Norplant alternative to join method mix soon.

Since Norplant was introduced in the 1980s, researchers have worked to simplify this very safe and effective contraceptive implant comprised of six 3-cm levonorgestrel-releasing capsules. (1) They succeeded by developing in the 1990s what is now trademarked as Jadelle: an implant containing only two 4-cm levonorgestrel-releasing rods. Now, Jadelle is beginning to be introduced into the developing world as an alternative to--and potential replacement for--Norplant.

The biggest practical difference between the two implants is that Jadelle is easier to insert and remove, an advantage for both clients and providers.

"We recognized that six capsules were rather complicated to remove and insert, so we had hoped that we could develop more efficient implants," says Irving Sivin, senior scientist with the New York-based Population Council's implant development program. The Population Council developed Jadelle and also Norplant, which is now approved in more than 60 countries, including the United States.

Among clinicians using standard techniques to remove Norplant or Jadelle, Jadelle took only half the time to remove (a mean of approximately 5 minutes for Jadelle versus 10 minutes for Norplant). (2) Saving time in this way, Sivin says, may give providers more opportunity to counsel or otherwise help clients. Jadelle is also associated with fewer insertion and removal complications. In a study conducted among some 1,000 women using Norplant or Jadelle, 15 percent of Norplant users had some type of removal complication (such as bruising, pain, broken implants, or multiple incisions), compared with only 7 percent of Jadelle users. (3)

Of note, duration of effectiveness is up to seven years for Norplant and only up to five years for Jadelle, which may be another important practical consideration for potential users. Otherwise, the two delivery systems are comparable. "The pregnancy rates have been identical for the two, at 1.1 per 100 women over a five-year period, roughly two pregnancies per 1,000 women per year," says Sivin. In the study of some 1,000 women using Norplant or Jadelle, mean annual discontinuation rates due to menstrual disturbances (such as prolonged or heavy bleeding, intermenstrual spotting, and absence of bleeding) were approximately 4 per 100 women for both delivery systems. (4)

Jadelle has been approved in several European countries, Thailand, and Indonesia. In 2002 the International Planned Parenthood Federation added the method to its commodities list. USAID has not yet added it to its commodities list but will be working with the manufacturer to establish a public-sector price. Meanwhile, the Population Council is planning activities with PROFAMILIA in the Dominican Republic to determine the client preferences, educational materials, and provider training necessary for family planning programs to make a transition from Norplant to Jadelle.

REFERENCES

(1.) Croxatto HB. Progestin implants for female contraception. Contraception 2002; 65(1):15-19; Sivin I, Moo-Young A. Recent developments in contraceptive implants at the Population Council. Contraception 2002;65(1):113-19.

(2.) Sivin I, Campodonico I, Kiriwat O, et al. The performance of levonorgestrel rod and Norplant contraceptive implants: a five-year randomized study. Hum Reprod 1998; 13(12):3371-78.

(3.) Sivin, Campodonico, Kiriwat.

(4.) Sivin, Campodonico, Kiriwat.