Norplant facts

August 13, 1991|By George Huggins, M.D., Francis Scott Key Medical Center Francine Sinofsky, M.D., Robert Wood Johnson Medical Center, New Jersey Planned Parenthood Population Council Maryland Department of Health Wyeth-Ayerst Laboratories.

How long has Norplant been around? The first implants were tested in 1968. It was available for general use in Finland in 1983. Norplant was first introduced in the United States in 1990. In clinical studies worldwide, 55,000 women have participated since 1973.

How does it work? Simultaneously, three stages are set that are hostile to conception: The progestin in Norplant fools the body into thinking it has ovulated, so it doesn't. The cervical mucus makes access to the uterus rough going for sperm. And the endometrium -- the lining of the uterus dispensed during menstruation -- rejects any attempts to be implanted by a fertilized egg should the sperm make it through the cervix.

How soon does it work? Effective within 24 hours. When removed, fertility resumes within 72 hours.

Do I need a backup method? "We haven't seen anybody get pregnant in the first or second month in our study," if the implant is inserted within seven days of a menstrual cycle, says Dr. Francine Sinofsky, chairman of the obstetrics and gynecology department at Robert Woods Johnson Medical Center in New Jersey.

Does it hurt; does the implant impede movement? No. A local anesthetic is used. However, the insertion procedure can leave a bruise on the arm that lasts a week or longer.

Does the implant disintegrate or move? The Siliastic used in Norplant has been used in heart valves and hip replacements for 20 years and is not the same used in breast implants. The implants do not migrate from the arm. Tests showed implants in other areas might migrate.

What are the potential side effects? Irregular menstrual bleeding, acne, weight gain, nausea, dizziness,skin rash, appetite change, ovary enlargement, excessive facial or body hair growth, water retention, bloating and moodiness have been reported in studies. Health-care officials say the side effects are mild and symptoms usually abate after the first year of use.

Can I have it removed before five years? Yes.

Can I get it again? New implants can be gotten in five, 10 or 15 years. No long-term effects have been seen in long-term studies.

Why is it so expensive? Wyeth-Ayerst Laboratories, the U.S. distributor, charges $300 for the Norplant kit that is manufactured in Finland. The doctor or health-care provider usually charges an additional $200 to $500. All costs are one-time and upfront. The cost of five years of birth control pills is about $900.

Many insurance companies cover Norplant, including Blue Cross-Blue Shield. Many health maintenance organizations started covering the procedure Aug. 1. Medical Assistance pays for it, too, and the state has a program that helps pay for the kits.

What's the future of implants?

Other birth-control capsules being tested include those that dissolve and those of varying durations.

How does this compare with the pill? Norplant eliminates the daily responsibility of remembering to take a pill. With Norplant, a woman may experience unpredictable menstrual bleeding and other side effects. Norplant does not have estrogen and its progestin component is a lower dose than the pill.

The pill, however, creates regular, predictable cycles with which some women feel more comfortable and reliable. The estrogen component is thought to introduce such side effects as elevated cholesterol; difficulty for diabetics to regulate insulin; hypertension; and changes in the clotting factor that can lead to strokes.

As patients age, doctors often recommend that they cease taking the pill. Norplant, however, can be used by women who are in their late 30s and older.

Can smokers use Norplant? Dr. Francine Sinofsky says "yes. Of course, we try to get our patients to quit smoking, but smokers can use Norplant. The problems with smoking and birth control pills are estrogen related."

Who shouldn't use Norplant? Women with acute liver disease or cancerous or non-cancerous liver tumors; unexplained vaginal bleeding; breast cancer; or blood clots in the legs, lungs or eyes.

Women with the following are not precluded from Norplant, but should discuss these conditions with their health-care providers first:

Women weighing more than 150 pounds; women with breast disease, diabetes, elevated cholesterol or triglycerides, high-blood pressure, headaches, gallbladder, heart or kidney disease, and women with a history of scanty or irregular periods.

Does it interact with other drugs? "There's not enough data to know for sure. But there's little data to suggest that there are higher pregnancy rates in women using antibiotics" like tetracycline, said Dr. Sinofsky. However, the prescriptions Dilantin or Tegretol reduce the effectiveness of Norplant.

Does Norplant have an effect on premenstrual syndrome?

Anecdotal evidence suggests that women may experience lesser premenstrual syndrome. No clinical studies have been conducted to validate that experience.

Do underage patients need parental consent? Some HMOs require a guardian to give permission in person. Planned Parenthood does not require parental consent.

Does it guard against sexually transmitted diseases? Emphatically, no. Norplant protects against pregnancy. It does not protect against AIDS or any other disease.

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