From: aharvey@fwhnm02.fwrdc.rtsg.mot.com (Anne Harvey)
Subject: Norplant (long)
Organization: Cellular Infrastructure Group, Motorola, Inc.
Date: Thu, 16 Apr 1992 03:07:14 GMT

 
Last week I posted to misc.kids, soc.women, and sci.med requesting
experiences with the contraceptive Norplant.  Because I am nursing my
5 month old daughter, I was especially interested in any information
related to Norplant's use while breastfeeding.

In addition to my initial information from my OB/GYN, I now have
information from the net, my pediatricean, and a certified lactation
consultant.

First I'll give a brief description of Norplant in case you're not
familiar with it.  The Norplant system consists of six, very small,
thin flexible capsules, made of a soft rubberlike material, that are
inserted just under the skin on the inside of your upper arm in a
minor, outpatient surgical procedure. The capsules contain a synthetic
hormone, levonorgestrel (a progestin), that is also used as one of the
active ingredients in many oral contraceptives. Immediately after
insertion of the Norplant System, a very low continuous dose of the
hormone is released into your body. Pregnancy is prevented through a
combination of mechanisms. The most important ways are by inhibiting
ovulation, so eggs will not be produced regularly, and thickening the
cervical mucus, making it more difficult for the sperm to reach the
egg.  Compared to other methods of contraception, only male
sterilization has a lower failure rate than Norplant.  The average
annual pregnancy rate over a 5-year period for the Norplant System is
less than 1%.  The Norplant system provides five years of protection
but can be removed at any time.  When the Norplant capsules are
removed, you will return to your previous level of fertility (unlike
typical birth control pills, there is no need to wait several cycles
before trying to conceive).

There are several conditions which may preclude the use of Norplant.
Obviously don't use it if you are pregnant or think you may be.  Also
you may not want to use it if you have: liver disease, gall bladder
problems, unexplained vaginal bleeding, breast disease, blood clots,
diabetes, elevated blood pressure or cholestrol, headaches, heart
disease, or kidney disease.  There are certain drugs used for epilepsy
which may interact with Norplant making it less effective.  

Like any medication, women using Norplant may experience some
side-effects.  The most common of these is irregular menstrual
bleeding which may vary from woman to woman. Some women may have
prolonged bleeding, spotting between periods or no periods for several
months.    

Of course, any women should select the contraception best for her
after discussion with her physician.  Someone was good enough to
e-mail me a version of the brochure provided by the manufacturer which
I can forward to anyone who is interested.

Since I am breastfeeding, it is also important to me to know that the
drug will not affect my baby or my milk supply.  After speaking to my
OB/GYN, I called the pediatricean.  All three drs. in the office
agreed Norplant would not hurt the baby.

Next I called a certified lactation consultant.  Her research yielded
the following information.  Because the Norplant is progestin only and
is dispensed in such small amounts, it does not affect a nursing
mother's milk supply.  Only 1.1% of the adult dose of the medication
enters the breastmilk; this is not considered significant.  The
American Academy of Pediatrics has not yet rated Norplant.  However,
the Swedish National Board of Health which rates drugs for use by
pregnant and lactating women has given it a rating of "Class 2" for
lactating mothers.  Class 2 means that active ingredients enter the
breastmilk but in such small amounts that there is no risk to the
child.  The l.c. considers the Swedish group quite tough, so based on
this information she says that Norplant is ok for the nursing mother
who's child is over 8 weeks old.

Before making a decision, I wanted to hear some "real-life"
experiences.  Although I didn't receive mail from anyone who was
breastfeeding, the replies from the net by women who are using
Norplant was positive.  I've excerpted some of their comments:

    "It's wonderful. Really.  ... The best part of Norplant is that
    all the side effects I had from the Pill are gone....My period
    lasts 2 days with maybe another day of spotting.  No cramps ..."

    "The procedure is relatively simple...I now have a tiny (1/8 inch
    or so) scar, and you can't see the capsules unless I tighten the
    skin there. I don't even notice them, and never have to worry
    about forgetting my arm anywhere. ;) ...I think the best part
    about the whole thing is the peace of mind.  There are no pills to
    remember, no sponges to insert.. Since I'm sure my partner is
    disease free, we are free to be as spontaneous as we wish. It's my
    opinion that Norplant is one of the best inventions I've *ever*
    seen. :) "

    "I have had my Norplant for 1 month and so far - I love it....
    You can not tell it is in place, you can feel them but they are
    not visible.... so far no naseua, spotting, or signs that I have
    birth control in place."

I also received reply from a person whose sister became pregnant while
using Norplant and taking a drug for epilepsy.  (This is a documented
drug interaction.)

I also received several responses from people who did not have any
direct experience with Norplant but did bring up several concerns.
Most seem to fall into the following categories: 

    Concern about exposing my nursing daughter the hormones in
    Norplant.  I believe this issue has been addressed by the
    lactation consultant and pediatricean.  I have worked with the
    lactation consultant previously and found her to be very careful
    to do everything to ensure good health for mother and bay and
    success breastfeeding.  If she says Norplant is ok while nursing,
    I'm inclined to trust her.  

    Concern about scarring and the ability to reverse the affects of
    Norplant should I have adverse reactions.  Nothing I have found 
    mentions the possibility of extensive scarring and
    everything I have learned has indicated Norplant can be quickly
    and easily removed.  But Norplant has not been in wide use in the
    U.S. for many years, so I suppose this is a possibility which 
    cannot be ruled out.  

    Concern that Norplant is designed for long term use and that I may
    want to have another child in less than 5 years.  Norplant can be
    removed at any time.  I should return to my previous fertility
    more quickly than I would be able to with birth control pills.

One final concern is cost.  Norplant is not inexpensive.  My doctor
charges $650 for the procedure to insert the capsules.  Locally
Planned Parenthood charges $550 (+ $56 for exam + $10 for pregnancy
test).  There's an additional fee of approximately $200 to remove the
capsules.  Many medical insurance plans do not cover these costs.

Thanks to everybody who responded.  Send e-mail if you have any
questions or comments.  

anne
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|             Time flies like an arrow.  Fruit flies like a bannana.          |
|                                                                             |
|                                  Anne Harvey                                |
|                 Internet:aharvey@hpmail1.fwrdc.rtsg.mot.com                 |
|              The opinions contained herein are strictly my own.             |
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