Levonorgestrel implant use among adolescents

Abstract

The levonorgestrel implant (Norplant System; Wyeth-Ayerst Laboratories, Philadelphia, Pa.) is a highly effective and desirable form of contraception for the adolescent population today. Not originally marketed toward this group of young women, it has become a very popular form of birth control for this age group. Even though common side effects are frequently experienced with the use of the Norplant System, timely and reassuring counseling from nurse practitioners is very effective in allaying fears and dissatisfaction. At the Pediatric Clinic for Denton County, Texas, nearly one half of all teenagers enrolled in the Teen Pregnancy Program in 1992 chose the Norplant System as their method of birth control, with very successful results.

PIP: The contraceptive implant Norplant does not depend on foresight, memory, or willpower and is therefore an ideal contraceptive for adolescents. Norplant has six flexible implants filled with levonorgestrel and is a very effective, long-term (up to 5 years), and reversible contraceptive. Levonorgestrel thickens the cervical mucus, thus blocking the passage of sperm through the cervix, and inhibits ovulation. Insertion of the Norplant system, performed on an outpatient basis, involves a local anesthesia and a 2 mm incision. It takes, on average, 10 minutes. The implants protect against pregnancy 24 hours after insertion. Even though the manufacturer originally targeted career women and women in their late childbearing years, the predominant users are young, low-income women. Norplant's contraceptive effectiveness rate is 0.2% during the first year and increases to 3.9% during the fifth year. It is lower in women weighing more than 70 kg. Irregular menstrual bleeding is the most common side effect (up to 80% of users). It occurs especially during the first year of use. It is the major reason for discontinuation. The first year discontinuation rate is 5-7%. Contraindications include acute liver disease/jaundice, rifampin use, unexplained vaginal bleeding, pregnancy, history of blood clots, history of cardio- or cerebrovascular disease, and breast cancer. At a nurse-managed pediatric clinic serving low-income families in Denton County, Texas, the Teen Pregnancy Program's certified pediatric nurse practitioner (PNP) inserted 150 Norplant Systems by 1992 (about 50% of all teens in the program). Hispanic, Black, and White teenagers have all chosen Norplant. Once a teenager delivers, the PNP makes a home visit during the first postpartum week. The PNP does counsels the new mother about contraception and leaves brochures and handouts. This is an ideal time to discuss Norplant and the possible side effect of irregular bleeding and to determine whether the new mother can tolerate it.