that the nurse or doctor who will be doing the removal has been trained to perform the procedure.
Removal can be more difficult than the insertion. The incision for removal may need to be a bit longer than the original. A local anesthetic is injected at the end of the capsules. If you still feel some pain, tell your practitioner so you can be given extra anesthetic.
Because they are visible with either x-rays or ultrasound, Norplant
capsules are easily located. On rare occasions, a second visit is
needed to get out all the capsules.
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After the removal procedure, you will have some swelling and bruising similar to the aftereffects of the insertion. These will wear off in a few days. If your arm is very uncomfortable, ask your provider about taking something to ease the pain.
As soon as the capsules are removed, you will need to have another set inserted or start using another method if you want to avoid pregnancy.
COST
The Norplant implant alone costs $365. The practitioner’s fee for the insertion procedure is additional and will vary, depending on whether it is done by a private physician or in a publicly funded clinic, and can range from $50 to $400. If you keep your capsules for the full 5 years, the cost averages out to approximately $80 to
$150 a year.
Most or all of the cost of a Norplant insertion—the implant plus the insertion—is covered by Medicaid in many states, as well as by some health insurance plans. HMOs charge their usual modest co- payment for the exam and insertion.
If the removal procedure is not covered by insurance, low-in-
come women may be able to obtain funding through the Norplant
Foundation. For more information about financial help for remov-
ing Norplant, call 1-800-760-9030.
. 10 .
Depo-Provera
Depo-Provera is another progestin-only birth control method. It is an injection that protects against pregnancy for 3 months. Al- though Depo-Provera has been available for years in over 90 other countries and has been used by millions of women, it did not receive FDA approval in the United States until 1992. Since then it has become an extremely popular contraceptive, and at some women’s clinics it rivals the Pill in the number of women using it.
The progestin used in the injection, Depo-medroxyprogesterone acetate (DMPA), inhibits ovulation by suppressing the amounts of luteinizing hormone and follicle-stimulating hormone that a woman’s body usually produces in order to ovulate. Like other progestins, DMPA also makes the uterus inhospitable to any possible fertilized egg, and thickens the cervical mucus so it discourages the passage of sperm.
After the injection, the DMPA acts like a timed-release “depot”
of progestin in the muscle. Low levels are released constantly into the circulation until the depot is exhausted.
Depo-Provera injections are given once every 3 months to main- tain contraceptive impact and are more than 99 percent effective.
Studies thus far show no serious side effects from the use of DMPA.
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Like the other progestin-only methods, however, Depo-Provera gen- erally causes many months of irregular bleeding, usually followed by no bleeding at all.
Like all hormonal methods, injections of DMPA do not protect against AIDS or other sexually transmitted diseases.
EFFECTIVENESS AND REVERSIBILITY
Depo-Provera is highly effective as long as you are consistent in returning to the clinic for your next shot. When it is discontinued, however, normal fertility may not return as readily for some women as it does when other progestin-only methods are stopped.
Failure Rate
The failure rate for Depo-Provera is less than 1 percent. The injection (150 mg) is designed to last a little longer than 3 months, just in case it is not possible to return to the clinic or physician’s office exactly on schedule.
Reversibility
The effects of Depo-Provera do not disappear as rapidly as the other progestin-only methods, and a number of months may pass after the last injection before fertility is restored. Studies found that 68 percent of the women who did become pregnant after discontinu- ing Depo-Provera did so within 12 months. Almost all women conceived within 18 months after the last injection. Women with lower body weights became pregnant sooner than women with higher body weights. The length of time it took to become pregnant was not related to the duration of Depo-Provera use.
This long-lasting effect does not apply to all women, however. If
you give up this method but do not wish to become pregnant, to be
safe you must start using another contraceptive method within three
months after your final Depo-Provera injection.
IN A NUTSHELL
Dalam dokumen
the whole truth about - con• •tra cep• •tion
(Halaman 141-145)