Skip to main content
Log in

Adverse effects associated with contraceptive implants: incidence, prevention and management

  • Published:
Advances in Contraception

Abstract

Contraceptive implants are increasingly being used for fertility regulation all over the world. Reversible long-term use is their most appealing feature for many users. They have the practical advantage of overcoming the risks of user failure and low continuation rates associated with other methods that require continuous attention or motivation.

Disruption of menstruation, complications of insertion and removal, and infection at implant site, constitute the majority of adverse effects associated with contraceptive implants. This article reviews these various common adverse effects associated with contraceptive implants and their possible management and prevention.

In addition, we also discuss very rare events, like psychiatric disorders, pseudotumor cerebri, thrombotic, thrombocytopenic purpura and thrombocytopenia, that have been reported by some researchers. Further surveillance and research is necessary to determine if these rare adverse events are causally related to contraceptive implants. Until such a time, providers of contraceptive implants should be more selective in prescribing the contraceptive implants, especially in women with a history of and/or risk factors for stroke, cerebral and coron ary heart disease, thrombocytopenia and pseudotumor cerebri.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Croxatto HB. Norplant: Levonorgestrel-releasing contraceptive implant. Ann Med. 1993;25:155-60.

    Google Scholar 

  2. Segal SJ. Contraceptive implants. In: Arulkumaran S, Ng SC, eds. Current Issues in Obstetrics and Gynaecology. Singapore: Oxford University Press; 1996:271-82.

    Google Scholar 

  3. Wysowski DK, Green L. Serious adverse events in Norplant users reported to the Food and Drug Administrations Med Watch Spontaneous Reporting System. Obstet Gynaecol. 1995;85:538-42.

    Google Scholar 

  4. Diaz J, Faundes A, Olmos P, Diaz M. Bleeding complaints during the first year of Norplant use and their impact on removal rate. Contraception. 1996;53:91-5.

    Google Scholar 

  5. Pasquale SA, Knuppel RA, Owens AG, Bachmann GA. Irregular bleeding, body mass index and coital frequency in Norplant contraceptive users. Contraception. 1994;50:109-16.

    Google Scholar 

  6. Shoupe D, Mishell DR, Bopp BL, Fielding M. The significance of bleeding patterns in Norplant implant users. Obstet Gynecol. 1991;77:256-60.

    Google Scholar 

  7. Sivin I. International experience with Norplant and Norplant-2 contraceptives. Stud Fam Plann. 1998;19:81-94.

    Google Scholar 

  8. Balogh SA, Klavon SL, Basnayake S, Puertollano N, Ramos RM, Grubb GS. Bleeding patterns and acceptability among Norplant users in two Asian countries. Contraception. 1989;39:541-53.

    Google Scholar 

  9. Datey S, Gaur LN, Saxena BN. Vaginal bleeding patterns of women using different contraceptive methods-An Indian experience. Contraception. 1995;51:155-65.

    Google Scholar 

  10. Faundes A, Avarez F, Brache V, Jimenez E, Tejada AS. Hormonal changes associated with bleeding during low dose progestagen contraception delivered by Norplant subdermal implants. Adv Contracept. 1991;7:1-10.

    Google Scholar 

  11. Alvarez-Sanchez F, Brache V, Thevenin F, Cochon L, Faundes A. Hormonal treatment for bleeding irregularities in Norplant implant users. Am J Obstet Gynecol. 1996;174:919-22.

    Google Scholar 

  12. Waldman S et al. Norplant Levonorgestrel Implants. A Summary of Scientific Data. New York, NY: The Population Council. 1990.

    Google Scholar 

  13. Mishell DR. Overview of contraception. In: Wallace EE, Zucker HA, eds. Reproductive Medicine and Surgery. Baltimore, MD, USA: Moseby; 1995:289-316.

  14. Darney PD, Atkinson E, Tanner S, MacPherson S, Hellerstein S, Alvarado A. Acceptance and perceptions of Norplants users in San Francisco, USA. Stud Fam Plann. 1990;21:152-62.

    Google Scholar 

  15. Cullins VE. Preliminary experience with Norplant in an inner city population. Contraception. 1993;47:193-203.

    Google Scholar 

  16. Croshy UD, Schwarz BE, Gluck KL, Heartwell SE. A preliminary report of Norplant implant insertion in large urban family planning program. Contraception. 1993;48:359-66.

    Google Scholar 

  17. Darney PD. Hormonal implants: Contraception for a new century. Am J Obstet Gynecol. 1994;170:1536-43.

    Google Scholar 

  18. Sivin I. Contraception with Norplant implants. Hum Reprod. 1994;9:1818-26.

    Google Scholar 

  19. Moore LL, Valuck R, McDougall C, Fink W. A comparative study of one-year weight gain among users of medroxyprogesterone acetate, levonorgestrel implants and oral contraceptives. Contraception. 1995;52:215-20.

    Google Scholar 

  20. Spellacy WN, Birk SA. The effect of intrauterine devices, oral contraceptives, oestrogens and progestogens on blood pressure. Am J Obstet Gynecol. 1972;112:912-19.

    Google Scholar 

  21. Hall WD, Doublas MB, Blumenstein BA, Hatcher RA. Blood pressure and oral progestational agents: a prospective study of 119 black women. Am J Obstet Gynecol. 1980;136:344-8.

    Google Scholar 

  22. Shen Qifong, Lin Deliang, Jian Xiurong, Li Haifong, Zhang Zhongshu. Blood pressure changes and hormonal contraceptives. Contraception. 1994;50:131-41.

    Google Scholar 

  23. Hatasaka H. Implantable levonorgestrel contraception: 4 years of experience with Norplant. Clin Obstet Gynaecol. 1995;38(4):859-71.

    Google Scholar 

  24. Nelson LA. Neutralizing pH of lidocaine reduces pain during Norplant system insertion procedures. Contraception. 1995;51:299-301.

    Google Scholar 

  25. Speroff L, Darney P. Long-acting steroids methods. In: A Clinical Guide for Contraception. Baltimore, Maryland: Williams and Wilkins; 1992.

    Google Scholar 

  26. Sarma SP, Wamsher JG, Whitlock SW. Removal of deeply inserted, nonpalpable levonorgestrel (Norplant) implants. Contraception. 1996;53:159-61.

    Google Scholar 

  27. Twickler DM, Schwarz BG. Imaging of the levonorgestrel implantable contraceptive device. Am J Obstet Gynecol. 1992;167:572-3.

    Google Scholar 

  28. Diaz J, Rubin J, Faundes A et al. Comparison of local signs and symptoms after the insertion of Norplant implants with and without a scalpel. Contraception. 1991;44:217-21.

    Google Scholar 

  29. Zuber TJ, DeWitt DE, Patton DD. Skin damage associated with the Norplant contraceptive. J Fam Pract. 1992;34:613-16.

    Google Scholar 

  30. Klavon SL, Grubb GS. Insertion site complications during the first year of Norplant use. Contraception. 1990;41:27-37.

    Google Scholar 

  31. Alfa MJ, Sisler JJ, Harding GKM. Mycobacterium abscessus infection of a Norplant contraceptive implant site. Can Med Assoc. 1995;153:1293-6.

    Google Scholar 

  32. Konje J, Odukuya O, Otolorin E, Ewings P, Ladipo O. Carbohydrate metabolism before and after Norplant removal. Contraception. 1992;46:61-9.

    Google Scholar 

  33. Konje J, Otolorin E, Ladipo O. The effect of continuous subdermal levonorgestrel (Norplant) on carbohydrate metabolism. Am J Obstet Gynecol. 1992;166:15-19.

    Google Scholar 

  34. Konje J, Otolorin E, Ladipo OA. Changes in carbohydrate metabolism during 30 months of Norplant. Contraception. 1991;44:163-72.

    Google Scholar 

  35. Singh K, Viegas O, Ratnam S. Effect of Norplant implants on liver, lipid and carbohydrate metabolism. Contraception. 1992;45:141-53.

    Google Scholar 

  36. Singh K, Viegas O, Liew D, Singh P, Ratnam S. Two year follow-up of changes in clinical chemistry in Singaporean Norplant acceptors: Metabolic changes. Contraception. 1989;39:129-36.

    Google Scholar 

  37. Singh K, Viegas O, Loke D, Ratnam SS. Effect of Norplant-2 rods on liver lipid and carbohydrate metabolism. Contraception. 1992;45:463-72.

    Google Scholar 

  38. McDonald GW, Fisher GF, Burnham C. Reproducibility of the oral glucose tolerance test. Diabetes. 1965;14:473-80.

    Google Scholar 

  39. Koopersmith TB, Lobo RA. Insulin sensitivity is unaltered by the use of the Norplant subdermal implant contraceptive. Contraception. 1995;51:197-200.

    Google Scholar 

  40. Shamma FN, Rossi G, HaiHassan L et al. The effect of Norplant on glucose metabolism under hyperglycaemic hyperinsulinaemic conditions. Fertil Steril. 1995;63:767-72.

    Google Scholar 

  41. Shoupe D, Mishell DR. Norplant: Subdermal implant system for long-term contraception. Am J Obstet Gynecol. 1989;160:1286-92.

    Google Scholar 

  42. Croxatto HB, Diaz S, Robertson DN, Pavez M. Clinical chemistry in women treated with levonorges-trel implants (Norplant) or a TCu 200 IUD. Contraception. 1983;27:281-8.

    Google Scholar 

  43. Mainwaring R, Hales HA, Stevenson K et al. Metabolic parameter, bleeding and weight changes in US women using progestin only contraceptives. Contraception. 1995;51:149-53.

    Google Scholar 

  44. Otubu JAM, Towobola OA, Aisien AO, Ogunkeye OO. Effects of Norplant contraceptive subdermal implants on serum lipids and lipoproteins. Contraception. 1993;47:149-59.

    Google Scholar 

  45. Wagner KD. Major depression and anxiety disorders associated with Norplant. J Clin Psychiatr. 1996;57:152-7.

    Google Scholar 

  46. Lewis A, Hoghughi M. An evaluation of depression as a side effect of oral contraceptives. Br J Psychiatr. 1969;115:697-701.

    Google Scholar 

  47. Chaudhuri SK, Chattopadhyay RN, Maitra SK et al. Effects of progesterone on some brain neurotransmitters in intact rats. Ind J Physiol Pharmacol. 1992;36(4):255-8.

    Google Scholar 

  48. Grant EG, Davies JD. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphates. Br Med J. 1968;3:777-80.

    Google Scholar 

  49. Sheenan DV, Sheenan KH. Psychiatric aspects of oral contraceptive use. Psychiatr Ann. 1976;6:500-8.

    Google Scholar 

  50. Shaarawy M, Fayad M, Nagui AR et al. Serotonin metabolism and depression in oral contraceptive users. Contraception. 1982;26:193-204.

    Google Scholar 

  51. Maes M, Claes M, Schotte C et al. Disturbances in dexamethasone suppression test and lower availability of L-tryptophan and tyrosine in early puerperium and in women under contraceptive therapy. J Psychosom Res. 1992;36:191-7.

    Google Scholar 

  52. Alder JB, Fraunfelder FT. Levonorgestrel implants and intracranial hypertension. N Eng J Med. 1995;332:1720-1.

    Google Scholar 

  53. Radhakrishnan K, Ahlskog JE, Cross SA, Kurland LT, O'Fallon WM. Idiopathic intracranial hypertension (pseudotumour cerebri): descriptive epidemiology in Rochester, Minn 1976 to 1990. Arch Neurol. 1993;50:78-80.

    Google Scholar 

  54. Ruggenenti P, Remuzzi G. Thrombotic thrombocytopenic purpura and related disorders. Hematol Oncol Clin N Am. 1990;4:219-41.

    Google Scholar 

  55. Fraser JL, Millenson M, Malynn ER, Uhl L, Kruskall MS. Possible association between the Norplant contraceptive system and thrombotic thrombocytopenic purpura. Obstet Gynaecol. 1996;87:860-3.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, K., Chye, G. Adverse effects associated with contraceptive implants: incidence, prevention and management. Advances in Contraception 14, 1–13 (1998). https://doi.org/10.1023/A:1006559124829

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006559124829

Keywords

Navigation