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Recommendations for Contraceptive Use

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NORPLANT® Implants


Q.4. Are there any age/parity restrictions on NORPLANT® Implants?

Recommendations

Rationales
a) No. NORPLANT® Implants may be used at any age at which the woman is at risk for pregnancy (e.g., past menarche and through menopause). a) The contraceptive effect of NORPLANT® Implants ceases within 24 hours of removal and return to fertility is comparable to that of women who have not used contraception; 40 to 50% of women become pregnant after three months and 75 to 95% of women are pregnant by 12 months post-removal.
  1. Noerpramana N-P. The Norplant removal training and service at Dr. Kariadi Hospital, Semarang, Indonesia. Advances in Contraception December 1991; 7(4):389-401.
  2. Sivin I, Diaz S, Holma P, Alvarez-Saneuez F, Robertson DN. A four-year clinical study of Norplants. Studies in Family Planning 1983;14(6-7):184-191.
  3. Singh K, Viegas OAC, Ratnam SS. A three-year evaluation of Norplant in Singaporean acceptors. Advances in Contraception 1990;6:1-9.
Older Women:  
b) NORPLANT® Implants may be used by women through menopause. b) Many providers consider NORPLANT® Implants to be an especially appropriate method for older women, since they contain no estrogen.
  1. Norplant Contraceptive Subdermal Implants: Managerial and Technical Guidelines. Geneva, World Health Organization, 1990.

Because women greater than 35 years of age are at increasing risk for endometrial (and ovarian) cancer, it is particularly important to:

  • carefully evaluate irregular bleeding before inserting NORPLANT® Implants and
  • more carefully consider cancer as a possible cause if the woman returns with irregular bleeding after prolonged amenorrhea.
  1. Herbst AL, Mishell DR, Stenchever MA, Droegmueller W. Comprehensive Gynecology, 2nd edition. St. Louis, Mosby Year Book, 1992, pp 1082-1083.
  2. Parazzini F, La Vecchia C, Bocciolone L, Franceshi S. The epidemiology of endometrial cancer. Gynecologic Oncology 1991;41:1-16.
    3.
Adolescents:
c) Use of NORPLANT® Implants leads to amenorrhea in a small proportion of women, less than that for women using progestin-only injectables. Some evidence suggests that a hypoestrogenic state within the first two years after menarche may increase the risk of osteoporosis later in life, particularly for women with other risk factors for osteoporosis (i.e., women who are small-boned, underweight, white or Asian, smokers or malnourished). However, for those adolescents age 15 or under, for whom NORPLANT® Implants is the most appropriate method, the benefits of the method generally outweigh the risks. c) Amenorrhea, while on progestin-only contraceptives, is generally evidence of lower estrogen levels (although not as low as menopausal levels). Estrogen is necessary for the development and maintenance of strong bones (to prevent osteoporosis). The peak strength (density) of spinal bone is reached by girls around age 16; the greatest increase in bone density occurs in the first two years post-menarche.
  1. Faśndes A, Alvarez-Sanchez F, Brache V, Jimenez E, Tejada AS. Hormonal changes associated with bleeding during low dose progestogen contraception delivered by Norplant subdermal implants. Advances in Contraception 1991;7(1):85-94.
  2. Shoupe D, Mishell DR, Bopp BL, Fielding M. The significance of bleeding patterns in Norplant implant users. Obstetrics and Gynecology 1991;77:256-260.
  3. Bonjour JP, Theintz G, Buchs B, Slosman D, Rizzoli R. Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. Journal of Clinical Endocrinology and Metabolism 1991; 73: 555-563.
  4. Theintz G, Buchs B, Rizzoli R, Slosman D, Clavien H, Sizonenko PC, Bonjour JP. Longitudinal monitoring of bone mass accumulation in healthy adolescents: Evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. Journal of Clinical Endocrinology and Metabolism 1992;75:1060-1065.
  5. Dhuper S, Warren M, Brooks-Gunn J, Fox R. Effects of hormonal status on bone density in adolescent girls. Journal of Clinical Endocrinology and Metabolism 1990;71:1083-1088.

Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.

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