What is Norplant?

Norplant is a method of birth control that uses hormones to prevent pregnancy. A set of small, thin, flexible capsules are filled with a synthetic form of the female hormone progesterone. These capsules are placed under the skin of a woman's arm. The hormone dissolves slowly from the capsules into the bloodstream. One set of capsules prevents pregnancy for up to 5 years.

Twenty-four hours after the capsules are placed under the skin, the level of progesterone in the body is high enough to prevent ovulation if the Norplant was implanted within the first five days of the menstrual cycle. The lining of the uterus also becomes thinner, making it more difficult for an egg to implant. In addition, the mucus in the vagina thickens and inhibits the entry of sperm into the uterus.

This method of contraception has been used in other countries for many years, and it has been approved for use in the U.S. since 1990.

How is it used?

You are given an anesthetic to numb your upper arm. A small cut is made in your arm (about one-eighth of an inch long). Six capsules are placed under the skin through this small opening. The procedure takes 10 to 15 minutes and can be done in your health care provider's office. Usually stitches are not needed.

Keep the small opening in your arm clean and covered with a small bandage until it is healed. You may have some bruising and soreness around the area. This should go away in about a week. There is a small chance that the area will become infected. Call your health care provider if you have signs of infection, such as redness or swelling in the area where the capsules were placed. If an infection persists even after you get treatment for it, your provider will have to remove the capsules.

Each capsule is a little over 1 inch long and as thick as a matchstick. After 5 years, the capsules will run out of hormone and must be removed. A new set can be inserted the same day the old capsules are removed. If you plan to get pregnant in less than 3 years, you should consider using other methods of birth control.

What are the benefits?

The benefits of Norplant are:

• It prevents pregnancy for up to 5 years. After the capsules are removed, your ability to get pregnant will return to normal within 24 hours.

• The capsules are painless once they are implanted. Usually they are usually nearly invisible except in very thin women.

• Progesterone is released at a lower level than you would receive from birth control pills, and it is not combined with the hormone estrogen. For these reasons Norplant is safer than birth control pills.

• Your chance of becoming pregnant is less than 1% per year over the 5-year period.

• There is no interruption of sex. You do not have to take any pills or insert any devices to prevent pregnancy.

• Although the initial cost of Norplant is high (about $700), Norplant is cheaper than birth control pills over the 5-year period.

Please note: If you take phenytoin (Dilantin) or carbamazepine (Tegretol) for epileptic seizures, Norplant is not as effective in preventing pregnancy. These medications reduce the effectiveness of the progesterone. This means you have a greater chance of getting pregnant with this method of birth control.

What are the disadvantages?

The increased level of progesterone in your body may cause some changes in menstrual bleeding, such as:

• irregular periods

• spotting between periods

• occasional prolonged episodes of bleeding and spotting

• no periods.

These changes in your periods will decrease with continued use of Norplant, usually within a year.

The increased hormone level can also cause:

• headaches

• nausea

• dizziness

• acne

• weight gain

• breast tenderness and discharge

• mood changes.

You should not use Norplant if:

• You are pregnant or think you may be pregnant.

• You are breast-feeding and your baby is less than 6 weeks old.

• You have unexplained vaginal bleeding.

• You have breast cancer or liver disease.

Norplant does not protect you against sexually transmitted diseases, such as AIDS. Latex condoms are the only safe way to protect against AIDS.

When should I call my health care provider?

Call your health care provider if:

• You have abdominal pain.

• You have vaginal bleeding that requires changing a pad more often than every hour.

• You are not breast-feeding but you have discharge from your breasts.

• You have redness, swelling, or numbness in the area where the capsules are implanted.

• The capsules start to come out through the skin.