Norplant subdermal implant

Cardamakis E, Georgopoulos A, Fotopoulos A, Sykiotis GP, Pappas AP, Lazaris D, Tzingounis VA. Clinical experience with Norplant subdermal implant system as long-term contraception during adolescence. Eur J Contracept Reprod Health Care 2002 7(1) 36-40. 

Reservoir devices Parenteral Norplant subdermal implant... 

A modified system, Norplant-2, requires only two instead of six rods. In 140 women using the Norplant-2 contraceptive subdermal implant system there were no accidental pregnancies over 3 years (52). Adverse effects that caused withdrawal from the study were acne, headache, and pain at the implant site. The termination rate for these medical reasons in year 3 of the study was 4.6%. The other main reason for termination was prolonged menstrual flow the 3-year cumulative termination rate for menstrual irregularities was 3.8%. 

Several subdermal implants are available that provide contraceptive efficacy for 1 to 5 years depending on the formulation (Table 46.10). These implants consist of progestins contained within individual rods that are surgically implanted into the upper arm. As indicated in Table 46.10, varying durations of action can be expected depending on the number of rods implanted. Currently, Norplant is not available in the United States, and Implanon has only received approval" status by the U.S. FDA. These formulation is subject to the same adverse effects as other progestin-only methods. 

IMPLANT CONTRACEPTIVE SYSTEM. Levonorgestrel, a progestin, is available as an implant contraceptive system (Norplant System). Six capsules, each containing levonorgestrel, are implanted under local anestiiesia in die subdermal (below the skin) tissues of the mid-portion of die upper arm. The capsules provide contraceptive protection for 5 years but may be removed at any time at die request of the patient. See Table 52-3 for more information on ways to promote an optimal response when taking die contraceptive hormones. 

Davies GC, Newton JR. Subdermal contraceptive implants—a review with special reference to Norplant. Br J Fam Plann 1991 17 4. 

Faundes A. Prevalence of enlarged ovarian follicles among users of levonorgestrel subdermal contraceptive implants (Norplant). Am J Obstet Gynecol... 

A product similar in approach to Norplant is the biodegradable subdermal capsular implant Capronor, which releases levonorgestrel over 12-18 months. Doses of 12 and 21.6 mg in capsules of differing size have been compared (3). Ovulation occurred in all cycles at the lower dose and in a quarter of cycles at the higher dose, so it is likely that the contraceptive... 

If removal is not expertly handled in problematic cases, considerable scarring can result, and some users have proceeded to litigation as a consequence of such complications. Complications in the removal of Norplant capsules have been evaluated in 3416 cases from 11 countries (48). Complications were reported in 4.5% of removals, usually attributable to implants being broken during removal (1.7%) or being embedded below the subdermal plane (1.2%). Logistic regression analysis showed that the most important risk factors for complicated removals were complications at insertion and an infection at the implant site (before or at the time or removal). For women without complications, the mean removal time was 12 minutes, but for those with complications the mean increased to 30 minutes. These results illustrate the necessity of proper insertion technique, under aseptic conditions. Capsules become surrounded by a fibrous sheath within 3 months after implantation beyond a few months, there is no difference in complication rate by duration of use. 

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