Norplant

Definition

Norplant is a long-acting hormone that is inserted under the skin and prevents conception for up to five years. Depo-Provera is also a hormone, but it is administered by intramuscular injection and provides protection against pregnancy for three months. The hormone in Norplant and Depro-Provera is progestin, a synthetic hormone similar to one found naturally in a woman's body.

Purpose

The purpose of these hormones is to prevent pregnancy. Both are about 99% effective in achieving this goal. Neither of these methods provide protection from AIDS or other sexually transmitted diseases.

Depo-Provera is given as a shot (injection) and works in several ways to prevent conception. First, it prevents the egg (ovum) from maturing and being released, and it causes the mucous in the cervix (opening into the uterus or womb) to thicken, making it difficult for the sperm to enter. Depo-Provera also causes the lining of the uterus to become thinner, making implantation of a fertilized egg unlikely. The injection must be given within the first five days of a normal period and provides protection against pregnancy for three months. It is recommended that a second contraceptive device be used for two weeks after the first injection.

Norplant capsules contain a synthetic hormone that is slowly released over a period of up to five years. It functions like Depo-Provera in that it prevents the ovaries from producing ova (eggs) and also results in thicker mucous in the cervix, which prevents the sperm from passing through the cervix. Norplant can be inserted at any time.

Preparation

The woman being considered for Depo-Provera will have a pelvic and breast examination, a Pap test, blood pressure check, weight check, and a review of her medical history. Women who have diabetes mellitus, major depression, blood clotting problems, liver disease, or weight problems should use this approach only under strict medical supervision. It should not be used if the woman is pregnant, has unexplained vaginal bleeding, suffers from severe liver disease, has breast cancer, or desires to become pregnant within 18-24 months. Advantages of this approach may include a decreased risk of cancer of the lining of the uterus (endometrial cancer) and the cessation of menstrual periods.

Individuals who select Norplant will receive the same basic physical examination as for Depo-Provera. If approved for this method, a site of implantation will be selected (usually the inside of the upper arm), and the area prepared for minor surgery. The skin will be washed with soap and water, and an antiseptic, such as iodine solution, will be applied. The physician will use a local anesthetic to numb the area, a small incision will be made, the six Norplant capsules will be inserted, and the incision sewn up (sutured). Protection against pregnancy normally begins within 24 hours. If necessary, the implants can be removed in 15-20 minutes. Norplant should not be used by women who are pregnant, have blood clotting problems, or have unexplained vaginal bleeding. Advantages include light periods with less cramping and decreased anemia. This form of birth control may also be protective against endometrial cancer.

Because Depo-Provera and Norplant use only the hormone progestin, they may provide an alternative for women who can not use estrogen-containing birth control pills.

Risks

The most common side effects associated with Depo-Provera are yellowing of the skin, headache, nervousness, dizziness, abdominal pain, hair loss, rash, increase in the number of migraine headaches, increased or decreased interest in sexual intercourse, the development of dark spots on the skin, depression, and weakness. Danger signs that need to reported immediately include weight gain, heavy vaginal bleeding, frequent urination, blurred vision, fainting, severe abdominal pain, and coughing up blood. Because the effects of Depo-Provera may last up to 12 weeks, it may take a longer time for women trying to conceive to become pregnant after discontinuing the injections.

The main reactions to Norplant include headache, weight gain, irregular periods or no period at all, breast tenderness, acne, gain or loss of facial hair, color changes of the skin over the area of insertion, and ovarian cysts. The doctor should be notified immediately of lumps in the breast, heavy vaginal bleeding, yellowing of the skin or eyes, or infection of the incision. Women who use Norplant are discouraged from smoking.

Normal results

These two methods normally result in 99% successful contraception.

Key Terms

Hormone

A chemical produced in a gland or organ and transported by the blood to another area of the body where it produces a specific effect.

Further Reading

For Your Information

Books

• Dickason, Elizabeth Jean, Bonnie Lang Silverman, and Judith A. Kaplan. Maternal-Infant Nursing Care., 3rd ed. St. Louis: Mosby-Year Book, Inc., 1998.
• Gorrie, Trula Meyers, Emily Slone McKinney, and Sharon Smith Murray. Foundations of Maternal-Newborn Nursing, 2nd ed. Philadelphia: W.B. Saunders Company, 1998.
• Nichols, Francine H., and Elaine Zwelling. Maternal-Newborn Nursing: Theory and Practice. Philadelphia: W. B. Saunders Company, 1997.
• Olds, Sally B., Marcia L. London, and Patricia Wieland Ladewig. Maternal-Newborn Nursing: A Family Centered Approach. Menlo Park: Addison-Wesley, 1996.

  Other

• Healthy Devil Online, Duke University. "Contraceptive Options: Depo-Provera." http://152.3.65.120/h-devil/contrac/dp.htm.
• Planned Parenthood Federation of America, Inc. "Is Depo-Provera For You?" http://www.plannedparenthood.org/Library/birthcontrol/depoforyou.html.
• Planned Parenthood of Western Washington. "Depo Provera." http://www.ppww.org/depo.htm.
• Planned Parenthood of Western Washington. "Norplant." http://www.ppww.org/norplant.htm.

Gale Encyclopedia of Medicine. Gale Research, 1999.