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Norplant Implants

Oral contraceptives are the most widespread method of birth control, and they are well liked by most of the women who use them. However, if they were asked to name just one complaint about the Pill, most would probably say that it's hard to remember to take a tablet every day. To combat the problems that can arise from forgetting to take the Pill regularly (or not using a condom every time, or leaving the diaphragm at home...), researchers began searching for birth control methods you don't need to remember.

Scientists at the Population Council in New York City, an international, nonprofit contraceptive research organization, spent more than 20 years and over $20 million developing and introducing Norplant implants. This new system is effective for up to 5 years without replacement. Women around the world have been using the implants since the early 1980s. The Food and Drug Administration approved them for use in the United States at the end of 1990.


What the Implants Do

The Norplant implant system is a set of 6 matchstick sized, hormone­containing capsules made of flexible tubing. The tubing is a blend of silicone and plastic called Silastic. The capsules are inserted by a trained professional just below the skin of a woman's upper inner arm (the part of the arm that lies against the side of the rib cage when the arms are at rest). The doctor uses a device that looks like a syringe (called a “trocar”) to place the capsules in a fan­like shape. Thin women will probably be able to see the cap sules under the skin once they are inserted, but for most others they aren't noticeable.

NORPLANT: PROS AND CONS

The irregular bleeding caused by Norplant implants is the biggest complaint among users. However, those who stop having periods altogether cite this as an advantage. Here's a summary of the implant's pros and cons:
Advantages

Extremely effective
Safe for most women
Long­lasting
No need to remember to use
Doesn't interrupt sex
No estrogen­related side effects
Can stop the menstrual cycle
Decreases menstrual cramps and pain
Decreases anemia
Possibly reduces the risk of pelvic inflammatory disease (PID)
Possibly reduces the risk of endometrial cancer
Disadvantages

Offers no protection against sexually transmitted diseases (STDs)
Can be somewhat visible in thin women
Costs more than other types of birth control at the outset
Requires doctor's assistance and a surgical procedure for removal
Can produce nuisance side effects, especially irregular bleeding

Starting 24 hours after the capsules are placed under her skin, the user is protected from pregnancy by the progestin called levonorgestrel, which slowly leaks out of the capsules and enters the bloodstream. The implants contain no estrogen. They will continue to release progestin for up to 5 years. Because they are not biodegradable, they must then be removed. Your doctor can insert another set of implants at the same time the old set is removed, if you want to continue using the method.

The implants should be inserted within 7 days of the start of your menstrual cycle, just to make sure you aren't already pregnant. Although there is no evidence that the Norplant system will hurt a developing baby, most experts believe it's best not to expose it to hormones.

The insertion procedure is done on an outpatient basis. Your doctor will give you a local anesthetic to numb the area, then make a small incision. It takes about 15 or 20 minutes to place all 6 capsules. The area will probably be tender, bruised, or slightly swollen for a day or two.

If you want the implants removed—when the five­year effectiveness begins to wear off, you want to get pregnant, or you simply don't like the method—you will again need a minor outpatient surgical procedure. Removal is often more difficult than insertion, sometimes requiring 2 sessions before all 6 capsules are removed. Two visits are necessary when swelling of the surrounding tissue becomes an impediment to the doctor and a discomfort to you.

Removals often present a problem for doctors because your skin tissue forms an envelope around the implants, making them difficult to grab with the tweezer­like instrument often used to take them out. The tissue envelope, which gets thicker and harder to remove as time goes on, must first be disrupted before the capsules inside can be pulled out. Many clinicians can remove a set of six capsules in 30 minutes. Some take longer, while others complete the procedure in as little as 10 minutes.

Twenty­four hours after the capsules have been removed, your protection from pregnancy ends.

Many women and their doctors were dubious about the system's eventual success when it was first introduced in the United States. They wondered why women would want to have these tiny sticks buried beneath their skin. To their surprise, the odd new method became almost an instant hit. In just over 2 years, 750,000 American women have chosen the implant system.

Most of these women received the implants with the help of the Medicaid system or private insurers. Norplant implants do have high up­front costs; the kit itself is about $365, insertion costs can start at $100, and removal costs average $400 to $500. However, depending on where you live, the implants may cost less than or about the same as 5 years' worth of birth control pills.

Dr Mohans Diabets
American Diabetes Association
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