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Recommendations for Contraceptive Use |
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NORPLANT® Implants |
Classification of Selected
Procedures for NORPLANT® Implants
Procedure |
Class |
Rationale |
| Pelvic examination (speculum and
bimanual) |
C |
- Conditions which would restrict use of NORPLANT® Implants
should be identified by history before method initiation.
- A pelvic exam may reveal reproductive tract infections or
reproductive tract malignancies which should be treated for optimal preventive care.
Routine pelvic exam screening for asymptomatic women, in the absence of tests for cervical
cancer, however, is a low yield procedure1.
- In some cases, a pelvic exam may help evaluate the question
of pregnancy beyond 6 weeks duration: in this case it is Class A.
- A pelvic exam is not necessary to ensure safe use of
NORPLANT® Implants as a contraceptive method.
|
| Blood pressure |
C |
- Screening for high blood pressure is part of optimal
preventive health care.
- NORPLANT® Implants do not affect blood pressure2.
|
| Breast examination |
C |
- For all women of reproductive age or beyond, a breast exam
is recommended for optimal preventive health care.
- NORPLANT® Implants do not cause breast cancer2.
Lumps that are suspicious for cancer should be evaluated. While any hormonal treatment
may, in theory, cause such lumps to grow, pregnancy causes much higher hormonal levels;
therefore, potential malignancies of the breast should not be a reason to delay a woman's
access to the use of this contraceptive method.
|
| Sexually transmitted disease
(STD) screening by lab tests (for asymptomatic persons) |
C |
For optimal health care, clients
at risk for STDs (by personal history or socio-demographic risk factors) should be offered
STD screening where possible. However, presence of an STD will not affect the safe use of
NORPLANT® Implants. |
| Cervical cancer screening |
C |
- Cervical cancer screening is indicated for women at risk of
cervical carcinoma, and is recommended for optimal preventive health care for women of
reproductive age or beyond (particularly women at risk of STDs).
NOTE: Cervical cancer screening is advised for
optimal preventive care for all women at risk of cervical cancer (e.g., smokers, women
with partners having multiple partners,women with young age at first intercourse, etc.).
All women at risk should ideally have access to a practical method of cervical cancer
screening, treatment and follow up.
- NORPLANT® Implants use has no known relation to
risk of cervical carcinoma2.
|
| Routine, mandatory lab tests
(e.g., cholesterol, glucose, liver function tests) |
D |
The effects of NORPLANT®
Implants on cholesterol, blood glucose and normal liver function are slight, and of no
demonstrated clinical significance3. |
Specific counseling points for
NORPLANT® Implants use:
- efficacy
- common side effects
- correct use of method
- signs and symptoms for which to return to the clinic
- STD protection (when/as appropriate)
|
A |
- Accurate client education is essential for maximum quality
of family planning services.
- Appropriate counseling about common contraceptive side
effects at the time of method selection can lead to improved client satisfaction and
contraceptive continuation4.
|
| Counseling concerning change in
menses, including irregular or absent menstrual bleeding |
A |
NORPLANT® Implants may cause
increased frequency of bleeding in some women and decreased bleeding in others; changes in
bleeding patterns tend to decrease over time5. Bleeding pattern changes are the
most common side effect of NORPLANT® Implants and the most common cause of
discontinuation5. |
KEY:
Class A = essential and mandatory or otherwise
important in all circumstances, for safe and effective use of the contraceptive method
Class B = medically/epidemiologically rational in
some circumstances to optimize the safe and effective use of the contraceptive method, but
may not be appropriate for all clients in all settings
Class C = may be appropriate for good preventive
health care, but not materially related to safe and effective use of the contraceptive
method
Class D = not materially related to either good
routine preventive health care or to the safe and effective use of the contraceptive
method
Citations:
Huber DH, Huber SC. Screening oral
contraceptive candidates and inconsequential pelvic examinations. Studies in Family
Planning 1975;6(2):49-51.
NORPLANT® Levonorgestrel Implants: A
Summary of Scientific Data. New York, The Population Council 1990, p 11.
Singh K, Viegas OAC, Loke DFM, Ratnam SS.
Effect of NORPLANT® Implants on liver, lipid and carbohydrate, metabolism. Contraception
1992;45(2):141-153.
Cotten N, Standback J, Maidouka H,
Taylor-Thomas JT, Turk T. Early discontinuation of contraceptive use in Niger and The
Gambia. International Family Planning Perspectives 1992;18(4):145-149.
NORPLANT® Levonorgestrel Implants: A
Summary of Scientific Data. New York, The Population Council 1990, pp 9-11. |
