The Experts below are selected from a list of 4404 Experts worldwide ranked by ideXlab platform
Irving Sivin - One of the best experts on this subject based on the ideXlab platform.
-
Human Reproduction vol.9 no. 10 pp. 1818-1826. 1994 i ® •Contraception with Norplant implants*
2016Co-Authors: Irving SivinAbstract:Norplant8 progestogen-only implant contraception provides several years of effective protection against pregnancy following a single application. It is reversible whenever desired, with return to normal fertility. Drug release and concentrations are maximal in the first month of use, when a set of six capsules releases ~ 85 /tg/day of levonorgestrel. Release is 25-30 /tg/day at 60 months. Circulating drug concentrations and pregnancy rates vary inversely with body weight at placement, but even among heavier women, failure rates are below those of oral contraceptives in the general population. Side-effects are most marked at the initiation of use. Disruption of normal menstrual patterns occurs in 70-80 % of recipients initially. Menstrual blood loss is decreased, however, and most women experience modest increases in haemoglobin. Headache, acne, other skin or hair problems, changes of weight and of mood and abdominal pain, are the most common side-effects attributed to Norplant ® contraception. The frequency of occurrence of side-effects diminishes with increased duration of use. The comparative paucity of major side-effects, coupled with the method's convenience and effectiveness and its very long action have made Norplant ® implants highly acceptable in both developing and developed countries. Key words: contraception/levonorgestrel/Norplant
-
post marketing surveillance of Norplant contraceptive implants i contraceptive efficacy and reproductive health international collaborative post marking surveillance
Contraception, 2001Co-Authors: O Meirik, Irving Sivin, Timothy M M Farley, Soledad DiazAbstract:To examine the safety and contraceptive efficacy of Norplant the authors undertook a 5-year follow-up study of women using Norplant an IUD or sterilization in 8 developing countries. Women attending family clinics were enrolled if they consented and were medically eligible for Norplant an IUD or female sterilization. Women who chose to use an IUD or resorted to surgical sterilization served as controls and were frequently matched in 5-year age bands with women who chose to use Norplant. At admission women had a physical examination and their medical histories demographic and socioeconomic characteristics were recorded. Follow-up visits were scheduled in the first 6 weeks after admission and semi-annually thereafter for 5 years irrespective of change of contraceptive method. Incidence rate ratios of health events were estimated for initial and current contraceptive method use. This paper reports reproductive health events and contraceptive efficacy. Altogether 7977 women initiating use of Norplant 6625 of IUD and 1419 of surgical sterilization were admitted. Their mean ages at initiation were 28.5 28.5 and 29.6 years respectively. More than 99% were married or cohabiting and parous. 5-year follow-up was completed by 94.6% of the women. By the end of 5 years the mean duration of first segment use per initiator was 4.16 years for Norplant 4.10 years for IUDs and 4.96 years for sterilization accounting for 39337 woman-years for Norplant 31915 for IUDs and 7071 for sterilization. The study accumulated 78323 woman-years of observation. Pearl pregnancy rates for Norplant copper IUDs and female sterilization were 0.27 0.88 and 0.17 per 100 woman-years respectively. Users of Norplant copper IUDs and sterilization had rates of ectopic pregnancy of 0.30 0.68 and 0.13 per 1000 woman-years respectively. Major health events related to the reproductive system were rare. Rates of acute pelvic inflammatory disease were significantly lower among Norplant users than IUD users (p = 0.004). The rate of ovarian enlargement was significantly higher in Norplant users than controls (p < 0.001) but not rates of hospitalization for this condition. Vaginitis and vaginal discharge and low abdominal pain were significantly less frequent in Norplant users that in the other groups. Bleeding disturbances were more frequent among Norplant users than controls but not anemia. The study confirms the high contraceptive efficacy of Norplant copper IUDs and female sterilization. The incidence rates of major reproductive health problems were low. There was no significant excess of serious reproductive morbidity among users of Norplant compared to users of IUDs and sterilization. (authors modified)
-
Post-marketing surveillance of Norplant contraceptive implants: II. Non-reproductive health. International Collaborative Post-Marketing Surveillance of Norplant.
Contraception, 2001Co-Authors: Meirik O, Irving Sivin, Timothy M M Farley, Soledad Diaz, John A. CollinsAbstract:This controlled cohort study aimed to evaluate the safety and efficacy of Norplant contraceptive implants in developing countries. Women initiating Norplant use were index subjects and women initiating IUD use or surgical sterilization were controls. Consenting participants at 32 clinics in 8t developing countries were admitted and followed up every 6 months for 5 years. Major and less serious health events during the follow-up were recorded. Incidence rate ratios of health events adjusted for clinic were estimated for initial and current method use. This paper reports non-reproductive health events. The study involved 7977 women initiating use of Norplant 6625 of IUD and 1419 of sterilization. 5 years of follow-up were completed for 94.6% of the women. The study accumulated 78323 woman-years of observation. The initial method chosen accounted for 84.4% or more of observed woman-years in users of Norplant IUD or sterilization. 22 of the recorded 34 deaths were due to accidents suicide or homicide. Few deaths or major health events were due to cancer or acute cardiovascular diseases and were not associated with the contraceptive method used. The incidence rates of major health events were low and with two exceptions there was no significant excess risk of serious morbidity for Norplant users compared with controls; among Norplant initiators gallbladder disease occurred at an incidence rate of 1.5 per 1000 woman-years and was weakly associated with use of Norplant (rate ratio 1.52 [95% confidence interval: 1.02 2.27]). For current Norplant users compared to controls the rate ratio of a combined variable of hypertension and borderline hypertension was significantly elevated (1.81 [1.12 2.92]). The occurrence of less serious health events was also low and several of them were significantly more often reported among Norplant users. Headache-migraine weight gain mood disturbances pruritus eczema and acne had incidence rates among Norplant users of 11.5 4.5 2.8 1.5 1.4 and 0.9 per 1000 woman-years respectively and were significantly higher than in controls. Respiratory health problems nonspecific symptoms and several ill-defined conditions were also significantly more often reported for Norplant users but some of the excess incidence may be attributable to reporting and detection bias. The study confirms the safety with respect to serious disease of Norplant IUDs and sterilization. (authors modified)
-
a 5 year evaluation of Norplant contraceptive implants in china
Obstetrics & Gynecology, 1994Co-Authors: L D Zhang, Y L Liu, S H Wang, Irving SivinAbstract:By June 1987 in China researchers enrolled 10718 women who had chosen the long acting contraceptive implant Norplant at 12 different centers to evaluate the efficacy safety and acceptability of Norplant. Overall contraceptive effectiveness was high (99.7%/year; 5 year cumulative rate = 98.5%). Pregnancy rates increased with weight (5 year rate: 0.8% for 70 kg; p < 0.0001). Nevertheless annual average pregnancy rates were less than 1%. Women who were at least 35 years old at enrollment had a significantly lower cumulative pregnancy rate than did women in all the younger 5-year age groups (0.7% vs. 1.5-3%; p < .05 for each comparison). Extrapolation showed that Chinese women who weighed no more than 50 kg could use Norplant for 7 years at a pregnancy rate of less than 1% annually. The incidence of ectopic pregnancy was 0.09/1000 woman years which is 93% lower than that for Norplant users in the US. Among pregnant women 3.1% experienced an ectopic pregnancy compared to 17.4% in trials used to obtain US regulatory approval. Menstrual disturbances were the leading side effect and reason for Norplant removal. The 5-year gross termination rate was 20.2%. The 5-year cumulative continuation rate was 72.1%. The death rate during Norplant use was 2/10000 years but none of the deaths were linked to Norplant use. Supervised hands-on training accounted for the low rate of insertion complications (4.7/10000 years). This study was the largest clinical trial of contraceptive implants in the world. These findings suggest that among Chinese women Norplant is a safe effective and acceptable long-term contraceptive method.
Peter Rogers - One of the best experts on this subject based on the ideXlab platform.
-
immunolocalization of endothelin and neutral endopeptidase in the endometrium of users of subdermally implanted levonorgestrel Norplant
Human Reproduction, 1995Co-Authors: Marion M Marsh, Peter Rogers, Biran Affandi, Anna R Butt, Simon C Riley, Beatrice Susil, J K Findlay, Lois A SalamonsenAbstract:In Indonesia 107 women requesting insertion of the contraceptive implant system Norplant at the Klinik Raden Saleh in Jakarta kept a daily menstrual diary for 90 days before endometrial biopsy and allowed venous blood samples to be taken six times in the two-week period also before endometrial biopsy so researchers could examine the roles of endothelin (ET) and neutral endopeptidase (NEP) in menstrual bleeding changes in women using Norplant. They compared the degree of immunostaining in the endometrial biopsy samples of these women with those of 55 controls most of which came from women in Melbourne Australia. The endometrium of the Norplant group exhibited low glandular and luminal epithelial ET immunostaining as did the normal endometrium during the proliferative phase. Glandular epithelial ET immunostaining in the Norplant group fell considerably during the secretory or menstrual phases however. NEP immunoreactivity was greater in the endometrium of Norplant users than in that of controls suggesting that enzyme activity may have been increased locally among Norplant users. This increase may have accounted for the low ET reactivity. ET immunoreactivity was not related to duration of implant use or total number of bleeding days. These findings indicate that since Norplant users are at an increased risk of abnormal uterine bleeding ET may control menstrual bleeding. It is not known whether ET acts as a mitogen in endometrial repair and regeneration or as a vasoconstrictor to stop bleeding after menstruation.
-
Endometrial endothelial cell proliferation in long-term users of subdermal levonorgestrel
Human Reproduction, 1994Co-Authors: Anne M. Goodger, Peter Rogers, Biram AffandiAbstract:: Quantification of endothelial cell proliferation by use of immunohistochemical staining of routinely processed endometrium revealed minimal angiogenesis in Norplant implant acceptors. It was hypothesized that the increased microvascular density of the endometrium of Norplant users and their bleeding problems reflect a levonorgestrel-induced increase in endothelial cell proliferation. 34 endometrial biopsies from 32 women attending the Raden Saleh Clinic in Jakarta, Indonesia, were collected 3-12 months after Norplant insertion. The mean endothelial cell proliferation index for the 32 Norplant users was 0.39 +or- 0.16%; 24 of the 34 biopsies showed no evidence of cell proliferation. There was no significant variation in this index based on the histologic appearance of the biopsy, bleeding pattern, or peripheral blood estrogen and progesterone concentrations. This index is significantly lower than that recorded in another study (8.99 +or- 1.64) during a normal menstrual cycle. Also observed was a significantly increased number of endothelial cells per sq. mm in Norplant users (317.40 +or- 13.88) compared to normally cycling women (223.25 +or- 10.31). Although the study hypothesis was rejected, the factors behind the increased density of blood vessels and endothelial cells in the endometrium of Norplant users remain unclear. It is possible that levonorgestrel induces a reduced rate of regression of the blood vessels compared to the rest of the tissue, or that there is a reduced rate of endothelial cell death or turnover.
-
Cytokeratins 8 18 and 19 in endometrial epithelial cells during the normal menstrual cycle and in women receiving Norplant.
Contraception, 1993Co-Authors: Sugito Wonodirekso, Biran Affandi, Wachju Hadisaputrat, Peter RogersAbstract:Cytokeratins 8, 18 and 19 are members of the cytoskeletal intermediate filament protein family. They are expressed in all simple epithelial tissues, including endometrium, and are recognised as dynamic structures that can be affected by numerous external factors. The Norplant system is a subdermal slow release levonorgestrel implant commonly used as a long-acting progestogen contraceptive. Norplant implants have been shown to have atrophic effects on endometrial epithelial and stromal cells, and cause a range of endometrial bleeding problems among users. The aim of this study is to describe changes in the immunohistochemical expression and distribution of cytokeratins 8, 18 and 19 in endometrial epithelial cells of Norplant implants users and normal menstrual cycle controls. Endometrial biopsies were collected from 65 control normal cycle women and 37 Norplant implants acceptors. The normal menstrual cycle was classified histologically into 9 stages; one menstrual, five proliferative and three secretory. Norplant implants bleeding patterns were categorised into 6 groups according to current World Health Organisation (WHO) definitions; amenorrhoea, frequent bleeding, infrequent bleeding, irregular bleeding, "normal" bleeding, and prolonged bleeding. The tissues were fixed in formalin, embedded in paraffin, and stained immunohistochemically. Semi-quantitative scoring of the staining intensity was performed. Apical versus basal intracellular cytokeratin distribution was also evaluated. The staining intensity was significantly stronger in control endometrial tissue compared to Norplant implants tissue. In control tissues, cytokeratins were predominantly located in the apical region of epithelial cells (52% of biopsies) and in Norplant implants tissues they were predominantly distributed equally between the apical and basal portions of epithelial cells (43% of biopsies). There was no particular cytokeratin distribution pattern associated with the different stages of normal cycle or the different Norplant implants bleeding patterns. It was concluded that long-term exposure to levonorgestrel significantly reduced the cytokeratin expression in endometrial epithelial cells (P < 0.001).
Biran Affandi - One of the best experts on this subject based on the ideXlab platform.
-
A Randomized FiveYear Comparative Study of Two LevonorgestrelReleasing Implant Systems: Norplant® Capsules and Jadena® Rods
Indonesian Society of Obstetrics and Gynecology, 2016Co-Authors: Biran Affandi, Rusdi S Ridwan, Hasan R M Hoesni, Thamrin Tandjung, Tm Ichsan, Rizani Amran, Heriyadi Manan, Eka R Gunardi, Noor Pramana, Suryo HadiyonoAbstract:Objective: To provide a randomized comparison between Jadena® and Norplant® in terms of efficacy and acceptability among Indonesian women. Method: This study was a phase IV, open label, randomized, multicenter study throughout Indonesia. Subjects were Indonesian adult women who were randomized to receive Jadena® or Norplant® as their contraceptive method. The subjects were recruited from 6 large cities in Indonesia, such as Medan, Palembang, Jakarta, Semarang, Surabaya, and Makassar. Result: Of 600 subjects, 301 women getting to Jadena® and 299 women to Norplant® were enrolled between August 1998 and February 1999. The mean age was 29.8 (SD 5.3) years old, ranging from 18 to 40 years old. We did not find the pregnancy during the study. Non-pregnancy probability at the end of one year was similar between Jadena® (0.920 (SD 0.016)) and Norplant® users (0.916 (SD 0.084)). The continuation rates of Jadena® at one and three-year were 95.3% and 66.8%; whereas, the continuation rates of Norplant® was 94.3% at year-1 and 70.2% at year-3. Conclusion: The new two rod levonorgestrel subdermal system (Jadena®) showed similar efficacy with the old six capsule levonorgestrel subdermal system (Norplant®) in term of birth control. Both implant systems also have similar tolerability profile. Jadena® is easier to insert and remove than Norplant®. Keywords: birth control, efficacy, implan
-
immunolocalization of endothelin and neutral endopeptidase in the endometrium of users of subdermally implanted levonorgestrel Norplant
Human Reproduction, 1995Co-Authors: Marion M Marsh, Peter Rogers, Biran Affandi, Anna R Butt, Simon C Riley, Beatrice Susil, J K Findlay, Lois A SalamonsenAbstract:In Indonesia 107 women requesting insertion of the contraceptive implant system Norplant at the Klinik Raden Saleh in Jakarta kept a daily menstrual diary for 90 days before endometrial biopsy and allowed venous blood samples to be taken six times in the two-week period also before endometrial biopsy so researchers could examine the roles of endothelin (ET) and neutral endopeptidase (NEP) in menstrual bleeding changes in women using Norplant. They compared the degree of immunostaining in the endometrial biopsy samples of these women with those of 55 controls most of which came from women in Melbourne Australia. The endometrium of the Norplant group exhibited low glandular and luminal epithelial ET immunostaining as did the normal endometrium during the proliferative phase. Glandular epithelial ET immunostaining in the Norplant group fell considerably during the secretory or menstrual phases however. NEP immunoreactivity was greater in the endometrium of Norplant users than in that of controls suggesting that enzyme activity may have been increased locally among Norplant users. This increase may have accounted for the low ET reactivity. ET immunoreactivity was not related to duration of implant use or total number of bleeding days. These findings indicate that since Norplant users are at an increased risk of abnormal uterine bleeding ET may control menstrual bleeding. It is not known whether ET acts as a mitogen in endometrial repair and regeneration or as a vasoconstrictor to stop bleeding after menstruation.
-
Cytokeratins 8 18 and 19 in endometrial epithelial cells during the normal menstrual cycle and in women receiving Norplant.
Contraception, 1993Co-Authors: Sugito Wonodirekso, Biran Affandi, Wachju Hadisaputrat, Peter RogersAbstract:Cytokeratins 8, 18 and 19 are members of the cytoskeletal intermediate filament protein family. They are expressed in all simple epithelial tissues, including endometrium, and are recognised as dynamic structures that can be affected by numerous external factors. The Norplant system is a subdermal slow release levonorgestrel implant commonly used as a long-acting progestogen contraceptive. Norplant implants have been shown to have atrophic effects on endometrial epithelial and stromal cells, and cause a range of endometrial bleeding problems among users. The aim of this study is to describe changes in the immunohistochemical expression and distribution of cytokeratins 8, 18 and 19 in endometrial epithelial cells of Norplant implants users and normal menstrual cycle controls. Endometrial biopsies were collected from 65 control normal cycle women and 37 Norplant implants acceptors. The normal menstrual cycle was classified histologically into 9 stages; one menstrual, five proliferative and three secretory. Norplant implants bleeding patterns were categorised into 6 groups according to current World Health Organisation (WHO) definitions; amenorrhoea, frequent bleeding, infrequent bleeding, irregular bleeding, "normal" bleeding, and prolonged bleeding. The tissues were fixed in formalin, embedded in paraffin, and stained immunohistochemically. Semi-quantitative scoring of the staining intensity was performed. Apical versus basal intracellular cytokeratin distribution was also evaluated. The staining intensity was significantly stronger in control endometrial tissue compared to Norplant implants tissue. In control tissues, cytokeratins were predominantly located in the apical region of epithelial cells (52% of biopsies) and in Norplant implants tissues they were predominantly distributed equally between the apical and basal portions of epithelial cells (43% of biopsies). There was no particular cytokeratin distribution pattern associated with the different stages of normal cycle or the different Norplant implants bleeding patterns. It was concluded that long-term exposure to levonorgestrel significantly reduced the cytokeratin expression in endometrial epithelial cells (P < 0.001).
Soledad Diaz - One of the best experts on this subject based on the ideXlab platform.
-
post marketing surveillance of Norplant contraceptive implants i contraceptive efficacy and reproductive health international collaborative post marking surveillance
Contraception, 2001Co-Authors: O Meirik, Irving Sivin, Timothy M M Farley, Soledad DiazAbstract:To examine the safety and contraceptive efficacy of Norplant the authors undertook a 5-year follow-up study of women using Norplant an IUD or sterilization in 8 developing countries. Women attending family clinics were enrolled if they consented and were medically eligible for Norplant an IUD or female sterilization. Women who chose to use an IUD or resorted to surgical sterilization served as controls and were frequently matched in 5-year age bands with women who chose to use Norplant. At admission women had a physical examination and their medical histories demographic and socioeconomic characteristics were recorded. Follow-up visits were scheduled in the first 6 weeks after admission and semi-annually thereafter for 5 years irrespective of change of contraceptive method. Incidence rate ratios of health events were estimated for initial and current contraceptive method use. This paper reports reproductive health events and contraceptive efficacy. Altogether 7977 women initiating use of Norplant 6625 of IUD and 1419 of surgical sterilization were admitted. Their mean ages at initiation were 28.5 28.5 and 29.6 years respectively. More than 99% were married or cohabiting and parous. 5-year follow-up was completed by 94.6% of the women. By the end of 5 years the mean duration of first segment use per initiator was 4.16 years for Norplant 4.10 years for IUDs and 4.96 years for sterilization accounting for 39337 woman-years for Norplant 31915 for IUDs and 7071 for sterilization. The study accumulated 78323 woman-years of observation. Pearl pregnancy rates for Norplant copper IUDs and female sterilization were 0.27 0.88 and 0.17 per 100 woman-years respectively. Users of Norplant copper IUDs and sterilization had rates of ectopic pregnancy of 0.30 0.68 and 0.13 per 1000 woman-years respectively. Major health events related to the reproductive system were rare. Rates of acute pelvic inflammatory disease were significantly lower among Norplant users than IUD users (p = 0.004). The rate of ovarian enlargement was significantly higher in Norplant users than controls (p < 0.001) but not rates of hospitalization for this condition. Vaginitis and vaginal discharge and low abdominal pain were significantly less frequent in Norplant users that in the other groups. Bleeding disturbances were more frequent among Norplant users than controls but not anemia. The study confirms the high contraceptive efficacy of Norplant copper IUDs and female sterilization. The incidence rates of major reproductive health problems were low. There was no significant excess of serious reproductive morbidity among users of Norplant compared to users of IUDs and sterilization. (authors modified)
-
Post-marketing surveillance of Norplant contraceptive implants: II. Non-reproductive health. International Collaborative Post-Marketing Surveillance of Norplant.
Contraception, 2001Co-Authors: Meirik O, Irving Sivin, Timothy M M Farley, Soledad Diaz, John A. CollinsAbstract:This controlled cohort study aimed to evaluate the safety and efficacy of Norplant contraceptive implants in developing countries. Women initiating Norplant use were index subjects and women initiating IUD use or surgical sterilization were controls. Consenting participants at 32 clinics in 8t developing countries were admitted and followed up every 6 months for 5 years. Major and less serious health events during the follow-up were recorded. Incidence rate ratios of health events adjusted for clinic were estimated for initial and current method use. This paper reports non-reproductive health events. The study involved 7977 women initiating use of Norplant 6625 of IUD and 1419 of sterilization. 5 years of follow-up were completed for 94.6% of the women. The study accumulated 78323 woman-years of observation. The initial method chosen accounted for 84.4% or more of observed woman-years in users of Norplant IUD or sterilization. 22 of the recorded 34 deaths were due to accidents suicide or homicide. Few deaths or major health events were due to cancer or acute cardiovascular diseases and were not associated with the contraceptive method used. The incidence rates of major health events were low and with two exceptions there was no significant excess risk of serious morbidity for Norplant users compared with controls; among Norplant initiators gallbladder disease occurred at an incidence rate of 1.5 per 1000 woman-years and was weakly associated with use of Norplant (rate ratio 1.52 [95% confidence interval: 1.02 2.27]). For current Norplant users compared to controls the rate ratio of a combined variable of hypertension and borderline hypertension was significantly elevated (1.81 [1.12 2.92]). The occurrence of less serious health events was also low and several of them were significantly more often reported among Norplant users. Headache-migraine weight gain mood disturbances pruritus eczema and acne had incidence rates among Norplant users of 11.5 4.5 2.8 1.5 1.4 and 0.9 per 1000 woman-years respectively and were significantly higher than in controls. Respiratory health problems nonspecific symptoms and several ill-defined conditions were also significantly more often reported for Norplant users but some of the excess incidence may be attributable to reporting and detection bias. The study confirms the safety with respect to serious disease of Norplant IUDs and sterilization. (authors modified)
Robert T Brown - One of the best experts on this subject based on the ideXlab platform.
-
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.
