COUNTYWIDE : 4 Doctors Trained in Contraceptive Use

Four gynecologists on Wednesday were the first Orange County doctors to learn how to insert Norplant, the five-year contraceptive implant for women.

During the training at UCI Medical Center in Orange, the gynecologists used an artificial arm to learn how to place Norplant’s six thin, flexible silicon-rubber capsules, each 1.3 inches long, under the skin. The implant continuously releases a steady dose of levonorgestrel, a synthetic form of the female hormone progesterone, that acts to prevent conception for up to five years.

Audrey Ashby, a spokeswoman for Wyeth-Ayerst Laboratories in Philadelphia, which manufactures Norplant, said more than 500 physicians have already been trained nationwide.

Women can expect to pay $500 to $600 to receive the new contraceptive--$350 for the product and $150 or more to a physician for insertion fees. These physician charges may be paid again upon removal, boosting the total cost of the implant to about $750.

The implant’s effectiveness is close to that of sterilization and better than that of oral contraceptives, said John Riha, an Orange County representative for Wyeth-Ayerst. Norplant, which has a failure rate of less than 1% and is reversible, has been heralded by the company as the most significant contraceptive since birth control pills were introduced 30 years ago.

“The reason that this will be an accepted method of birth control is that it doesn’t carry with it the same hazards as the IUD (intrauterine device) and it does not require daily thought,” said Dr. William Thompson, who is in charge of the Norplant training at UCI Medical Center. Norplant does not contain estrogen, a component in birth control pills known to cause such serious complications as blood clots, he said.

But not every woman will accept Norplant’s known problems. Fifteen to 20% of a group of Norplant test patients studied at USC Medical Center wanted the implants removed within the first year, Thompson said.

Most of these women, he said, disliked the most common side effect, which is irregular menstrual bleeding that can last for about a year.

Other complications may include headaches, nervousness, nausea, dizziness, acne, change of appetite, weight gain, breast pain and hair loss, according to Wyeth-Ayerst. Some women complained about pain, itching and infection at the insertion site, the company reported. Based on 849 removals of the implant, company studies showed that 6.2% experienced difficulties.

Thompson said most of his patients have fears about having pain during insertion and removal of the implant. Women are given an injection of a local anesthetic, so most do not complain of much pain, he said.

The Population Council, an international nonprofit organization concerned with reproductive health issues, began research on Norplant in 1966. More than 500,000 women in 46 countries have used the product, according to information released by Wyeth-Ayerst.

Women who have been asking for the drug, which was approved by the Food and Drug Administration on Dec. 10, can now call their doctors to see if they are among the few who have been trained to insert the product.