The inability to easily remove Norplant has surely frustrated many physicians
and patients. We have developed a technique for removal of these implants that simplifies this time-consuming procedure.
The Norplant system was first developed in 1966 by the Population Council’s International
Committee for Contraceptive Research (ICCR), and was first approved by the US Food and Drug Administration in December
of 1990. It has since been used on every continent, and by nearly 1 million women in the United States alone. The
six silastic implants release a continuous low dose of the hormone levonorgestrel. The primary contraceptive action
is via a change in cervical mucus, creating an environment which is hostile to sperm penetration. Inhibition of
ovulation likely plays a smaller role.
The contraceptive efficacy of Norplant is one of the highest observed among all
contraceptive methods, with an annual pregnancy rate of 0.2% during the first two years of use. Although there
is unlikely to be any adverse health effects from retained implants, every Norplant system should eventually be
removed, either at the end of its five year effective period, or earlier upon patient request. The most likely
reason for a woman seeking early removal of the Norplant system is irregular bleeding. Other reasons for early
Norplant removal include headaches, mood changes, hair loss, and the desire to become pregnant.
Extensive patient education and counseling prior to insertion is the most effective
means of increasing patient acceptance. However, the fact remains that a significant proportion of women will chose
to have Norplant removed early. This, combined with the fact that we have now passed the five-year anniversary
of Norplant’s introduction to the United States, means that a large number of implants will now need to be removed.
Thus, the need for a safe and easy removal technique is obvious. We feel that our technique offers an effective
alternative to those currently available.
Our technique is a modification of the "U" technique originally described
by Dr. Untung Praptohardjo from Indonesia. We utilize a modified No Scalpel Vasectomy (NSV) clamp. Most implants
which have been properly inserted can be removed in 5-10 minutes, although some could take up to 20 minutes.
For the most part, the removal of Norplant requires more skill and patience than
does its insertion. We feel that our technique is easy to learn, and can be performed quickly and safely. For practitioners
who may be interested in learning more about this technique, our video is currently available through the ACOG
Library.
