The Benefits and Risks of Implants

Scientists have noted few if any serious complications with Norplant implants, probably because they don't contain estrogen, and release their contents slowly, thereby avoiding hormonal surges. To be on the safe side, the manufacturer relays warnings based on experience with the Pill, which contains estrogen. (For risks and complications of OCs, see preceding section of this chapter.) Other possible complications include bleeding irregularities, follicular abnormalities, tubal pregnancies, harm to the infant during breastfeeding, and thromboembolic disorders. Insertion site infections can also prove troublesome.

Don't Use Norplant Implants If You... Suspect you are pregnant Have abnormal, unexplained vaginal bleeding Take antiseizure medication or the antibiotic rifampin Have active thromboembolic disease (blood clots) Know or suspect you have breast cancer Have acute liver dysfunction

Bleeding irregularities: Since many women have irregular periods while using Norplant implants, it's possible that more serious conditions marked by vaginal bleeding could be overlooked. These conditions include cervical and endometrial cancer.

If you're like many other women, your period may gradually stop while you're using this method, a condition known as "amenorrhea." But if you use Norplant implants and you suddenly stop having periods after being regular, it could mean you're pregnant. If you have 6 weeks or more of amenorrhea following normal periods, take a pregnancy test.

Follicular abnormalities: In the normal reproductive cycle, many ovarian follicles compete to become the one dominant enough to produce an egg. Those follicles not quite making the grade degenerate in a process known as "atresia." Although Norplant implants suppress the ovulatory system in about 50 percent of users, sometimes follicles do start growing. Researchers have noted that in Norplant users, follicular atresia is sometimes delayed, causing follicles to grow beyond their normal size. These growths can't easily be distinguished from ovarian cysts. Although the enlarged follicles disappear on their own most of the time, if they twist or rupture, surgery may be required.

Tubal pregnancies: Tubal, or ectopic, pregnancies do occur among women using Norplant implants, but less often than among women using no method of birth control. If you begin to feel abdominal pain, especially after your implants have been in place for a long time, seek medical care to rule out ectopic pregnancy.

When Growth Won't Stop Although the Norplant system prevents release of an egg, it will sometimes allow a follicle to begin developing. Lacking the usual hormonal cues that cause all but a dominant follicle to disappear at the end of a cycle, the out-of-control newcomer will continue to grow until it resembles a large ovarian cyst. In time, such enlarged follicles usually disappear. However, there is a slight danger of twisting or rupture, which could require surgery.

Breastfeeding: Progestin-only methods like Norplant implants and Depo-Provera have no impact on breast milk production; on the contrary, some studies show that milk production increases in the presence of progestins.

When studies were conducted on the Norplant system in the United States, some of the subjects were women who had the implants placed while they were breastfeeding. Six weeks after delivery, these women were given Norplant implants, and their breastfed children were then monitored for 3 years. Small amounts of the system's hormone could be found in the infants, but it did not affect their growth or health.

Unfortunately, no American women were studied earlier than 6 weeks after giving birth, making it impossible for the Food and Drug Administration to recommend the use of Norplant implants for women right after delivery. This lack of support from the FDA makes it difficult for doctors to recommend immediate postpartum insertion, even though studies outside the U.S. have documented its safety.

The issue is probably moot, because the act of breastfeeding can provide pregnancy protection for at least 6 weeks postpartum. Women in many developing countries (and even a small number of American women) actually use breastfeeding as a means of contraception. The method, which requires breast milk to be the infant's only source of nutrition, is known as the lactational amenorrhea method, or "LAM."

Thromboembolic disorders: Progestins are not known to cause the clots or blockages of blood vessels found in thromboembolic disease, but if you have an active case, your physician may suggest another method. If you develop any such disorder while using the implants, you should probably have them removed. If you had thromboembolic disease in the past, you are probably not a good candidate for Norplant implants.

Insertion site complications: With proper antiseptics, the insertion site seldom becomes infected. The skin can become irritated even several months after insertion, but this, too, is rare.

Newer Implants More Effective Many women interested in receiving Norplant implants—especially when the method was first introduced—were told that they would be less effective in women weighing over 154 pounds. This is no longer the case. Initially, the capsules were made of a dense material that somewhat reduced their effectiveness. All implants manufactured now contain softer, less dense tubing that allows for greater flow of hormones out of the tubes and into the bloodstream.