Norplant: birth control option finds favor

August 13, 1991|By M.K. Guzda | M.K. Guzda,The Evening Sun

REGINA SMITH wanted her tubes tied.

She was 17 and had just given birth to her daughter, Crystal.

She didn't want another unplanned pregnancy, but her doctors told her that, as a rule, they don't sterilize teen-agers.

After her daughter was born 18 months ago, the South Baltimore woman used no birth control method, she says. "I won't take the pills," she says adamantly, shaking her head while hoisting baby Crystal on her hip. "They're a pain and a hassle to remember every day."

The pain and hassle were reduced last week, when, in a 20-minute procedure, a midwife inserted into Regina Smith's upper arm a birth control implant lasting five years.

Introduced in April to the Baltimore region, Norplant offers women one of the hormones used in birth control pills at a lower dose and without the panic felt when a pill is forgotten. Now that more medical professionals have received training and more women have learned about the option, demand has increased since the first implants were offered in March.

"This has given women an incredibly good option that is long overdue," said Dr. George Huggins, chairman of obstetrics and gynecology at Francis Scott Key Medical Center, where more than 200 implants (and no removals) have been performed. Since February, 35,000 to 40,000 women in the United States have obtained the implant, according to its distributor.

Effective within 24 hours, the implants -- six silicon-rubber capsules about 1 1/2 inches long and one-tenth of an inch wide -- are slid under the skin of the upper arm. The area is numb from a local anesthesia and the tiny in cision is taped. No stitches are needed.

Powdered crystals of levonorgestrel, a synthetic hormone used as a companion to estrogen in birth control pills, leech through the tiny straws and slowly seep into the woman's bloodstream.

The war on sperm is three-pronged with Norplant: Not only does ovulation cease, but a thickening of cervical mucus barricades sperm's travels and the lining of the uterus is made inhospitable to a fertilized egg.

The dose of 85 micrograms when first inserted trickles down to 50 micrograms by nine months, 35 micrograms by 18 months and then levels off to about 30 micrograms until year five, when the implant should be replaced.

By comparison, birth control pills, which are diluted by digestion, use 50 to 150 micrograms of progestin, plus estrogen.

"The uniqueness is certainly in the method of delivery," said Barbara Kaplan, spokeswoman for Planned Parenthood, where 144 implants have been done and the waiting list has dozens of names. "I think it's very revolutionary."

Robin Allen, 34, and mother of four, says the revolution is a tad late but nonetheless welcome.

This is it," she said, shaking her head and criss-crossing her hands like an umpire calling the runner safe. "I love my children to death, but I don't want any more."

Her 4-month-old daughter, Janiece, dolled up in white lace and tiny gold earrings, is cuddled on her's mother's lap. Allen answers a question about where her three boys go to school with a 10-minute, breathless description of their best and worst subjects.

The East Baltimore woman wanted a birth control method as nearly permanent as having her tubes tied, she says, but she also wanted to avoid surgery.

"This is it."

She received the implant last week, after a 30-minute patient-education session and several pages of literature about Norplant. There was a little bruising on her arm where the Norplant was inserted but the procedure "was a breeze," she says. "Nothing like what I thought it would be. It wasn't a problem. I feel the same as I did the day before."

A year after getting Norplant as a test patient, Jennifer Kelly, 20, and a University of Maryland student, is also pleased.

"When I was on the pill, I thought it was the best thing. But . . . Norplant, it's even better."

Kelly said she's been spared the side effects that can come with Norplant, the main culprit being unpredictable menstrual bleeding.

"I had my period in May and not again 'til February," says Kelly, who will work this fall at the university's health center as a peer counselor, talking to women about Norplant.

Unlike the pill, which regulates the menstrual cycle so predictably that a person can plan a vacation on it, Norplant makes the cycle variable, random and inconsistent.

In the absence of estrogen -- the cycle regulator in the pill -- the lining of the uterus builds up until each individual body dispenses with it. The usual cyclical bleeding patterns are replaced by intermittent and random sloughing of the uterus, or menstruation.

For some women, it could be four-day periods every two weeks. For others, it could be eight-day periods every two months. For others, like Kelly, periods can come once every eight months. Every woman's response is different, say physicians.

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