Objective: To investigate the experience of the users of a levonorgestrel-releasing contraceptive implant (Nor-plant) and reasons for early removal.
Study design: Two hundred fifty-one women who had Norplant placed through the Ohio State University Department of Obstetrics and Gynecology were sent a questionnaire that included general demographic questions and questions regarding preplacement education; reasons for choosing Norplant; problems experienced due to Norplant; reasons for removal, if applicable; and overall satisfaction.
Results: One hundred eleven questionnaires (44%) were completed and analyzed. Twenty-four (21.6%) of patients had Norplant removed, 32 (28.8%) planned on early removal, and 55 (49.5%) desired continued use. Ninety-eight percent of women who planned continued use of Norplant had received reading material as part of their preplacement counseling and 95% felt adequately counseled. This is significantly higher than women who had Norplant removed or planned on early removal. Convenience, problems with other contraceptive methods and effectiveness were the most important reasons why patients chose Norplant. Menstrual changes were the most common side effect, experienced by 80% of all women in the study. Weight gain, headache, mood changes, mastalgia and acne were also frequently reported. Women who had Norplant removed were significantly more likely to have experienced dizziness when compared to women desiring continued use. Women planning early removal were also more likely to have experienced dizziness in addition to acne, headache, hair loss and other side effects. Menstrual irregularities, followed by mood changes and headaches, were the most important side effects associated with early Norplant removal. Overall, 68% of users were at least somewhat satisfied with Norplant.
Conclusion: Norplant contraception was a satisfactory form of birth control for the majority of patients in the study despite the frequent occurrence of side effects. Reading material regarding benefits and side effects of Norplant is an important aspect of patient counseling and may improve long-term use of Norplant.
PIP: To improve counseling services for new users of the levonorgestrel-releasing contraceptive implant (Norplant), the 251 women who had the implant inserted through the Ohio State University Department of Obstetrics and Gynecology during 1991-94 were mailed a questionnaire concerning their experiences. Responses were received from 111 (44%) of these women; 24 (21.6%) had already had the implants removed after a mean duration of use of 14.6 months, 32 (28.8%) planned on early removal, and 55 (49.5%) desired continued use. There were no significant differences between these 3 groups in terms of age, gravidity, parity, type of provider, or interval between counseling and placement. Among women who planned to continue Norplant use, 98% had been provided with reading material as part of their preinsertion counseling and 95% characterized this counseling as adequate; these rates were significantly lower in the other 2 groups. Frequently reported side effects included menstrual changes (80%), weight gain (53%), headache (50%), mood changes (59%), mastalgia (47%), and acne (47%). Menstrual irregularities, mood changes, and headaches were the side effects cited most frequently among women who opted for early removal. Overall, 75 users (68%) were satisfied or very satisfied with the method, 15 (14%) were somewhat dissatisfied, and 18 (16%) were very dissatisfied. Consistent distribution during preinsertion counseling of reading materials on Norplant and its side effects is recommended to enhance method acceptance.