Did you know that a new contraceptive just became available in Durango? Implanon was approved for use in this country over two years ago, but its manufacturer has been very cautious in making it available.
Almost all women can safely use Implanon. It is effective for up to three years, and can be removed easily when the user wants. Best of all, once it is in place, it requires no action on the woman’s part to provide essentially perfect protection against pregnancy. Compliance is not a problem with this contraceptive method.
The availability of effective contraceptive methods is one of the three most important factors in helping to lower fertility rates in poor countries. (The other two factors are education of girls and lowering child mortality rates. Thanks to almost universal literacy and modern pediatric care in our country, we don’t have to worry about these two factors.) The sad fact is that half of pregnancies conceived in the United States are unplanned. Can a method that is reliable and simple to use help lower this statistic?
Implanon is similar to Norplant in some ways, but has significant differences. You may remember that Norplant consisted of six flexible plastic rods filled with a hormone. Although it was initially well received, a problem forced it off the market a number of years ago.
Many women were keen on Norplant, but doctors weren’t. It had to be inserted properly, so each of the rods was right under the skin of the woman’s arm. Norplant was difficult to remove if it were placed too deep. Bad insertion technique is what got Norplant into trouble. Too many were inserted by people who weren’t properly trained, so doctors attempted removal and ran into difficulties.
The similarities between Implanon and Norplant include the hormonal makeup, which has no estrogen. Both Norplant and Implanon just use a progestin, making them safe—especially for women with blood clotting disorders or migraine headaches. Both systems cause menstrual irregularity; most women using them either have irregular menstrual bleeding. Both offer very reliable contraception, with failure rates of just a fraction of a percent. Both have the hormone in one or more flexible plastic rods that are implanted under the skin of a woman’s arm. Implanon has only one rod, which makes insertion and removal much easier than Norplant’s six.
Learning from the Norplant fiasco, the manufacturer of Implanon has taken precautions to prevent it from getting misused. Implanon will only be available to doctors (and other medical providers) who have completed a comprehensive training program. I attended such a program in Durango in August with a dozen other providers. After practicing the technique on plastic models, we were all impressed with how easy Implanon is to insert and remove. In real people insertion or removal is done with a bit of local anesthesia and takes just a minute or two.
How do women like Implanon? According to the manufacturer, women like it very much. They advised us, however, to warn women before getting this contraceptive method that it will mess up their menstrual cycles. Almost all women will have some spotting or irregular bleeding with Implanon. After a period of adjustment, however, some women will stop bleeding entirely. Skipping periods is entirely safe. Fewer periods helps prevent anemia and PMS, and is the goal of some new birth control pill formulations.
An Implanon wearer should not be aware of its presence. The implant is placed under the skin of a woman’s upper arm. The rod is small and flexible, so an observer cannot see it hidden below her skin. A health care provider (or the woman herself) can find it easily by touching in the correct place.
Implanon works in two different ways. Most important is that the hormone stops ovulation. Without an egg, pregnancy cannot begin. An additional action is that the hormone makes cervical mucus impenetrable to sperm. These two actions make it very reliable, with only one failure per year per thousand women using it.
When a woman wishes to conceive, her fertility should return quickly after Implanon is taken out. Likewise, if a woman doesn’t like the method (for instance, if the irregular bleeding gets to her), the side effects are rapidly reversed as soon as it is removed.
Implanon might not be the contraceptive answer for all couples, but it provides another method that will be safe and effective for some. I am glad that we can now offer it in Durango!
© Richard Grossman MD, 2007
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