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Contraceptive Update: Contraceptive Pearls
(May 2003)
The "Contraceptive Pearls" offer answers to commonly asked questions about family planning. These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population and Reproductive Health, United States Agency for International Development (USAID). They are reprinted with permission. To view archives of Jim Shelton's Pearls online, visit Jim Shelton's Pearls online
Oral Contraceptives and Tuberculosis
Question: In my country we are building up our tuberculosis (TB) program so more women are being diagnosed with TB. Is it all right for women with TB to take oral contraceptives (OCs)?
Answer: Yes. TB is a World Health Organization (WHO) category 1 for OCs (okay to use in any circumstances). So, women with TB should have that choice.
However, one drug commonly used for TB, rifampicin, can reduce the efficacy of OCs (either combined OCs or progestin-only OCs.) So, for women taking rifampicin, OCs are not usually recommended unless other alternative methods are not available or not acceptable (WHO category 3).
Reference: World Health Organization. Improving access to quality care in family planning: Medical eligibility criteria for contraceptive use (Second edition). 2000. Geneva.
Implanon
Question: I have heard there is a new single-rod contraceptive implant available. What can you tell me about it?
Answer: Implanon is a 3-year single rod, sub-dermal, progestin-releasing implant marketed by the pharmaceutical company Organon. An interesting feature is a specially-designed, preloaded applicator that eliminates the need for a separate incision. Insertion and removal are somewhat easier than Norplant. Implanon is currently approved in Europe and a number of other countries. Clinical studies have been conducted in the US and presumably application for approval has been made to the US Federal Drug Administration (FDA).
Implanon vs. Norplant
Question: How does Implanon compare to Norplant?
Answer: See table below. The apparent advantages of Norplant are the longer duration and the cheaper price currently. The advantage of Implanon is the ease of insertion and removal because of the single implant and the special inserter. Norplant uses the traditional 2nd generation progestin levonorgestrel, while Implanon uses a 3rd generation progestin 3-ketodesogestrel at a level that is perhaps a bit higher in relative dosage. Effectiveness and side effects appear to be pretty similar.
COMPARISON OF IMPLANON AND NORPLANT
Norplant Implanon Duration of Potential Use 7 years but still US FDA-labeled as 5 years 3 Years Number of Implants 6 1 Ease of Insertion and Removal More difficult Easier and faster
(has special inserter)Progestin Levonorgestrel 3-ketodesorgestrel (etonorgestrel) Cost Public sector price available Public sector price appears higher than Norplant