Norplant: a new contraceptive option

WOMEN'S HEALTH

February 23, 1993|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

Norplant is raising expectations and a few eyebrows. It is a highly effective contraceptive, with an average rate of fewer than two pregnancies per 1,000 women per year. But what is unusual about Norplant is that it is a long-acting contraceptive. After being inserted, Norplant works for up to five years and does not require any daily maintenance.

Here are some questions women are asking about it.

Q: What is Norplant?

A: Norplant is a long-acting contraceptive delivered through six tiny capsules inserted in the upper arm. The key component to Norplant is the hormone Levorgestrel, which is the same hormone used in the birth control pill. Unlike some versions of the pill, there is no estrogen in Norplant, and the Levorgestrel dosage is lower than in the pill.

Q: If I want to use Norplant, what do I do?

A: Only health care providers can administer Norplant. Your health care provider will probably review all your options so that you can choose the contraceptive that fits your lifestyle and medical profile.

Understand that Norplant involves a doctor's visit to begin and end use.

Norplant may be helpful to women who have trouble with a contraceptive routine, such as taking a pill every day or remembering to insert a diaphragm. If you want to delay pregnancy for several years, rather than several months, Norplant could be for you.

Norplant costs about $365, which is similar to the cost of the pill over five years. In Maryland, private in

surers and HMOs vary on how much of the cost they will cover. Medicaid reimburses providers.

Q: How do I start to use Norplant?

A: Your doctor or nurse practitioner inserts Norplant capsules into your upper arm using local anesthetic and a tiny incision. The whole procedure takes about 10 minutes. Stitches are not required, but soreness or bruising may occur for a few days. Once inserted, the capsules remain in place. You should be able to feel them with your fingers. The capsules are effective within 24 hours after they are inserted.

Q: If I want to stop using Norplant, will it be harder to get pregnant?

A: Implants can be removed at any time, but only by a health care provider. After the inserts are removed, it is possible to become pregnant within the next month. Seventy-five percent of women who are trying to get pregnant do so in the next year, which is similar to fertility rates after using the IUD, the pill and most other methods.

Q: What are the side effects of Norplant?

A: Menstrual irregularities, including spotting, are extremely common. The side effects are significantly reduced after the first year for most women.

Your health care provider can review with you possible side effects prior to insertion.

Once inserted, you and your health care provider should meet again to determine if any effects that you are experiencing are due to Norplant, and together you can determine a course of action. Whenever you experience unusual symptoms or side effects, discuss them with your health care provider.

Q: Is Norplant safe?

A: Clinical trials, mostly conducted outside the United States, have examined Norplant's relationship to cholesterol, insulin, liver and kidney function, and have found Norplant to be safe.

Norplant probably does not heighten the risk of strokes and heart attacks, as may be the case with the pill. However, until long-term studies are completed, people at risk for heart disease should elect non-hormonal contraception.

Q: If Norplant is safe and effective, why is there controversy regarding Norplant and sexually transmitted diseases (STD)?

A: Some people are concerned that the fact that a woman does not have to take a pill on a daily basis to protect against unwanted pregnancy may affect routine use of condoms to protect against the risk of STDs such as chlamydia, gonorrhea, syphilis, herpes or AIDS.

Using Norplant protects against unwanted pregnancy, but it will not protect you against STDs. If you are sexually active, it is important to continue to use condoms to prevent STDs.

Norplant is a valuable new addition to our repertoire of contraceptive options. Each woman has a unique set of lifestyle and medical concerns regarding contraception, and she must be able to make the contraceptive choice that is best for her.

For Norplant information, write to the Population Council at 1 Dag Hammarskjold Plaza, New York, N.Y. 10017, or call (212) 339-0500.

Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.

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