Norplant

Norplant (LEVONORGESTREL) is a new contraceptive that became commercially available in the United States in February, 1991, after its approval by the Food and Drug Administration. Norplant consists of six matchstick-size silicone capsules that are inserted in a woman's upper arm. The capsules release small amounts of progestin over five years and must be inserted and removed by a trained medical professional.

Common uses

Norplant is an extremely effective contraceptive. Women using the drug have an annual pregnancy rate of less than 1% over a five-year period. Levonorgestrel is used to prevent pregnancy by inhibiting ovulation (the release of an egg from an ovary) and by causing the cervical mucous to thicken, which makes it harder for sperm to move toward the uterus.
Levonorgestrel is used to prevent pregnancy for up to 5 years.

Before using

Norplant should not be used in women with liver disease, breast cancer, or blood clots. Women who believe they may already be pregnant or those with vaginal bleeding should first see a physician. However, since Norplant does not contain estrogen like some birth control pills, older women, women who smoke, and women with high blood pressure are not restricted from using the system.

Directions

It is recommended that a woman considering Norplant implants undergo a medical examination. This may include giving a medical history and having a pelvic exam to ensure that she has no diseases or conditions that would make it unsafe for her to use Norplant implants.
To make sure the woman is not pregnant, Norplant implants should be inserted within seven days after the onset of menstrual bleeding, or immediately postabortion. However, Norplant implants may be inserted at any time during the menstrual cycle, provided the woman is not pregnant and effectively uses a nonhormonal method for at least seven days after insertion.
The implants are inserted under the skin of the inner side of the upper arm in a minor surgical procedure. A local anesthetic is injected and the clinician makes a small incision—2 mm long. The capsules are placed one at a time in a fan shape using a special hollow needle called a trocar. The procedure typically takes 10 to 15 minutes. Because a local anesthetic is used, there should be little or no pain. Usually the incision is covered with protective gauze and a small adhesive bandage.
Generally, any specially trained physician, nurse, nurse-midwife, or other healthcare professional can do the insertion. The prevailing laws will determine who is allowed to perform the procedures. Women should confirm that their healthcare provider has been instructed in the procedure before he or she inserts or removes the Norplant implants.
Norplant becomes effective within 24 hours after insertion. If the woman has the implants inserted within seven days of her menses, she can have sexual relations without a backup method 24 hours later. If the capsules were inserted at another time of the menstrual cycle, the woman should use a nonhormonal backup method.

Possible side effects

you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:
• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
• possible blood clot in the lung (shortness of breath or pain in the chest);
• possible blood clot in an arm or leg (pain, redness, swelling, or numbness of an arm or leg);
• headaches with a change in pattern, severity, or length, or that are unending in nature or accompanied by changes in vision;
• high blood pressure (severe headache, flushing, blurred vision); or
• liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue).
• infection at the insertion site;
• pain, numbness, or tingling in the arm with the implanted capsules; or
• movement of the capsules under the skin.
Other, less serious side effects may be more likely to occur. Talk to your doctor if you experience
• breakthrough, heavy, or prolonged menstrual bleeding;
• lack of menstrual bleeding;
• pain, swelling, or bruising at the insertion site;
• headache or dizziness;
• nausea;
• breast tenderness;
• changes in weight or appetite;
• oily skin or acne; or
• changes in hair growth.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

If you take too much

Since the implanted capsules continuously release a low dose of levonorgestrel, missing a dose does not occur when using this form of levonorgestrel.

Additional information

Norplant can be removed at any time by creating a second incision and withdrawing the capsules. Norplant is normally removed when the five year period is over and reinsertion of a new set is preferred, or if:
• Pregnancy is desired
• Different birth control is preferred
• Complications arise
Removal can be uncomplicated, but removal difficulties have been reported with a frequency of 6.2%, based on 849 removals. Removal difficulties include: multiple incisions, capsule fragments remaining, pain, multiple visits, deep placement, lengthy removal procedure, or other.

Drug interactions

Other medications may decrease the effectiveness of levonorgestrel. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, while using levonorgestrel.