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Birth Control Hormonal Methods (cont.)


The FDA approved the contraceptive use of implants (levonorgestrel, brand name Norplant) in 1990. In 2003, the manufacturer decided not to continue marketing the Norplant System to health care professionals. The company has chosen to focus on developing other birth control options. Current users with medical questions may call the Norplant System Information Line at (800) 364-9809.

This method consists of inserting 6 silicone rubber rods (about the size of matchsticks) under a woman's skin in her upper arm. They can be seen and felt under the skin.

Implanon implant provides serum concentrations that are adequate for contraception coverage for approximately three years. The Norplant implant releases medication throughout the period of use and begins to work within the first 24 hours. Protection may be provided for 5 years. The hormone stops ovulation.

  • How effective: Norplant is as effective as surgical sterilization. Overall, pregnancy rates increase from 0.2% in the first year to 1.1% by the fifth year. Effectiveness of Implanon in overweight women has not been defined. Women who weighed >130% of their ideal body weight (IBW) were not studied. Because serum concentrations are inversely related to body weight and decrease with time after insertion, etonogestrel implant may be less effective in overweight women.

  • Advantages: Implants last a long time. A woman can become fertile again once the implants are removed (again, surgically). When Implanon is removed, the return to fertility is rapid, with the return of ovulation within three weeks

  • Disadvantages: A minor surgical procedure is necessary to place and remove them. Difficulty in removal is a disadvantage. Menstrual irregularities are common along with other side effects, including weight gain, headaches, mood changes, growth of facial hair, flow of milk from nipples, and acne. This method does not protect against STDs.

  • Additional risks:Implants are often used for women who have just had a child and are breastfeeding, for those who have trouble remembering to take birth control pills or use other birth control methods, and for women who should not get pregnant because of a medical condition. Implants are not recommended for heavy smokers or women with a history of ectopic pregnancy, diabetes, high cholesterol, severe acne, high blood pressure, heart disease, migraine, or depression.

Although the Norplant system is no longer available, a new single-rod system (Implanon) using a form of the progestin desogestrel and providing 2-3 years of contraception is currently available in Europe and has recently been approved by the FDA in the United States.

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