Subdermal contraceptive implants time-release a constant dose of progestin and typi­cally are used for up to 5 years. Norplant was the first such method introduced in the United States, in 1990. However, due to multiple lawsuits and court battles, the manu­facturer announced in 2002 that it would stop production of Norplant. As of 2005,

Norplant

A hormonal method of birth control using doses that are implanted in a woman’s arm and that can remain in place for up to 5 years.

Norplant implants are no longer available for new users but current users can continue using it until it expires.

An improved version of Norplant—called Jadelle—was approved by the FDA in 1996 but has not been marketed in the United States. Jadelle consists of two silicone cylinders that are implanted in a woman’s forearm through a small incision. The im­plantation procedure takes about 10 minutes and is usually performed in a healthcare provider’s office. Jadelle can be left in place for 5 years, after which the cylinders must be surgically removed. Fertility is restored as soon as the cylinders are removed.

Other hormonal implants are being researched today. A single-rod progesterone im­plant, Implanon, was approved by the FDA in 2004. The single-rod system has been found to provide a more stable release of hormones than Norplant (Bennink, 2000; J. E. Edwards & Moore, 1999).

How They Work The implants are often inserted during the first 7 days of a woman’s menstrual cycle and contain time-released hormones (synthetic progestin) that suppress ovulation, thicken cervical mucus, and render the endometrium inhospitable to the zygote.

Effectiveness Subdermal implants have been found to be 99.95% effective in the first year of use; effectiveness rates decrease consistently after the third year. Also, women who weigh more than 154 pounds generally absorb lower hormonal concentra­tions, which may increase the chances of pregnancy.

Advantages Women who are unable to use oral contraceptives may be able to safely use subdermal implants. They are a highly effective, long-lasting, easily reversible contraceptive method with a rapid onset of protection. They require a simple implanta­tion procedure; have no estrogen side effects; decrease menstrual flow, cramping, and risk of endometrial cancer; and increase spontaneity.

Disadvantages Insertion and the implants’ costs are estimated at $500 or more, depending on the physician’s fees. Women using implants may experience irregular bleeding or other menstrual problems, arm pain, bleeding from the injection site, headaches or vision problems, dizziness, cramping, nausea, weight gain or loss, hair growth or loss, and general weakness (Hatcher, 2004). Additional side effects may in­clude skin rash or acne, visible injection site and cylinders, painful removal proce­dures, and possible scars after removal (when protective scar tissue grows around the implants). In the future, scientists hope to develop self-dissolving cylinders so that re­moval is unnecessary.

Similar to oral contraceptives, subdermal implants’ contraceptive effectiveness can be affected by the use of other drugs. In addition, these methods offer no protec­tion from STIs.

Cross-Cultural Use Prior to FDA approval in the United States, Norplant had been used throughout Europe, Latin America, and Asia. In several countries today, im­plants are one of the most popular contraceptive choices. In South Africa, 27% of women use implants (Nicholas, Daniels, & Hurwitz, 2004).