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Implanon: new birth control rod under the skin of your arm » Family Planning

Implanon: new birth control rod under the skin of your arm

October 24th, 2008 by maggie chen Leave a reply »

In my first entry, I discussed how I would be writing about the organizations that are working to increase access to contraception, as well as new methods that are in development. This week, I’m jumping to one such new method.

You might remember hearing about Norplant, which was an implantable birth control method used in the 1980’s and 1990’s. Norplant was a set of six small silicone capsules filled with levonorgestrel (a progestin used in many hormonal methods; progestin is the synthetic form of progesterone which occurs naturally in the body). By 1996, more than 50,000 women had filed lawsuits against Wyeth pharmaceuticals, the manufacturer of Norplant. Many of the complaints were from women who claimed they had not been adequately warned about the side effects of Norplant, such as irregular bleeding, headaches, nausea and depression. More on the lawsuits here.

Needless to say, Norplant was taken off the market in the US. Interestingly, it is still used in the developing world: the UN Population Fund found that 6.2 out of 100 rural women in a region of Bangladesh still use Norplant.

When I was working at a teen clinic two summers ago, I started to hear murmurs about how excited the doctors and NPs were about the upcoming Implanon training. Implanon is essentially the follow-up to Norplant. It is a single-rod implantable contraceptive, about the size of a matchstick. After the rod is implanted just under the skin of a woman’s inner upper arm, it provides greater than 99%-effective contraception for up to three years. It contains etonogestrel, which is another form of progestin.

I wanted to shed some light on Implanon this week to hear what you think of the method itself, and its potential for use by women who have limited access to birth control. Consistent use of birth control pills has been difficult to sustain for women in rural areas because of the need for frequent pill refills, and I think that longer term methods, such as IUDs, Implanon, and Depo-Provera should be made available to women who cannot go to a pharmacy 4-12 times a year. The also have the added benefit of being more discreet in some ways, as with these methods, there is no external evidence that the woman is using contraception. However, the possibility of women being able to use contraception without their partners’ approval seems unlikely with the number of countries that require a husband’s permission in matters of family planning.

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6 comments

  1. afmurray@stanford.edu says:

    I am commenting briefly on your entry on Implanon; it seems to be a great method for some women, but I think it also has one of the problems that went along with Norplant. This was that the implants lasted too long. (And I am wondering if three years is a little too long.) Women misunderstood that they would be “sterile” for up to six years with Norplant, and, as I am sure you know, women, unable to access physicians’ help easily, occasionally tried to cut the implant out of their arms themselves. They simply did NOT want to be sterile that long. No doubt Implanon was introduced and tested extensively and perhaps the three-year duration was decided upon after credible interviewing and consultation with women from all walks of life and particularly in rural/remote village areas. I certainly hope so, and, if so, it sounds like a good method.

  2. wayva@stanford.edu says:

    It seems like Implanon would be a better solution for women who cannot have regular access to a pharmacy. How do they take it out in the end? Do they have to go back to the pharmacy.

    I had no idea that a husband’s permission was required in matters of family planning by many countries. It doesn’t surprise me at all, however, I would like to know, do many husbands prevent their wives from taking contraceptives? I can see it going both ways, where a husband may want fewer children as well or might be offended by the suggestion.

  3. mjromano says:

    Through my work in Honduran clinics I saw that doctors strongly favoring long-term birth control methods like depo-provera, which the healthcare providers justified by saying that most women couldn’t/wouldn’t remember to take daily pills nor would condoms be effective. I think contraceptive methods that women can use without the explicit consent of their partners are important in many cases, and that would include pills, injections, and implants. I am, however, skeptical of contraceptive methods that require regular or extensive healthcare provider involvement. In the case of Implanon, women need a surgical (although minimally invasive) procedure to start or stop using birth control. I think an ideal contraceptive method would allow women to start and stop at will without the involvement of a medical professional, but that is not to say that Implanon can’t play a valuable role for many women today. Trying to evaluate the needs of women as well as pharmaceutical companies is very complicated and maybe impossible. I’m curious to hear more about Implanon as it becomes available.

  4. jliebner@stanford.edu says:

    I like how we both wrote about Norplant this week. I hadn’t done much research into Norplant, so I was surprised to hear that it has been banned from many countries. It is one of the contraceptive methods still recommended in Jamaica by the National Family Planning Board. I am curious how the new method, Implanon, resolves the health issues of Norplant. I agree with you that long-term, inconspicuous birth control methods like Implanon are incredibly important, where a woman can use birth control without her partner’s consent. However, I wonder if such methods would be permitted in certain countries where men have a higher social status. Would women be allowed to have such a procedure done without their partner’s consent? Also (and this is an obvious point), while Implanon appears to be an effective method of birth control, it will not prevent HIV transmission. This is where condoms are most effective, but yet prove ineffective when men refuse to use them.

  5. tasha88@stanford.edu says:

    Wow. I’ve never heard of this Norplant. Whenever I hear of using contraception in developing countries, most organizations seem to be fervent supporters of condoms. This method certainly does compensate the problems of getting refills of the pill although there is the secondary problem of what happens when they do want to have kids, as Anne pointed out.

    I’m curious. Are there any long-term side effects to Norplant? I know the old version of birth control had insane levels of estrogen, so many women later develop breast cancer and blood clotting like decades later. Or since, Norplant is already version 2.0, is there any concern?

    On a completely random note since you seem really knowledgeable about contraception, are there any long-term side effects of the HPV vaccine? It seems like the vaccine was rushed on to the market and I was shocked that some states like Texas were mandating when it wasn’t on the market for so long.

  6. tasha88@stanford.edu says:

    oh oops! I mean Implanon (the newer better one) not Norplant. I got confused. =]

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