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Barbara A Cromer - One of the best experts on this subject based on the ideXlab platform.
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depot medroxyprogesterone acetate depo provera and levonorgestrel norplant use in adolescents among clinicians in northern europe and the united states
Journal of Adolescent Health, 1998Co-Authors: Barbara A Cromer, K Bergkelly, Jannetje P Van Groningen, Belinda S Seimer, Leena RuusuvaaraAbstract:Abstract Purpose: To compare attitudes and practices related to clinicians' use of depot medroxyprogesterone acetate [Depo-Provera (DMPA)] and levonorgestrel implants in adolescents in three northern European countries and the United States. Methods: Between the fall of 1993 and the winter of 1995, surveys eliciting clinician attitudes and practices with the two contraceptive methods were collected from practitioners who provide contraceptive care to teens in Sweden ( n = 282), The Netherlands ( n = 197), Great Britain ( n = 108), and the United States ( n = 548). Results: Clinicians in Great Britain and the United States reported prescribing of DMPA, selected DMPA in their top three choices for contraception in teens, and had patients ask about DMPA more frequently than clinicians in Sweden or The Netherlands ( p p p p p Conclusion: Clinicians in the United States and Great Britain display more enthusiasm toward the use of the long-term progestins in adolescents than do clinicians in Sweden or The Netherlands. Continuing education programs could be designed to educate clinicians to allay their concerns about these contraceptives in countries where teen pregnancy is considered a problem.
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a prospective comparison of bone density in adolescent girls receiving depot medroxyprogesterone acetate depo provera levonorgestrel norplant or oral contraceptives
The Journal of Pediatrics, 1996Co-Authors: Barbara A Cromer, John D. Mahan, J M M Blair, Lara Zibners, Zoran NaumovskiAbstract:Abstract OBJECTIVE: To examine bone density among adolescents receiving different forms of hormonal contraception along with that of control subjects. METHODS: Baseline and 1-year measures of lumbar vertebral bone density were obtained in girls receiving depot medroxyprogesterone acetate (Depo-Provera) (n = 15), levonorgestrel (Norplant) (n = 7), or oral contraceptives (n = 9) and in girls receiving no hormonal treatment (n = 17). In a subsample of Depo-Provera users (n = 8), Norplant users (n = 3), and control subjects (n = 4), bone density measurements were repeated after 2 years. Bone density was measured by dual-energy x-ray absorptiometry. RESULTS: Body mass indexes, level of pubertal development, substance use, and reproductive histories were not significantly different among the groups. More black girls were represented in the initial Depo-Provera group ( p p p p p CONCLUSION: These data suggest that Depo-Provera may, at least temporarily, suppress the expected skeletal bone mineralization in adolescents, whereas Norplant and oral contraceptives are associated with the expected increase in bone density in this population. (J Pediatr 1996;129:671-6)
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a prospective study of adolescents who choose among levonorgestrel implant norplant medroxyprogesterone acetate depo provera or the combined oral contraceptive pill as contraception
Pediatrics, 1994Co-Authors: Barbara A Cromer, Rhonda Smith, J M M Blair, Johanna T Dwyer, Robert T BrownAbstract:Objectives. Levonorgestrel implants (Norplant) and medroxyprogesterone acetate injections (Depo-Provera) represent additional contraception options for adolescents. The purpose of this study was to examine prospectively clinical profiles among adolescents who chose one of the two long-term contraceptives compared with profiles among those who chose the combined oral contraceptive pill (OCP). Methods. Girls who needed contraception and did not require confidentiality were presented with a contraceptive menu consisting of Norplant (n = 58), Depo-Provera (n = 66), or OCP (n = 75). At baseline and follow-up visits over 6 months, patients were interviewed regarding gynecologic history, side effect symptoms, and satisfaction. The average age of subjects was 15.5 years (range 11 to 20 years); 66% were African-American and 34% white. Results. Significantly more teens who chose Depo-Provera (73%) reported having used some method of birth control previously than those selecting either Norplant (30%) or OCP (26%). Adolescents who chose either Norplant (34%) or Depo-Provera (43%) were significantly more likely to have been pregnant previously than those choosing OCP (12%). Those selecting Depo-Provera were significantly more likely to report a history of genital infection with Chlamydia trachomatis (42%) than those in the other two contraceptive groups (22%). Prevalences of reported recent depression and fatigue before initiation of treatment were high, exceeding 35% across the three groups. A total of 105 and 40 adolescents were assessed at 3 and 6 months, respectively. At follow-up, more than 80% of OCP users maintained regular menstrual cycles, whereas over 80% of those choosing Norplant or Depo-Provera had disrupted cycles. Complaints of nausea and dizziness among Norplant users and fatigue among Depo-Provera and OCP users increased significantly between the baseline and follow-up visits. Reports of local reactions to the Norplant device were common but not clinically significant. Blood pressure readings, facial acne, and body mass index did not change over time in any treatment group. Subjects in the Norplant and Depo-Provera groups appreciated freedom from daily compliance to maintain contraceptive effectiveness and the "hidden" nature of the method. Appointment compliance at the end of 6 months was 78% for Depo-Provera, 40% for Norplant, and 46% for OCP. Conclusions. The implant and injection forms of contraception appear to be especially popular among girls with previous pregnancies or birth control use. The common occurrences of medical symptoms and sexually transmitted diseases before initiation of therapy underscore the importance of baseline evaluation. Norplant users may be warned about nausea and dizziness as well as minor local symptoms around the insertion site and unpredictable uterine bleeding patterns. Adolescent patients choosing Depo-Provera may expect amenorrhea by the end of 6 months of therapy along with possible fatigue. Early intervention may be needed with adolescents who choose Norplant or OCP to encourage better compliance with follow-up appointments.
Andrew M Kaunitz - One of the best experts on this subject based on the ideXlab platform.
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depo provera and skeletal health a survey of florida obstetrics and gynecologist physicians
Contraception, 2008Co-Authors: Sarah Paschall, Andrew M KaunitzAbstract:Abstract Objective In November of 2004, the US Food and Drug Administration (FDA) issued a black box warning regarding skeletal health concerns with depot medroxyprogesterone acetate (DMPA) contraception. This FDA labeling change has the potential to impact how this contraceptive is used. Our goal was to assess the impact of the FDA decision on how Florida obstetrician-gynecologists prescribe DMPA. Methods A survey was conducted with questions and case scenarios regarding the use of DMPA before and after the black box warning. The survey was sent to all members of the Florida Obstetric and Gynecologic Society. Results Four hundred twenty-five surveys were mailed and 149 were returned — a 35% return rate. Forty-six percent of physicians surveyed indicated that they place a time limit on DMPA use, and 66% stated that this limit was based on the FDA black box warning. Sixty-five percent of respondents ordered bone mineral density (BMD) testing solely due to the use of DMPA, with 58% indicating that this decision was based on the black box warning. Eight (5.4%) of the respondents indicated they selectively prescribe bisphosphonates for patients based solely on the use of DMPA, while 33% of respondents state that they use estrogen supplementation. There was a trend towards fewer DMPA injections per week after the black box warning as compared to before; however, this trend was not statistically significant (p Conclusion Respondents may be writing fewer prescriptions for DMPA, are likely to institute a time limit on said prescription and are likely to order BMD testing, using the black box warning as justification. Continued education is necessary to prevent inappropriate restrictions on DMPA use and the performance and/or prescription of inappropriate tests and medications.
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current options for injectable contraception in the united states
Seminars in Reproductive Medicine, 2001Co-Authors: Andrew M KaunitzAbstract:Two injectable forms of hormonal contraception depot medroxyprogesterone acetate (DMPA Depo-Provera) and medroxyprogesterone acetate/estradiol cypionate (MPA/E2C Lunelle) are now available to American women. Both formulations have demonstrated high degrees of efficacy safety and ease of use in international and U.S. trials. Data on DMPA have shown a number of noncontraceptive and therapeutic benefits the most prominent of which is an 80% reduction in the risk of endometrial cancer. Although such benefits are less documented for MPA/E2C they are expected to be similar to those seen with DMPA and oral contraceptives. Minor side effects of both formulations include menstrual irregularities in the early months of treatment and amenorrhea with DMPA. Patient counseling about the potential for these side effects as well as possible risks is important to long-term successful use of these contraceptive methods. (authors)
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current options for injectable contraception in the united states
Seminars in Reproductive Medicine, 2001Co-Authors: Andrew M KaunitzAbstract:Two injectable forms of hormonal contraception depot medroxyprogesterone acetate (DMPA Depo-Provera) and medroxyprogesterone acetate/estradiol cypionate (MPA/E2C Lunelle) are now available to American women. Both formulations have demonstrated high degrees of efficacy safety and ease of use in international and U.S. trials. Data on DMPA have shown a number of noncontraceptive and therapeutic benefits the most prominent of which is an 80% reduction in the risk of endometrial cancer. Although such benefits are less documented for MPA/E2C they are expected to be similar to those seen with DMPA and oral contraceptives. Minor side effects of both formulations include menstrual irregularities in the early months of treatment and amenorrhea with DMPA. Patient counseling about the potential for these side effects as well as possible risks is important to long-term successful use of these contraceptive methods. (authors)
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injectable contraception with depot medroxyprogesterone acetate current status
Drugs, 1993Co-Authors: Andrew M Kaunitz, Allan RosenfieldAbstract:Depot medroxyprogesterone acetate (DMPA) the only injectable contraception approved in the United States in 1992 is used by 8-9 million women in more than 90 countries. DMPA inhibits ovulation by the reduction of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) plasma levels. The contraceptive efficacy of the usual dosage of 150 mg every 3 months is extremely high. In a World Health Organization-sponsored multi-center study no pregnancies were reported among 607 women (452 patient-years) using this regimen. Other trials have reported failure rates ranging from zero to 0.7% of women experiencing an accidental pregnancy during 1 year of use. The typical failure rate has been estimated as 0.3% which is comparable to the contraceptive efficacy of subdermal implants or tubal sterilization. Use of 300 mg every 6 months is associated with a higher failure rate of 2.3%. Following injection of 150 mg ovulation does not occur for at least 14 weeks. DMPA should be initiated within 5 days of delivery and the first Depo-Provera injection should be deferred until 6 weeks postpartum in nursing women. Episodes of irregular bleeding and spotting lasting 7 days are frequent during the first months of use. About 50% of women using DMPA for 1 year have amenorrhea. Women with diabetes should be monitored while using DMPA; but use of DMPA was not associated with significant changes in coagulation parameters. A 1979 WHO study found no increased risk of breast cancer in users on the other hand it markedly reduced the risk of endometrial cancer for 8 years following discontinuation. Bone density in 30 women who had used DMPA for 5 years was lower than in non-users although osteoporosis was not evident. Almost 70% of DMPA former users conceived within 12 months after discontinuation. Headache dizziness abdominal bloating mood changes alopecia and weight gain may occur in DMPA users. DMPA is particularly suitable for women with hemoglobinopathy. DMPA is safe and effective in appropriately selected patients.
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injectable contraception the usa perspective
Ippf Medical Bulletin, 1992Co-Authors: Andrew M KaunitzAbstract:Depot medroxyprogesterone acetate (DMPA Depo-Provera) is used for contraception by 8-9 million women in more than 90 countries including the US as of January 1993. Pharmacologically active levels of DMPA persist for 3-4 months following injection. A 150 mg dose is used most often for high contraceptive efficacy every 3 months. Norethindrone enanthate (NET-EN Noristerat) is somewhat less widely used and is not marketed in the US. Injectables act primarily by inhibiting ovulation lowering the levels of follicle-stimulating hormone and luteinizing hormone. Approximately 50% of women using DMPA for 1 year report amenorrhea whose occurrence is less frequent with NET-EN. Menstrual changes are the most frequent causes of discontinuation of injectables. In cases of heavy bleeding it is appropriate to undergo gynecological examination to rule out unrelated conditions such as vaginitis cervicitis or cervical lesions. The use of conjugated estrogen (12.5-2.5 mg daily) for 10-21 days will minimize bleeding. Some women using injectables experience headache dizziness bloating of the abdomen or breast and mood changes. Long-term use of DMPA or NET-EN can often result in 1-3 kg weight gain. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives was launched in 1979 to examine cancer risks with the use of DMPA in Thailand Mexico and Kenya. The relative risk of breast cancer was 1.21 which was statistically not significant. In women diagnosed with breast cancer under age 35 short-term exposure to DMPA was associated with a slightly increased breast cancer risk which however was not associated with duration of use. DMPA dramatically lowers the risk of endometrial cancer for at least eight years following discontinuation of its use. DMPA did not alter the risk of cervical cancer. Fertility returns in 70% of former users within 12 months; it is suitable for postpartum and lactating women and provides other noncontraceptive benefits.
Bahamondes L. - One of the best experts on this subject based on the ideXlab platform.
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Uso De Contraceptivos Reversíveis De Longa Duração E A Relação Entre Taxas De Descontinuidade Devido à Menopausa E à Esterilização De Homens E Mulheres
'Georg Thieme Verlag KG', 2017Co-Authors: Ferreira J.m., Castro S., Villarroel M., Silveira C., Bahamondes L.Abstract:Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Introduction Women require effective contraception until they reach menopause. The long acting reversible contraceptives (LARC) and the depot-medroxyprogesterone acetate (DMPA, Depo-Provera®, Pfizer, Puurs, Belgium) are great options and can replace possible sterilizations. Purpose To assess the relationship between the use of LARCs and DMPA and terminations ascribed to menopause and sterilizations in a Brazilian clinic. Methods We reviewed the records of women between 12 and 50 years of age attending the clinic that chose to use a LARCmethod or DMPA. Cumulative termination rates due to sterilization or because the woman had reached menopause were computed using single decrement life-table analysis over 32 years. We also examined all records of surgical sterilization at our hospital between the years 1980-2012. Results Three hundred thirty-two women had continuously used the same contraceptive until menopause, and 555 women had discontinued the method because they or their partners underwent sterilization. Fromyear 20 to year 30 of use, levonorgestrel intrauterine-releasing system (LNG-IUS - Mirena®, Bayer Oy, Turku, Finland; available since 1980), copper intrauterine device (IUD - available since 1980) and DMPA users showed a trend of cumulative higher discontinuation rates due to menopause when compared with the discontinuation rates due to sterilization. Over the study period, a steep decline in the use of sterilization occurred. Conclusion Over the past 15 years of research we have observed a trend: women usually preferred to continue using LARC methods or DMPA until menopause rather than decide for sterilization, be it their own, or their partners’. The annual number of sterilizations dropped in the same period. The use of LARC methods and DMPA until menopause is an important option to avoid sterilization, which requires a surgical procedure with potential complications. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.385210217#573747/2008-3, FAPESP, Fundação de Amparo à Pesquisa do Estado de São PauloFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP
R Marahatta - One of the best experts on this subject based on the ideXlab platform.
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awareness and practice of family planning methods in women attending gyne opd at nepal medical college teaching hospital
Nepal Medical College journal, 2008Co-Authors: Heera Tuladhar, R MarahattaAbstract:A cross sectional descriptive study of awareness and practice of family planning methods among 200 women of reproductive age attending gynecology out patient department (GOPD) of Nepal Medical College Teaching Hospital from 14 th May 2008 to 14 th July, 2008 was carried out. Most of the respondents (93.0%) were aware of at least one of family planning methods out of ten methods, but only 65.0% had ever used it and contraceptive prevalence rate was 33.5% which was slightly higher than the national data as 28.5%.The best known method of temporary contraception was depo provera (78.0%) followed by oral contraceptive pills (74.0%) and condom (71.0%) and least known methods were vaginal foam tablets/jelly (34.0%) and natural methods (16.0%). Among permanent family planning methods, awareness about female sterilization (81.0%) was more than male sterilization (77.0%) which was in accordance with studies done in other countries. Knowledge about emergency contraception was quite low (12.0%) as it was newly introduced in the country. Regarding current use of contraception depo provera (11.0%) was the most widely used followed by oral contraceptive pills (4.5%) and condom (4.5%). 5.5% had undergone female sterilization while only 2.5% of male partner had sterilization Knowledge of non contraceptive benefits of family planning methods was claimed by only 35.0% of the respondents, 27.0% reported awareness that condoms protect from HIV/AIDS and sexually transmitted diseases (STD) while knowledge about various adverse effects was widespread (52.5%). The most common source of information on contraception was media (55.5%), both printed and electronic. This study also observed that with increase in level of education, awareness also increased. Although most of the women were aware about the methods, they were ignorant about the details like duration of protection, return of fertility on discontinuation and non contraceptive benefits. The most common reason for discontinuation of FP methods was stated as side effects. A wide knowledge practice gap was evident in this study, which was similar to the findings of studies done in other developing countries. Improved female education strategies and better access to services are needed to solve these problems. The use of communication media suitable for the audience and adequate message is important in conducting effective family planning awareness activities. Efforts should be made to educate the public about the safety and convenience of modern, long-term, reversible methods of contraception among both healthcare professionals and the public.
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awareness and practice of family planning methods in women attending gyne opd at nepal medical college teaching hospital
Nepal Medical College journal, 2008Co-Authors: Heera Tuladhar, R MarahattaAbstract:A cross sectional descriptive study of awareness and practice of family planning methods among 200 women of reproductive age attending gynecology out patient department (GOPD) of Nepal Medical College Teaching Hospital from 14 th May 2008 to 14 th July, 2008 was carried out. Most of the respondents (93.0%) were aware of at least one of family planning methods out of ten methods, but only 65.0% had ever used it and contraceptive prevalence rate was 33.5% which was slightly higher than the national data as 28.5%.The best known method of temporary contraception was depo provera (78.0%) followed by oral contraceptive pills (74.0%) and condom (71.0%) and least known methods were vaginal foam tablets/jelly (34.0%) and natural methods (16.0%). Among permanent family planning methods, awareness about female sterilization (81.0%) was more than male sterilization (77.0%) which was in accordance with studies done in other countries. Knowledge about emergency contraception was quite low (12.0%) as it was newly introduced in the country. Regarding current use of contraception depo provera (11.0%) was the most widely used followed by oral contraceptive pills (4.5%) and condom (4.5%). 5.5% had undergone female sterilization while only 2.5% of male partner had sterilization Knowledge of non contraceptive benefits of family planning methods was claimed by only 35.0% of the respondents, 27.0% reported awareness that condoms protect from HIV/AIDS and sexually transmitted diseases (STD) while knowledge about various adverse effects was widespread (52.5%). The most common source of information on contraception was media (55.5%), both printed and electronic. This study also observed that with increase in level of education, awareness also increased. Although most of the women were aware about the methods, they were ignorant about the details like duration of protection, return of fertility on discontinuation and non contraceptive benefits. The most common reason for discontinuation of FP methods was stated as side effects. A wide knowledge practice gap was evident in this study, which was similar to the findings of studies done in other developing countries. Improved female education strategies and better access to services are needed to solve these problems. The use of communication media suitable for the audience and adequate message is important in conducting effective family planning awareness activities. Efforts should be made to educate the public about the safety and convenience of modern, long-term, reversible methods of contraception among both healthcare professionals and the public.
Robert T Brown - One of the best experts on this subject based on the ideXlab platform.
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longitudinal study of depot medroxyprogesterone acetate depo provera effects on bone health in adolescents study design population characteristics and baseline bone mineral density
Contraception, 2008Co-Authors: Christine Cole Johnson, Zeev Harel, Robert T Brown, Melanie A Gold, Ronald T Burkman, Ann Bruner, Margaret Stager, Laura K Bachrach, Paige S Hertweck, Anita L NelsonAbstract:Abstract Background This analysis was conducted to assess the baseline data and design methodology within an observational longitudinal comparison of use vs. nonuse of the injectable (intramuscular) contraceptive depot medroxyprogesterone acetate (DMPA-IM) and its effect on bone mass in adolescent women. Study Design A prospective, observational, open-label, unmatched-cohort, safety study in females aged 11–18 years. Participants either self-selected DMPA-IM (Depo-Provera®) 150 mg to be administered every 12 weeks for up to 240 weeks with a 120-week post-treatment follow-up or were nonusers (users of nonhormonal contraception or sexually abstinent) who were to be followed up for up to 360 weeks. As each participant entered the study, bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine, hip and femoral neck regions, along with total body bone mineral content; serum and urine specimens were obtained for assay of bone metabolism markers and participants' histories of parity and tobacco and alcohol use were obtained. Results A total of 389 participants were enrolled: 169 elected to begin DMPA-IM; 26 chose nonhormonal methods and 194 were abstinent. The baseline characteristics indicated significant disparities between DMPA-IM users and nonusers: compared with the nonusers, DMPA-IM users had more advanced chronologic and gynecologic ages, were more likely to have smoked, been pregnant and included more blacks. These factors would likely influence bone accretion rates independent of DMPA-IM exposure. Comparison of participant BMDs with standard reference data revealed that the study cohorts did not match reference populations closely enough to make a direct between-cohort comparative analysis feasible. Conclusions The baseline differences in cohort characteristics preclude a meaningful comparison of mean BMD changes over time between DMPA-IM users and nonusers cohorts, and comparisons of changes in Z-scores between cohorts were also not appropriate. Therefore, within-participant BMD decreases from baseline were established as safety thresholds, and the proportion of individuals crossing those thresholds on a persistent or progressive basis was identified as the revised primary end point.
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a prospective study of adolescents who choose among levonorgestrel implant norplant medroxyprogesterone acetate depo provera or the combined oral contraceptive pill as contraception
Pediatrics, 1994Co-Authors: Barbara A Cromer, Rhonda Smith, J M M Blair, Johanna T Dwyer, Robert T BrownAbstract:Objectives. Levonorgestrel implants (Norplant) and medroxyprogesterone acetate injections (Depo-Provera) represent additional contraception options for adolescents. The purpose of this study was to examine prospectively clinical profiles among adolescents who chose one of the two long-term contraceptives compared with profiles among those who chose the combined oral contraceptive pill (OCP). Methods. Girls who needed contraception and did not require confidentiality were presented with a contraceptive menu consisting of Norplant (n = 58), Depo-Provera (n = 66), or OCP (n = 75). At baseline and follow-up visits over 6 months, patients were interviewed regarding gynecologic history, side effect symptoms, and satisfaction. The average age of subjects was 15.5 years (range 11 to 20 years); 66% were African-American and 34% white. Results. Significantly more teens who chose Depo-Provera (73%) reported having used some method of birth control previously than those selecting either Norplant (30%) or OCP (26%). Adolescents who chose either Norplant (34%) or Depo-Provera (43%) were significantly more likely to have been pregnant previously than those choosing OCP (12%). Those selecting Depo-Provera were significantly more likely to report a history of genital infection with Chlamydia trachomatis (42%) than those in the other two contraceptive groups (22%). Prevalences of reported recent depression and fatigue before initiation of treatment were high, exceeding 35% across the three groups. A total of 105 and 40 adolescents were assessed at 3 and 6 months, respectively. At follow-up, more than 80% of OCP users maintained regular menstrual cycles, whereas over 80% of those choosing Norplant or Depo-Provera had disrupted cycles. Complaints of nausea and dizziness among Norplant users and fatigue among Depo-Provera and OCP users increased significantly between the baseline and follow-up visits. Reports of local reactions to the Norplant device were common but not clinically significant. Blood pressure readings, facial acne, and body mass index did not change over time in any treatment group. Subjects in the Norplant and Depo-Provera groups appreciated freedom from daily compliance to maintain contraceptive effectiveness and the "hidden" nature of the method. Appointment compliance at the end of 6 months was 78% for Depo-Provera, 40% for Norplant, and 46% for OCP. Conclusions. The implant and injection forms of contraception appear to be especially popular among girls with previous pregnancies or birth control use. The common occurrences of medical symptoms and sexually transmitted diseases before initiation of therapy underscore the importance of baseline evaluation. Norplant users may be warned about nausea and dizziness as well as minor local symptoms around the insertion site and unpredictable uterine bleeding patterns. Adolescent patients choosing Depo-Provera may expect amenorrhea by the end of 6 months of therapy along with possible fatigue. Early intervention may be needed with adolescents who choose Norplant or OCP to encourage better compliance with follow-up appointments.