Norplant Has Advantages, But It's Not For Everybody

Q. I am a 31-year-old divorcee with three children. I do not want any more children right now, but since I may marry again, I do not want any permanent birth-control method. Can you tell me the pros and cons of Norplant? - Cynthia T., Greenwich, Conn.

A: The Food and Drug Administration approved the use of Norplant in the United States in December 1990, but it was first available in 1968 in Chile. Since 1968, more than 500,000 women worldwide have used the contraceptive. It works by releasing a hormone that prevents a fertilized egg from implanting in the uterus. Studies show it prevents pregnancy 99.8 percent of the time.

However, in comparison to other contraceptive methods, Norplant is more expensive and tends to have more side effects. Because of this, it is generally recommended only for patients who like its convenience, or when other methods have failed.

What Norplant is

Norplant is a synthetic form of the hormone progestin, called levonorgestrel. It is implanted into the body, remains active for five years and then is removed.

The levonorgestrel is contained in six flexible capsules, each about 1 1/3 inches long. To insert the capsules, a physician makes a small cut in the underside of a woman's upper arm and pushes the capsules into place under the skin. When it's time to remove the capsules, they're pulled out through a similar cut. The procedures are done with a local anesthetic. If the patient wants another five

years of contraception, new capsules can be implanted.

Over the five years, the hormone is slowly released. During the first year, more levonorgestrel is released than in the remaining four years, and this may explain why most side effects occur during the first year or two.

An expensive choice

Norplant kits cost about $375 each. The cost for the physician's time to insert the tubes is about $225 to $350 and the cost of removal, which tends to be more difficult than insertion, is about $400 to $550. Insurance coverage varies by company.

Norplant does not protect against sexually transmitted disease; no contraceptive does except condoms. So condoms still must be worn to protect against infections, including the AIDS virus.

Side effects

Norplant has been studied extensively internationally, but U.S. studies of its benefits and effects have been few. In one study at the Francis Scott Key Medical Center in Baltimore, 246 women given Norplant were evaluated for side effects and patient satisfaction. Dr. Vanessa Cullins, professor of obstetrics and gynecology, found that 70 percent of the women experienced at least one side effect one month after the Norplant was inserted. Of these, 28 percent experienced three or more side effects.

Of the 70 percent who had side effects, 49 percent reported headaches; 48 percent, irregular bleeding; 24 percent, acne; 22 percent, weight gain; 19 percent, increased appetite; 18.5 percent, dizziness; 10 percent, bloating; 9 percent, depression; and 8 percent, nervousness. Twenty-six percent thought the worst thing about Norplant was the irregular bleeding. However, even with the relatively large number of side effects, 78 percent rated Norplant as excellent, and 95 percent said they would recommend it to other women.

Not for everyone

Some birth-control centers, in order to help women decide whether they can tolerate Norplant's possible side effects, have prescribed Ovrette, a progestin-only minipill, for several months. This gives the woman a chance to see how her body reacts to the hormone, writes Janice Emerling, a staff midwife at the Center for Addiction and Pregnancy at Key Medical Center, in the March 1993 issue of the Journal of Nurse-Midwifery.

But Norplant is not for every woman; one leading Norplant researcher said he believes it is a good choice only for those who have not succeeded with other contraceptives. "For most women, oral contraceptives are probably the best choice," says Dr. Philip Darney, professor of obstetrics and gynecology and reproductive sciences at the University of California, San Francisco.

"Today's birth-control pills are not the same as in the 1960s and 1970s. They have very few side effects and even have shown to be beneficial in reducing ovarian cancer."

The Medical Adviser, produced by the Palo Alto Medical Foundation using a database that contains articles from more than 3,500 medical journals, appears occasionally in Focus on: Health and Fitness.

(Copyright, 1993, the Palo Alto Medical Foundation.)

Focus on: Health & Fitness, compiled by Nancy Bartley, appears every Thursday in the Scene section. Other Focus subjects during the week are: Consumers, Sunday; Parenting, Tuesday; Managing Money, Wednesday; and Real Life, Friday. To suggest a story or calendar item, write to any of these subjects, c/o Scene, The Seattle Times, P.O. Box 70, Seattle 98111.