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a) During the First Five Years:
During the first five years of use, NORPLANT® Implants are a highly effective contraceptive method. Therefore, no additional contraceptive method is required to provide pregnancy protection.
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a) The cumulative pregnancy rate of users of NORPLANT® Implants at the end of five years of use is 1%.
- Sivin I. Contraception with Norplant Implants. Human Reproduction 1994;9(10):1818-26.
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b) After the First Five Years of Using NORPLANT® Implants:
Under some circumstances (for example, if immediate removal is not practical in a woman weighing more than 60 kg or if the client refuses removal), it is reasonable for the client (and provider) to consider choosing any of the contraceptive methods in addition to the implants after the first five years when levonorgestrel has diminished to low levels. However, there is theoretical concern that the combination of a copper or inert intrauterine device (IUD) with NORPLANT® Implants may result in an unacceptable increase in menstrual blood loss enhancing the risk of anemia.
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b) If NORPLANT® Implants removal is delayed beyond five years or if a woman refuses removal, the client and provider may consider using an additional contraceptive method to avoid an unwanted (and possibly ectopic) pregnancy, particularly for women heavier than 60 kgs using NORPLANT® Implants with hard tubing. Since the blood levels of levonorgestrel are very low to begin with and are especially low after five years of hard tubing use, it is unlikely that safety problems will occur when NORPLANT® Implants are used in combination with another contraceptive method, including other hormonal methods. No contraindications exist against such dual method use. However, since both IUDs and progestin-only methods are associated with increased menstrual bleeding, there is concern that combined use of an IUD with NORPLANT® Implants could result in an even higher loss of menstrual blood increasing the risk of anemia in at risk populations.
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c) For sexually transmitted disease (STD) protection:
At any time, for STD protection, condoms or other barrier methods may be used.
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c) Like other hormonal methods, NORPLANT® Implants use does not protect against STDs. Therefore, using condoms in combination with NORPLANT® Implants will help protect against STDs, including human immunodeficiency virus (HIV).
Supplemental use of contraceptive methods in women using NORPLANT® Implants may be important to provide protection from pregnancy (after five years of use) and from STDs/HIV. However, since current experience with dual method use is limited, supplemental use should be undertaken only after careful consideration. Furthermore, the short-term provision of supplemental contraception should not reduce programmatic efforts for removing NORPLANT® Implants at the end of year five in women desiring removal. |
