Contraception- Implant ("Norplant")
- Are headaches a common side effect in women using Norplant?
- Can a woman who is breastfeeding use Norplant?
- Can a woman with a history of venous thrombo-embolic disease use Norplant?
- Does Norplant affect future fertility?
- Does Norplant cause acne?
- Does Norplant cause depression?
- How does Norplant work?
- How long does Norplant last?
- How well does Norplant work?
- Is menstrual cycle irregularity a common side effect of Norplant?
- Is weight gain a side effect of Norplant?
- What is the effect of Norplant on cholesterol?
- What is the effect of Norplant on ovarian cysts?
- What is the major advantage of Norplant?
- What is the natural history of bleeding in Norplant users?
- What is the treatment for menstrual cycle irregularity in women using Norplant?
- What medications may cause contraceptive failure on Norplant?
- What types of Progestin only contraceptive implants are available in Canada?
Are headaches a common side effect in women using Norplant?
Headaches occurring in Norplant users may be unrelated to the presence of the implant. If severe headaches develop associated with blurred vision following Norplant insertion, removal of the implants is recommended. A pseudotumour cerebri-like syndrome (benign intracracial hypertension) has been rarely reported in Norplant users and although it is uncertain whether or not the Norplant is causally related the implant should be removed.
Can a woman who is breastfeeding use Norplant?
Yes. Norplant has no adverse effects on lactation or coagulation and can be used in women who are breastfeeding. It is prudent, however, to wait until lactation is well established before insertion.
Can a woman with a history of venous thrombo-embolic disease use Norplant?
Yes. Norplant can be used even if a woman has a past history of venous thrombo-embolism. Progestins do not appear to increase the risk of thrombosis or thrombophlebitis. Women with a past history of thrombotic event can use progestin-only contraception, including implants whereas many of these individuals would be advised not to consider combined (estrogen/progestin) oral contraceptives. If a venous thrombo-embolic event occurs with an implant in place, the woman can be reassured that the implant will not affect management of the episode.
Does Norplant affect future fertility?
No. Progestin implants must however, be surgically removed before cycles will resume (and fertility is restored). There is usually no delay in the return of ovulation.
Norplant may have androgenic effects leading to the development of acne. This can usually be controlled with topical measures.
Does Norplant cause depression?
Progestin-only contraception may be associated with alterations in mood, possibly arising from alterations in serotonin metabolism. Clinical depression is however much less common. When depression is suspected close follow-up is mandatory, antidepressant medication should be given, and removal of Norplant may be necessary if there is not a satisfactory response to anti-depressants.
Levonorgestrel released from the implants causes endometrial suppression and thickening of cervical mucus [rendering the mucus impenetrable to sperm] for its contraceptive effect. Ovulation is inhibited in only 66 percent of women using Norplant and therefore is only one of the mechanisms of pregnancy prevention.
The contraceptive effect lasts for five years. If a woman is overweight (>70 kg) contraceptive efficacy is lower in the fourth and fifth year and the implants should therefore be exchanged earlier.
Norplant is a highly effective contraceptive, with an overall failure rate of 0.2 pregnancies per 100 women years (failure rate for 100 women using the method for one year). Most pregnancies associated with Norplant use are already present (but unrecognized) at the time of insertion. Accordingly every effort should be made to exclude pregnancy before Norplant insertion.
Is menstrual cycle irregularity a common side effect of Norplant?
Yes. Disturbance of the menstrual cycle is by far the most frequent reason for removal of the implants, and this must be emphasized in pre-therapy counselling. Some alteration of menstrual patterns will occur during the first year of use in approximately 60% of users. Abnormal bleeding may be a consequence of using Norplant but it may also arise from pathological causes such as infection or cervical pathology. Other causes of abnormal uterine bleeding should be ruled out in any woman if symptoms persist for more than 3 months.
Is weight gain a side effect of Norplant?
It may be. Over five years of use, Norplant users gain an average of 2.5Kg. Some women have gained weight excessively in a short period of time, necessitating removal of the implants. The weight gain is predominantly attributable to increased appetite, so that all users, especially adolescents, should be counseled about the importance of monitoring caloric intake and regular exercise.
What is the effect of Norplant on cholesterol?
A minor decrease in HDL-cholesterol levels from baseline levels has been reported. The clinical significance of this change is unknown.
What is the effect of Norplant on ovarian cysts?
Functional ovarian cysts have been reported in some users of Norplant. These usually regress spontaneously. This is more likely to occur in women who are not ovulating regularly.
What is the major advantage of Norplant?
The progestin implant provides the most effective reversible contraception available. It requires no additional responsibility on the part of the user beyond attendance for insertion and removal. Women who stop menstruating while using the implants may also benefit from the absence of menstrual bleeding and menstrual related symptoms.
What is the natural history of bleeding in Norplant users?
In Norplant users, 86 percent will have a change in their menstrual pattern. The alterations reported include: prolonged bleeding (40%), irregular bleeding (38%), intermenstrual spotting (37%), more frequent bleeding (16%) and amenorrhoea (12%). These changes are usually not associated with major blood loss. Pregnancy must be excluded whenever a woman has a significant change in her menstrual pattern.
What is the treatment for menstrual cycle irregularity in women using Norplant?
Treatment options for menstrual cycle irregularity in Norplant users include:
- A short course of a non-steroidal anti-inflammatory medication is often a useful temporizing measure, however this rarely provides a long-term solution
- Adding cyclical estrogen for 21 days (if there is no contraindication) with 2 mg ethinyl estradiol, 1.25 mg conjugated estrogen, or the combined oral contraceptive pill (OCP) for a couple months may help to build up a thin (atrophic) endometrium Neither of these treatment options will interfere with the contraceptive efficacy of Norplant.
What medications may cause contraceptive failure on Norplant?
Medications that affect the hepatic enzyme system should be avoided in women using Norplant because of lower blood levels of Levonorgestrel. These medications include Rifampin , Grisiofulvin and many anti-convulsants (Carbamazepine, Ethosuximide Phenobarbital, Phenytoin and Primidone). Norplant should also be avoided in epileptics because anti-epileptic drugs lower serum progestin levels secondary to increased protein binding altering Norplant's effectiveness.
What types of Progestin only contraceptive implants are available in Canada?
Norplant was discontinued in the fall of 2002. Currently, no similar product is available in Canada. The Norplant system consists of six silastic rods containing 36mg of Levonorgestrel, which is effective for five years. Though the product was discontinued, some people may still be using the product until 2007.
