Last year, a variety of long-term contraceptive options became available in the United States. Among the most significant advances is Norplant, which is now available in this area.
Q: What is Norplant and how does it work?
A: Norplant is a long-term method of contraception consisting of six soft capsules implanted into a woman's upper arm. Topical anesthesia is used to numb the area, and a tiny incision is made. A small device allows the physician or nurse practitioner to insert the rods one-by-one and place them in a fan shape. Stitches are not required since a butterfly bandage will close the incision.
The capsules release level doses of a synthetic hormone, levonorgestrel, which prevents pregnancy. Once inserted, the implant lasts for five years. It is then removed and a new implant can be inserted if a woman chooses.
Q: What are the side effects?
A: A high percentage of women report menstrual irregularities, including spotting, more or fewer days of bleeding, or absence of menstruation. For about 80 percent of women, the level of hormone drops during the first year and side effects become less pronounced. For other women, supplemental progestin or a combination of progestin and estrogen are helpful.
Q: How does it work?
A: The implant works by inhibiting ovulation and thickening cervical mucus, which prevents sperm from reaching an egg. Fertility returns when the implant is removed.
Q: How effective is Norplant?
A: Norplant is one of the most effective methods of reversible contraception. According to the Population Council, the five-year cumulative pregnancy rate is 3.9 per 100 women. The one-year rate is 0.2 per 100 women.
Q: Who should use Norplant?
A: Women who want a convenient method of contraception and who wish to postpone childbirth or space their children are good candidates for Norplant. In addition, those who want long-term contraception but do not want to be sterilized may choose Norplant. Some women cannot use contraceptives that contain estrogen, and these women may use Norplant since it has no estrogen.
Q: Does Norplant protect women from sexually transmitted diseases and the virus that causes AIDS?
A: No. A woman would still need to have her partner use a condom to prevent disease.
Q: What is the cost?
A: About $400, which is about the same as what oral contraceptives cost over five years. In Maryland, private insurers and HMOs vary on how much of the cost they will cover. Medicaid reimburses providers.
Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.