Levonorgestrel Subdermal Implants Research Articles

Effect of Levonorgestrel Implant on Lactation and Infant Growth: A Review

Background: Family Planning is a way to regulate the number of children born and the spacing of pregnancies through information, education, and the use of contraceptives. Postpartum contraception is important to obtain an optimal interpregnancy interval. Postpartum contraception should be initiated early; one of which is Long-Acting Reversible Contraception (LARC). Levonorgestrel can be used to prevent pregnancy because it interferes with ovulation, implantation, and fertilization. Objectives: This study aimed to assess the efficacy and effects of using levonorgestrel implants on breastfeeding and infant growth. Methods: Primary data were in the form of research papers obtained from ScienceDirect, PubMed, and Google Scholar published from the period 2010-2018. The keywords for the searches included: “levonorgestrel”, “levonorgestrel (LNG)-releasing implant”, “levonorgestrel on lactogenesis”, “levonorgestrel on infant growth”, and “levonorgestrel on breastfeeding”, which were used alone or in combination. Results: The 20 selected articles were reviewed based on five identified phrases. Levonorgestrel subdermal implants were shown to be a good choice for women who wanted effective contraception. When used by breastfeeding mothers, levonorgestrel subdermal implants affected neither infant growth (0-1 year of age) nor lactation duration. Conclusions: Levonorgestrel subdermal implants can be effective long-term contraception. These implants are safe for breastfeeding mothers and do not affect infant growth.

Predictors of Discontinuation of Subdermal Levonorgestrel Implants (Jadelle) at the Lagos University Teaching Hospital, Lagos, Nigeria: An Analytic Cohort Study.

Uptake and continuation of long acting reversible contraceptives (LARC) such as subdermal levonorgestrel implants are pivotal to the achievement of some sustainable development goals (SDG). We evaluated Jadelle uptake and factors affecting its discontinuation in the first three years of initiation at the Family Planning Clinic of the College of Medicine, University of Lagos (CMUL), Nigeria. A retrospective cohort study was conducted among 517 consecutive new Jadelle acceptors, at the family planning clinic of CMUL, between 1 October 2007 and 30 September 2010, who were followed up till 30 September 2011. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate factors affecting time to Jadelle discontinuation. Stata version 13 statistical software (StataCorp USA) was used for analysis. The mean age of Jadelle acceptors was 32.9 (S.D: ±5.4) years and uptake rate of Jadelle was 61.8%. The overall discontinuation rate was 19 per 100 women-years while the 1-year, 2-year and 3-year Jadelle discontinuation rates were 7.1%; 27.0% and 58.1% respectively. Increased age, (P=0.047) and previous contraceptive use (P <0.001) were independent predictors of Jadelle discontinuation. Menstrual irregularity (51.4%) and intention to get pregnant (40.3%) were the commonest reasons for discontinuation. The failure rate was low at 0.27 per 100 women-years. This study showed that Jadelle had a high uptake rate complimented by a low failure rate; and is quite suitable for postpartum childbirth spacing as well as ongoing long term contraception.

SATISFACCIÓN DE LAS USUARIAS DE IMPLANTES DE LEVONORGESTREL. EXPERIENCIA DEL HOSPITAL NACIONAL CAYETANO HEREDIA

OBJETIVOS:Determinar las características y el porcentaje de satisfacción de las usuarias de implante subdérmico de levonorgestrel (Norplant®)pertenecientes al Programa de Planificación Familiar del HNCH. DISEÑO: Estudio descriptivo, retrospectivo. MATERIAL Y METODOS : Del total de usuarios a quienes se les extrajo el implante entre enero 1995 y diciembre 1999, se incluyo 82. Los datos fueron obtenidos mediante una ficha de recolección de datos y una encuesta. La satisfacción fue evaluada mediante la escala de Likert. REULTADOS: El 71,9% de usuarias resulto satisfecha La tasa deembarazo fue 0%. El 70,7% de las usuarias presento algun efecto secundario, el mas frecuente fue la alteración de la mestruacion (47,6%). La principal ventaja fue la protección contra el embarazo a largo plazo (53,7%). Se registro 59% de continuidad a los 5 años y las principales causas de remoción temprana fueron deseo de embarazo (23,5%) y alteraciones mestruales (23,5%). Se encontró significancia estadística con la satisfacción evaluada en la siguientes variables: aumento de peso (p= 0,0077), dolor en zona del implante (p= 0,000055), síntomas depresivos (0,00000), nivel educativo (p =0,033), recomendación del metodo (p= 0,000) y deseo de reimplante (p= 0,0000). CONCLUSIONES: Los implantes subdérmicos de levonorgestrel resultan ser un metodo anticonceptivo muy bien aceptado por las usuarias, a pesar de los efectos secundarios que presentan, altamente efectivo y una buena alternativa para mujeres que deseen anticoncepción a largo plazo.

Contraception with levonorgestrel subdermal implants (Norplant) in Benin-City, Nigeria: a 12-year review.

The case notes of 377 clients who accepted Norplant out of 11961 acceptors of family planning methods in the Department of Obstetrics and Gynaecology University of Benin Teaching Hospital, between January 1985 and December 1996 were retrieved and analysed at the end of 2004, for socio-demographic characteristics of the clients, side effects and complications reported and reasons for discontinuation in relation to duration of use. The daily register of the acceptors were analysed for new acceptors of other methods during the same period and confirmed with their case notes. The acceptance incidence of Norplant was 3.2%. The mean age and parity of the acceptors were 32.2 +/- 4.5 years and 3.9 +/- 1.8 respectively. The duration of use ranged between 6 months and 13 years. 65% of the acceptors reported menstrual abnormalities. 48% of them reported reduced bleeding pattern, while 7.5% (25) discontinued method under 4 years of use because of increased bleeding episodes. Other side effects reported were headache 6%, weight gain 3%, mastalgia 1.8%, decreased libido 1.8%, abdominal pain 1.5% and hypertension 1.2%. 20.4% (68) discontinued the use under 4 years because of desire to have another baby. 38.6% (129) had implants removed at 5 years, while 20.1% (67) continued the use for 6-13 years before removal and replacement with another set. Husband's request for removal constituted 7.2% (24). The effectiveness was 100% as no pregnancy was reported during the study period. The continuation rate at 5 years was 58.7%. 43 clients were however lost to follow up. Norplant was found to be an effective and acceptable method of long-term reversible contraception with minimal side effects. The low incidence was attributed to the fact that the implants were donor driven and not included in the country contraceptive logistic system. Norplant acceptors who continued the use after 5 years did so, because they enjoyed it and did not want to part with them without replacement of new sets.

Safety, Efficacy and Acceptabilty of Norplant&lt;sup&gt;R&lt;/sup&gt; Implants in Jos, Northern Nigeria

Context: Norplant R is a long acting reversible progestogen method suitable for women of all ages. It is however not without side effects that may affect its continuous usage. Documentation of such changes is important for counselling acceptors to achieve user\'s satisfaction. Objective: To evaluate the safety, efficacy and acceptability of Norplant R amongst its acceptors. Study Design, Setting and Subjects: This study was part of ongoing prospective longitudinal studies that involved 23 women who had complete records at three years out of the 37 healthy non breast feeding informed volunteers recruited from our family planning clinic in August 1997. Data on socio-demographic characteristics, menstrual pattern, packed cell volume, weights, blood pressure, side effects and user\'s satisfaction were analysed. Results: The mean age and parity of the acceptors were 31.7 ± 3.4 years and 4.7 ± 1.0 respectively. Even though the mean weight at 12months (63.2 ± 11.7kg was not statistically different (p 0.5) from the mean weight at pre-insertion (62.5 + 11.2kg), there were statistical significant increases in weights at 2years (66.9 ± 12.1kg; p= 0.001) and at 3years (65.9 ± 11.6kg; p 0.01). Apart from the slight statistically significant increase (p 0.02) in systolic blood pressure at 2years, the blood pressure changes at 1year and 3years did not show significant changes. Main side effects were menstrual abnormalities, weight changes, headache, abdominal pain and dizziness. The packed cell volume significantly increased. Continuation rate was 100% and there was no pregnancy recorded. Users were satisfied with the method because of its convenience, low risk of pregnancy and long duration of action. Conclusion: Norplant R subdermal implant was an effective safe and acceptable method of contraception amongst the acceptors, despite its minimal side effects. Key Words: Norplant R Implants, Safety, Efficacy and Acceptability Norplant R is a registered trademark of The Population Council for levonorgestrel subdermal implants [ Trop J Obstet Gynaecol, 2004;21:95-99]

Acceptability of levonorgestrel subdermal implants versus tubal ligation for long-term contraception in a rural population of Zimbabwe

This prospective cohort study of 257 rural Zimbabwean women was designed to compare patient satisfaction with levonorgestrel subdermal implants (Norplant and reg;) versus tubal ligation (TL) as a method of long-term contraception. Women were equally satisfied with both methods. At 1 year, 96% of Norplant users and 97% of the TL group reported being “satisfied” or “very satisfied,” and 98% of Norplant users, and 99% of the TL cohort would recommend their chosen method to a friend or relative. Rating scores at both 6 months and 1 year were high and equal, with women in each cohort rating their method, on average, as 9 out of 10. Norplant users were significantly more likely to rate birth spacing as a reason for satisfaction with their method, whereas women in the TL cohort were more likely to select multiparity. The 1-year continuation rate with Norplant was 90%, with 4% discontinuing in order to have more children. Selecting the most appropriate method depends primarily on the potential desire of the woman to have more children.

Combination of subcutaneous levonorgestrel implants and transdermal dihydrotestosterone gel for male hormonal contraception

The primary aim of the present study was to determine the therapeutic dose of subcutaneous levonorgestrel (LNG) to induce azoospermia or severe oligozoospermia (&lt;3 × 106/mL) in normal men requiring contraception. Transdermal 5α‐dihydrotestosterone (DHT) was combined to the treatments to maintain peripheral androgen level. Forty‐three 21–45‐year‐old healthy men were enrolled in this phase II randomised and comparative clinical performance study. The subjects were allocated to five groups to receive: (1) transdermal DHT (AndractimR, Besins Iscovesco, Paris, France) and one subdermal LNG implant (Jadelle, Leiras, Turku, Finland); (2) transdermal DHT and two subdermal LNG implants; (3) transdermal DHT and four subdermal LNG implants; (4) transdermal DHT and oral LNG (Microluton, Schering, Germany); or (5) transdermal DHT only. A total of 27 men completed the suppression phase. None of them reached azoospermia. One subject with oral LNG and transdermal DHT reached &lt;3 million/mL at 5 months of suppression, but not repeatedly. Together 2/27 (7%) subjects, one with oral LNG and DHT and the other with four subdermal LNG implants and DHT reached &lt;5 million/mL temporarily. Altogether 9/27 (33%) subjects reached &lt;20 million/mL. Serum testosterone concentrations (S‐T) decreased significantly during the first 3 months of treatment with one, two and four LNG implants and DHT and during the next 3 months S‐T remained significantly lower with two or four implants. Serum oestradiol concentrations (S‐E2) decreased significantly during the first 3 months only with four implants, but at 6 months S‐E2 was lower also in the group with two implants. Serum luteinizing hormone (LH) decreased significantly only with two LNG implants and DHT gel at 5 and 6 months. Serum FSH did not decrease in any of the groups. None of the subjects filled the criteria to continue to the efficacy phase. A total of 16 men discontinued for various reasons. Of the 27 men completing the suppression phase, all have recovered to sperm levels &gt;20 million/mL. There were no changes in blood count, lipid profile, liver function tests, prostate‐specific antigen (PSA), sex hormone binding globulin (SHBG), prolactin or cortisol. The mixed antiglobulin reaction (MAR)‐IgG, MAR‐IgA or tray agglutination test (TAT) did not change during any of the treatments. The present study shows that the LNG implants themselves are well‐tolerated by men and safe, and might be suitable for replacing part of the testosterone used as injections to reduce the androgen dose during male hormonal contraception. The DHT gel was considered as quite or very uncomfortable by 66% of the men because of feeling cold during the time it was on the skin, but uncompliance in using the gel was not reported by the men.

Endometrial expression of glycodelin in women with levonorgestrel-releasing subdermal implants

Objective: To determine whether subdermal levonorgestrel implants induce endometrial expression of glycodelin. Design: Cross-sectional, blinded study. Setting: University clinic. Patient(s): One hundred and eight women with subdermal implants and 19 postmenopausal women. Intervention(s): Endometrial biopsies, curettages, and hysterectomies. Main Outcome Measure(s): Endometrial glycodelin expression was examined through immunohistochemistry, in situ hybridization, and morphologic endometrial dating. Result(s): Overall, 80% of the endometrial specimens obtained from women with subdermal levonorgestrel implants stained positive for glycodelin. Endometrial morphology of these women showed proliferative (71%), inactive/weakly proliferative (19%), menstrual or regenerating (6.5%), and other patterns (2.8%). Of these, 79%, 71%, 100%, and 100% were glycodelin positive, respectively. Nineteen specimens were obtained during the midcycle when glycodelin is not normally expressed: of these, 89% stained positive for glycodelin. Implant-related amenorrhea was associated with endometrial glycodelin expression in 58% of the women, whereas the endometrium specimens obtained from women with postmenopausal hypoestrogenic amenorrhea contained no detectable glycodelin. Conclusion(s): Subdermal levonorgestrel implant use is often associated with endometrial expression of glycodelin. Because glycodelin has been shown to inhibit sperm–egg binding, the induction of glycodelin may contribute to the contraceptive activity of the implant.

Clinical Experience with Levonorgestrel Subdermal Implants (Norplant??)* for Long-Term Contraception

Objective The study was undertaken to assess the efficacy, acceptability and tolerability profile of levonorgestrel 6-capsule subdermal implants (Norplant®) for long-term contraception, in Greek women.

The role of levonorgestrel implants in hormonal contraception

Levonorgestrel subdermal implants have been available worldwide for more than 15 years. Norplant was the first significant development in family planning since the oral and intrauterine contraceptives of the 1960s. No other contraceptive system has been so thoroughly evaluated before and after introduction; more than 6 million women have used Norplant and more than 50 000 women have participated in clinical trials with this product ,which show the safety ,efficacy and acceptability of implants for family planning. Technical advances in sustained-release steroid delivery now permit the safety and efficacy of Norplant to be transferred to a two-rod system that is faster and easier to insert and remove and is packaged in its own single-use trocar. Levonorgestrel implants will provide long-term family planning to women who have used Norplant and want to continue implant contraception ,and will appeal to a new generation of women who want a highly effective ,ultra-low-dose hormonal method without serious side-effects. Worldwide availability of implants that are easy to initiate and discontinue will broaden the appeal of low-dose ,sustained-release contraception to clinicians and users. Many women who rely on less effective ,harder-to-use methods will find that levonorgestrel implants are a simple alternative with minimal physiological impact.

A detailed analysis of menstrual blood loss in women using Norplant® and Nestorone® progestogen-only contraceptive implants or vaginal rings

Changes to the pattern of menstrual bleeding are almost universal in women using progestogen-only methods of contraception, and are an important cause of discontinuation of these methods. The present study was designed to explore the changes in menstrual bleeding patterns and objectively measure menstrual blood loss (MBL) in 110 women before and during one year of use of 4 different progestogen-only contraceptives: Norplant® subdermal levonorgestrel implants; Nestorone® progestogen 4-cm or 6-cm implants nominally delivering 100 μg or 150 μg daily; or a vaginal ring (CVR) delivering 1 00 μg of Nestorone (NES) daily (CVR users were limited to only 6 months of use). Groups could not be directly compared because of the differences in numbers of subjects and durations of treatment. The total MBL during each of the three 8-week collection periods during treatment decreased significantly in each group compared to the total blood loss in the two control cycles (greater than 50% decrease in all groups during the first 6 months), although the differences between individual women at the extremes remained considerable. The highest blood loss measured on any single day during the treatment collection periods was significantly reduced (p <0.001) in users of all four devices in all three collection periods compared to the control period (CVR users did not have a 3rd collection period). The Nestorone-releasing CVR was associated with an 88% reduction in mean MBL and a high incidence of amenorrhea at 6 months. There was considerable variation in percentage reduction in total blood loss at 6 and 12 months between individual women ranging from 100% (women with amenorrhea) to a small minority experiencing an increase compared with control cycles. The increases in measured blood loss during treatment were almost entirely in women with light bleeding in the control period and were related to prolonged episodes of light bleeding rather than heavy bleeding. Women contemplating use of a progestogen-only contraceptive method need to be counseled about alterations to the menstrual cycle but can be reassured that total blood loss will usually be much less than with normal cycles .

Prevalence of enlarged ovarian follicles among users of levonorgestrel subdermal contraceptive implants (Norplant)

Objective:The aim of this study was to determine the prevalence of enlarged follicles, as detected by a single clinical or ultrasonographic examination, among users of levonorgestrel subdermal contraceptive implants (Norplant implants). Study Design:This was a cross-sectional study of 103 users of Norplant implants and 50 users of the TCu380A intrauterine contraceptive device, all of whom received reproductive health services from PROFAMILIA, Santo Domingo, Dominican Republic. Bimanual pelvic examination and vaginal ultrasonography were performed. Enlarged follicles (>25 mm) were followed up weekly. The λ2 test was applied to these data. Results:Enlarged follicles were detected by ultrasonography in 17.5% of Norplant implants users and 4% of TCu380A intrauterine contraceptive device users, respectively (P < .04). There was no difference according to duration of use. The longest time to involution of the follicles was 4 weeks. Forty percent of the enlarged follicles detected by ultrasonography were also detected by bimanual pelvic examination. Conclusions:Enlarged follicles are a frequent finding among women who use Norplant implants, but they are less frequent than described in previous studies, which were based on serial ultrasonographic scans in selected groups of users. Physicians and users should be aware of the transient nature of these enlarged follicles, which do not require intervention.

Effects of hormonal contraceptives on bone mineral density.

The clinical research to date on the effects of 3 types of hormonal contraceptives, i.e. depot medroxyprogesterone acetate ('Depo-Provera'), levonorgestrel subdermal implants ('Norplant'), and oral contraceptives, on bone mineral density in premenopausal women is reviewed. The large variance in results across studies for each method is in part due to differences in research design, techniques for measuring bone mineral density, age of the study participants and type of oral contraceptive preparation. However, the balance of the evidence leans toward a positive effect of oral contraceptives on bone mineral density in women of all age. On the other hand, few observations have yet been published on the effects of the new progestin oral contraceptives on bone mineral density. The few extant data suggest a positive impact of levonorgestrel subdermal implants on bone mineral density in women of all ages. Although the findings are preliminary, it appears that depot medroxyprogesterone acetate may exert a negative effect on bone mineral density. More specifically, caution should be exercised in prescribing long term depot medroxyprogesterone acetate (e.g. > 5 years) especially in young adolescents (e.g. < 16 years old) who may not have yet reached peak bone mass.

Levonorgestrel subdermal implants. A review of contraceptive efficacy and acceptability.

Levonorgestrel 6-capsule subdermal implants (Norplant) are an effective form of reversible contraception. When implanted under the skin of the upper arm, they release drug into the circulation at a relatively constant rate over 5 years. Generally, the cumulative pregnancy rate at the end of 5 years' levonorgestrel implant use is less than 2 per 100 users. The implants provide contraceptive efficacy equivalent to, or better than, that provided by other reversible methods (including oral contraceptives). Younger women are more likely than older women to become pregnant while using levonorgestrel implants. Bodyweight was positively correlated with risk of pregnancy in a number of studies, but may not be a factor with the currently available 6-capsule implant formulation. Limited data suggest that a new 2-rod levonorgestrel subdermal system (Jadelle) is as effective as the more extensively studied 6-capsule system and has a similar tolerability profile. Fertility returns rapidly after the implants are removed. Use of levonorgestrel subdermal implants is compatible with breast-feeding. In several studies, discontinuation rates were 2 to 15% during the first year of use; cumulative 5-year discontinuation rates ranged from 22 to 64 per 100 women. Despite a substantial incidence of adverse events during therapy, levels of user satisfaction are generally high. Menstrual abnormalities (increased or decreased menstrual flow, spotting, irregularity and amenorrhoea) affect most women at some time during therapy and are the most frequent reason for discontinuing levonorgestrel implants before the end of 5 years' treatment (incidence of 4.2 to 30.7 per 100 users). Mood changes and headache also may lead to discontinuation. Other reported adverse events include skin reactions (including acne), dizziness and weight gain. Serious adverse events (such as stroke, thrombotic thrombocytopenia and idiopathic intracranial hypertension) have been reported during levonorgestrel implants therapy, but the population incidence is difficult to calculate and causality is unclear. According to 3 pharmacoeconomic analyses from an institutional or managedcare perspective, all contraceptive interventions result in net cost savings. It is not clear whether levonorgestrel implants provide greater or smaller economic benefits than combined oral contraceptives. Levonorgestrel subdermal implants provide effective long term contraception. Despite a high incidence of menstrual adverse events, overall levels of user satisfaction are high, and 1-year continuation rates are better than those for combined oral contraceptives. Levonorgestrel subdermal implants are a good choice of contraceptive method in women who desire effective contraception, but who are unable to, or prefer not to, comply with an oral regimen.

Levonorgestrel subdermal implants. Contraception on trial.

When they were introduced to the world market in the 1980s, levonorgestrel subdermal implants offered the promise of an exciting alternative to traditional hormonal contraception. They provide highly effective, long-acting protection from pregnancy, without the need for user compliance. Broad acceptability of the drug has been reported throughout the world. Recently, however, the implants have met with opposition. The drug is associated with a variety of adverse effects, and removal of implants can be problematic. Serious events have been reported in women using levonorgestrel subdermal implants, although causal relationships have not been demonstrated. Additionally, concerns have been raised over the potential for coercive use of the drug. Numerous law suits have been filed alleging serious problems with implants. As a result, the drug has received considerable negative media attention. Before the controversy over levonorgestrel subdermal implants erupted, contraceptive development had declined, resulting from limitations to profits and funding, legal threats, and changes in the insurance industry. The levonorgestrel subdermal implant experience may serve to accelerate this trend. While the introduction of levonorgestrel subdermal implants offered an alternative to the current array of medical contraception, its experience may serve to dampen future contraceptive development efforts. Costly litigation and much controversy involving the implants have acted to create disincentives to further research and development of new methods of medical contraception.

Contraception Update: Implantable and Injectable Methods

There are currently more options available to pediatricians caring for sexually active adolescents who wish to prevent pregnancy. The two progestin-only methods, levonorgestrel subdermal implants and DMPA injections, minimize or entirely remove the obstacle of patient compliance from contraceptive efficacy. Adolescents considering a progestin-only method of contraception should be counseled explicitly about the likelihood of menstrual irregularity with use. Perhaps more importantly, adolescents should be reminded that hormonal methods of contraception do not provide protection from sexually transmitted disease. Thus, male condom use should not only be recommended, but also concrete discussion and instruction on appropriate use should be given.

Endocrinology: Immunohistochemical sex steroid receptor distribution in endometrium from long-term subdermal levonorgestrel users and during the normal menstrual cycle

The bleeding problems experienced by users of subdermal levonorgestrel implants (Norplant) remain unexplained. The aim of the present study was to investigate the oestrogen (ER) and progesterone receptor (PR) distribution in levonorgestrel-treated endometrial biopsies from 31 subjects recruited in Jakarta, Indonesia, and to compare the sex steroid receptor immunostaining with that of endometrium from 58 normally cycling women from Melbourne, Australia. Sex steroid receptor immunoreactivity was additionally compared with days of exposure to subdermal levonorgestrel, serum oestradiol and progesterone levels and days of bleeding during a 90-day reference period. An immunohistochemical technique with an alkaline phosphatase anti-alkaline phosphatase (APAAP) detection system for use in formalin-fixed paraffin wax embedded endometrial tissue was employed. Significantly greater mean immunostaining scores of stromal PR were observed in Norplant compared with control endometrium at all stages across the cycle. No significant correlations were demonstrated between sex steroid receptor immunostaining and days of exposure to subdermal levonorgestrel, serum oestradiol or progesterone concentrations or days of bleeding during a 90-day reference period. Whether the elevated stromal PR immunostaining in Norplant-treated endometrium is a consequence of increased synthesis or reduced turnover of receptor remains unclear. As yet it is undetermined whether increased PR immunoreactivity corresponds to an increase in number of functional PR.

Adverse Drug Reactions: Premature Early Removal of Levonorgestrel Subdermal Implants Due to ADRs

Adverse Drug Reactions: Premature Early Removal of Levonorgestrel Subdermal Implants Due to ADRs

Contraceptive management for female adolescents with mental retardation and handicapping disabilities

Adolescent girls with mental retardation and handicapping disabilities have a need for sexual counseling and contraceptive management. Societal attitudes have changed, allowing these patients to experience normal and satisfying sexuality. The reproductive health concerns of these patients are extensive. Contraceptive selection varies with regard to the mental and physical capabilities of individual patients. The use of barrier methods, intrauterine devices, oral contraceptives, intramuscular medroxyprogesterone acetate, and sterilization has been discussed thoroughly in the past. No formal studies have been performed to evaluate the use of subdermal levonorgestrel implants in patients with mental retardation and physical disabilities.

Contraception with subdermal levonorgestrel implants as an alternative to surgical contraception at Ilorin, Nigeria

Acceptability and social characteristics of a cohort of Norplant®, IUD, pill and depo-medroxyprogesterone acetate (DMPA) acceptors who were seen at the University of Ilorin Family Planning Clinic over a 10-week period of the pre-introductory clinical trial of Norplant®, are compared. Findings indicate that Norplant® and DMPA are adopted as an alternative to sterilization by women advanced in reproductive age and of high parity. The pill and IUD are adopted mainly as birth-spacing methods. Women's education, but not previous use of a contraceptive method, influenced the adoption of Norplant®. The continuation rate at 12 months, a measure of acceptability, was highest, 93.7 per 100 women, for Norplant® and 77.9, 46.7 and 27.7 per 100 women for the IUD, DMPA and the pill, respectively. The need to address the high family size norms in the African subregion is discussed.