Who Should Consider Contraceptive Implants?

When the U.S. government approved the long-lasting contraceptive Norplant last year, it was heralded as an important advance by experts and a welcome option by women. Norplant includes six silicone capsules implanted beneath the skin of a woman’s inner arm. They slowly release a progesterone-like hormone that is also found in some birth-control pills. Norplant lasts five years but can be removed at any time.

Norplant is not yet on the market. But it may be available in many gynecologists’ offices nationwide later this month, says a spokeswoman for Wyeth-Ayerst Laboratories, which is marketing the implant. It is expected to cost about $350, plus physician’s fees for insertion and removal.

In the original studies, the implant was found less effective for women weighing more than 150 pounds because adequate amounts of the hormone failed to reach their bloodstreams. But a redesigned capsule now has thinner walls, boosting the efficiency of the implant for heavier women.

Some women wonder whether they should try the newest method. Here, two contraceptive researchers discuss the advantages and disadvantages of Norplant and other methods.

Dr. Daniel R. Mishell Jr., USC professor and chairman of obstetrics and gynecology

“Who should consider Norplant? People who have problems with the Pill and the intrauterine device (IUD).

“Norplant is not a first-line contraceptive. The Pill and the IUD are just as effective and are reversible. The IUD is easier to put in and to remove than Norplant. There are a lot of misconceptions that currently available oral contraceptives and the IUD are dangerous and Norplant is safe. The currently available Pill and IUD are safer than their predecessors.

“Norplant does cause irregular bleeding in most women. Some women gain weight on it. Norplant has no estrogen, which is an advantage for women with estrogen-related problems like tender breasts and nausea. The main advantage is convenience, since it lasts five years.

“I would not recommend it for anyone who doesn’t want contraception for at least three years, and preferably five.

“Cost may be a drawback. Twenty women called my office (to ask about Norplant) and when they heard the price, none made an appointment.”

Dr. Donna Shoupe, USC associate professor of obstetrics and gynecology

“If a woman is happy on the Pill and not having any medical problems, she should stay on it. The woman who is not clear about her contraceptive future should also stay on the Pill. All women should probably consider the Pill and the IUD as ‘first-line’ contraceptives.

“If a woman switches to Norplant, she should understand there are bleeding abnormalities which nearly all women experience. A woman should be willing to accept that and to be sure she does not want children for at least three years.

“The most common misconception about the Pill is that it puts you at high risk for cancer or infertility. Just the opposite is true. Women are often not aware of the non-contraceptive benefits of the Pill, such as a reduction in ovarian cancer and endometrial cancer and reduced blood loss and cramps during menstrual periods. With Norplant, we don’t know if these benefits accompany its use yet or not.

“The initial cost of Norplant will be a detriment for some women.”