Early removal of the Norplant System.

Abstract

Clinical researchers were able to interview 40 of 70 women (mean age 22; 75% Black; mean parity of 2) who had the levonorgestrel contraceptive implant system Norplant removed at Louisiana State University Medical Center during June 1992 to July 1993. They aimed to learn the major side effects of and primary reasons for removal of Norplant in women who had the system removed before the end of the 5-year term. The average duration of implant use was 13.4 months. Common side effects included headaches (59%) irregular uterine bleeding (56%) amenorrhea (54%) weight gain (49%) dizziness (44%) mastalgia (43%) and heavy uterine bleeding (41%). Most women suffered from more than one side effect. The average number of side effects was 6.8. The leading reasons for implant removal were irregular or heavy uterine bleeding (27%) amenorrhea (19%) headaches (16%) weight gain (14%) and hair loss (14%). The proportion of women who cited headaches and amenorrhea as a reason for removal was higher than expected. 87% of all women interviewed had attended patient education classes that addressed side effects. 82% knew before insertion of Norplant that bleeding disorders were a common side effect. These two aforementioned findings emphasize the need for more careful patient screening and selection before insertion of Norplant implants. Pre-insertion counseling should address headaches weight gain and hair loss since they were common cited reasons for removal. 47% of all women who had Norplant removed prematurely would recommend Norplant to a friend. Therapeutic interventions (ethinyl estradiol and nonsteroidal anti-inflammatory drugs [e.g. ibuprofen]) can help ameliorate the most commonly reported side effect: irregular bleeding. Only 4% of women were prescribed estrogen to control spotting or prevent amenorrhea. Yet some or all of the 46% of women whose menstrual problems precipitated Norplant removal might have benefitted from estrogen therapy.