Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, March 6, 1991 TAG: 9103060110
SECTION: VIRGINIA PAGE: B1 EDITION: METRO
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LENGTH: Long
After a few sessions of inserting the matchstick-size implants into a dummy arm made of rubber and foam, five physicians performed the 15-minute procedure on real patients.
"Everybody did fine," said Dr. Elizabeth Smith, an obstetrician-gynecologist who did the training. "The patients were all happy when they left."
"The procedure is a breeze," said Gail Mitchell, a 40-year-old professional woman who was the second patient to have the procedure.
Mitchell said she decided to try the implant because her age ruled out continuing on birth control pills. "This seemed like a safe and effective alternative."
The implantable contraceptive, called Norplant, is "the newest thing to come along in birth control for a long, long time," Smith said.
Norplant has been called revolutionary, not only for its five-year protection but also because it is reversible simply by removing the implants.
Smith and others, however, warn that Norplant is not a panacea and that other forms of birth control will continue to be more appropriate for many women.
"Norplant is certainly an important new addition to the options women have for birth control," said Kathryn Haynie, executive director of Planned Parenthood of the Blue Ridge. But some women, Haynie added, particularly younger women, may not choose the implant because they don't want to risk irregular menstrual bleeding, the most common side effect.
Other side effects include headaches, weight gain, fluid retention, nervousness, nausea, dizziness, acne and depression.
Norplant works much like birth control pills. It uses a synthetic female hormone that tricks the woman's pituitary gland into stopping the production of natural hormones that signal the ovaries to produce eggs. The implant also causes a thickening of mucus in the woman's cervix, which helps prevent sperm from ever reaching eggs that might be produced.
Norplant is extremely effective, with a pregnancy rate of less than 1 percent over five years. Half a million women in 46 countries have used the implant over the past two decades. It was approved for use in the United States late last year.
Norplant releases a synthetic hormone very slowly through six tubes of rubbery plastic, each about 1.3 inches long. The tubes are inserted under the skin of the woman's upper arm in a fan-like configuration through a [-inch incision. The procedure is done under local anesthesia in a physician's office.
Physicians throughout the country are being trained to perform the procedure by colleagues who have received training at university medical centers. Smith learned the procedure last week at the University of Virginia and held her first training session in Roanoke on Monday.
Smith said she will train obstetrician-gynecologists who are within a two-hour drive of Roanoke for the next several weeks. She also will train ob-gyn residents at Roanoke Memorial so they can perform the procedure on patients using the hospital's clinic.
About 8,000 physicians across the country should complete training by June, said a spokeswoman for Wyeth-Ayerst, the drug company marketing the implants.
"A big key to this is patient counseling and education," Smith said. Physicians are given a videotape to show to patients and are taught to look for factors that may make patients poor candidates for Norplant.
The implants should not be used in women who have breast cancer, blood clots, liver disease, abnormal genital bleeding or who are taking certain seizure medications. It is less effective in women weighing more than 155 pounds.
Norplant is aimed at younger women who want to delay pregnancy for at least a few years or older women who most likely will not have any more children but who don't like the permanency of sterilization.
That was a factor in Gail Mitchell's decision to try Norplant. "Sterilization is just so final," said Mitchell, who has no children.
The procedure is being covered by some insurance companies, and Medicaid programs in at least nine states have said they will pay for the procedure. The cost of Norplant itself is $350 for a five-year period plus the cost of physician fees. Medicaid is expected to reimburse physicians about $100.
Virginia's Medicaid program has yet to decide on covering Norplant. If the decision is no, then Norplant will be "out of reach" for many poor women, said Haynie of Planned Parenthood.
Haynie said her organization would like to offer Norplant to its clients but would be unable to do so without Medicaid funding.
The introduction of Norplant in the United States has sparked a debate about women's reproductive rights. Late last year, a California judge sentenced a 27-year-old convicted child abuser to use the birth control implant.
"Voluntary reproductive decisions are an intrinsic part of democracy," Haynie said. "Who would want to live in a country where others make decisions for you about your right to have children?
"We have to avoid the mentality that arose years ago with involuntary sterilization" of poor and mentally retarded women, she said.
by CNB