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  • Title: Levonorgestrel subdermal implants (Norplant) for long-term contraception.
    Author: Sharts-Engel NC.
    Journal: MCN Am J Matern Child Nurs; 1991; 16(4):232. PubMed ID: 1943533.
    Abstract:
    A system of subdermal implants that releases a steady dose of the levonorgestrel, Norplant is long-term, reversible, and effective contraceptive. The Norplant system includes 6 Silastic capsules inserted under the skin of a woman's upper arm during a minor surgical procedure. The capsules, each measuring 36 mm by 2.4 mm, release about 50 to 8 micrograms of levonorgestrel/day during the first year, a flow that decreases to 30-35 micrograms/day through the 6 year of use. The system, however, is recommended for 5 years. Norplant has several modes of action for preventing pregnancy: ovulation is suppressed at least 1/2 the time; if ovulation does occur, progesterone-release is depressed during the luteal phase; the cervical mucus becomes thick and impedes the migration of sperm; and levonorgestrel suppresses endometrial growth. Comparing favorably with the effectiveness of oral contraceptives, Norplant has a pregnancy rate of 1.5 pregnancies/100 users over 5 years. Fertility returns promptly after removal of the implants. Norplant users have expressed a high level of satisfaction with the method. Although up to 80% of users report some menstrual changes (such as irregularity, midcycle bleeding, or spotting), there is a continuation rate of about 80% after the 1st year. Norplant appears well-suited for the following groups of women: 1) those over 35 years of age who are opposed to surgery or who cannot use other contraceptives; 2) those who have difficulties implementing other regimes; 3) those of whom estrogens are contraindicated; and 4) those taking teratogenic medications. Norplant can be initiated safely immediately postpartum or after abortion, but a 6-week delay is recommended for lactating mothers.
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