NORPLANT, THE new contraceptive implant that protects against pregnancy up to five years, is stirring interest from women across the state. Planned Parenthood of Maryland reports receiving several hundred phone inquiries about the device in the last week.
The contraceptive, which consists of six match stick-size capsules placed just under the skin of a woman's upper arm, won U.S. Food and Drug Administration approval in December and is now being distributed by Wyeth-Ayerst Laboratories to practitioners across the country.
The first two implants locally were performed at Francis Scott Key Medical Center last Friday. The first implant at Johns Hopkins Hospital was performed yesterday, and Planned Parenthood expects to insert the contraceptive in its first patients within the next two weeks.
"We've been hearing from women of all ages asking all kinds of questions," says Barbara Kaplan, director of marketing and communications for PPM. "They want to know, 'Will anyone know that I'm on it? Can you see it in my arm? Will I still be able to work out? How soon can I get it?'"
She said most of the calls to the non-profit health care organization's eight centers across the state have been from women in their 20s, even though the implant has been hailed by researchers as suitable for women of all ages.
"The ideal person for Norplant is someone who has had a contraceptive failure or a problem with another method who either has finished her childbearing or doesn't want any children for a substantial period of time," says Dr. George Huggins, chairman of obstetrics and gynecology at Key, where three physicians have been trained to implant the device.
The tiny plastic capsules contain Levonorgestrel, a synthetic hormone that is slowly and continually diffused through the capsule walls into the bloodstream. Levonorgestrel has been used for years in some birth control pills. But unlike the pill, Norplant contains no estrogen, which has been blamed for many of the side effects associated with the pill, particularly in women over 35 who smoke.
The rods are inserted in a fan-like configuration in the non-dominant arm through a 1/8-inch incision. The minor surgical procedure is done with a local anesthetic and takes about 15 minutes in a doctor's office or clinic.
The manufacturer claims a 99.8 percent effectiveness against pregnancy for five years, and fertility is said to return within days after the device is removed from the arm. Norplant has been tested on more than 500,000 women worldwide, says Huggins, who has performed the procedure extensively in Indonesia and has taken part in clinical trials in the United States.
Doctors say that in most cases, the outline of the implant cannot be detected in a woman's arm, and the device will not interfere with one's daily routine as much as remembering to take a pill, although they warn that irregular menstrual bleeding is the major side effect of Norplant.
In fact, disruption of the menstrual cycle was reported by 70 percent of the women who took part in clinical trials, says Dr. Doris Tirado, medical director of Planned Parenthood of Maryland.
Incidence of other side effects -- such as headaches, nausea, acne, weight gain -- are minimal, she says. Tirado and a nurse practitioner on staff who has conducted training sessions nationally for the drug company will be performing Planned Parenthood's first implants at the Howard Street center.
While interest in Norplant here is strong, there are still only a handful of trained professionals locally who can perform the procedure. The first step toward changing that was taken by the Association of Reproductive Health Professionals, which conducted a practicum for area physicians, nurse midwives and nurse practitioners in Towson last week. The 65 clinicians
practiced inserting and removing the device on foam rubber arm models.
"But that's only an introduction," says Tirado, who warns that the practitioners "still need hands-on training" and that the availability of the contraceptive system to Baltimore area women will take time to evolve.
Meanwhile, potential patients need to be counseled in what to expect from the innovative system. "It's very, very important that we explore their reasons for being interested in this particular method," says Tirado. "They need to understand exactly what they're getting into."
While the implant is said to be almost as easy to remove as to insert-- it takes about a half hour -- and can be removed at any time, it is not inexpensive.
The total procedure -- including the cost of the device, pre-insertion and post-insertion exams and counseling -- can run as much as $850. Costs will vary depending on where the procedure is done and what kind of medical insurance a woman has. Some insurers, including the state's Medicaid program, have agreed to pay a portion of the cost under prescription drug plans.
In addition, women need to keep in mind the expense -- difficult to predict -- of removing the device, or replacing it, five years down the road.
"That's another reason continued counseling is so important to women who decide on this method," says Tirado. "The more informed the consumer is, the more accepted it will be."