Contraceptive Implants

O. A. Ladipo, S. A. Akinso


In response to the need of some women for long-acting, effective and safe contraceptives, the scientific community developed non-biodegradable progestational subdermal implants that act by making the cervical mucus viscous, with ovulation inhibition and thinning of the endometrial lining. The contraceptive protection is within 24 hours and the cumulative failure rate is low. Contraceptive implants require little or no motivation following adequate counselling. In current use are multirod implants (Norplant I and Norplant II Jadelle) and single rod implant (Implanon and Uniplant). Although menstrual symptoms associated with progestational regimens are the major compliance and acceptability factors within the first year of use, menstrual disturbance generally improves. Continuation rates for implant use are high among those who have had adequate pre-insertion counselling because the perceived advantages greatly outweigh the nuisance effects. Other side effects of implants are similar to those observed with hormonal pills - headache, weight changes, mood swings and abdominal bloating. Training of physicians and nurses in the art of insertion and removal techniques is a pre-requisite for a successful implant programme. This should also be backed by integration of implants into the national commodity logistics systems to ensure adequate local budgetary provision for contraceptive implant procurement rather than reliance on donor supply. (Afr J Reprod Health 2005; 9[1]: 16-23)  

Keywords: Contraception, implant, counselling, insertion, removal 

Full Text:



Folkman J and Long DM. The use of silicone rubber as a carrier for prolonged drug therapy. J Surg Res 1964; 4: 139-142.

Dziuk PJ and Cook B. Passage of steroids through silicone rubbers. Endocrinology 1966; 78: 208-211.

Segal SJ and Croxatto HB. Single administration of hormones for long-term control of reproductive function. Presentation of the XXIII Meeting of American Fertility Society, April 14-16, Washington, DC, 1967.

Segal SJ. Contraceptive subdermal implants. In: Mishell DR Jr (Ed.) Advances in Fertility Research. New York: Raven Press, 1982, 117-127.

Croxatto HG, Diaz S, Atria P, Cheviakoff S, Rosath S and Oddo H. Contraceptive action of megesterol acetate implant in women. Contraception 1975; 4: 155.

Heinonen OP, Slone D, Monson R.R, Hook EB and Shapiro S. Cardiovascular birth defects and antenatal exposure to sex hormones. N Engl J Med 1977; 296-267.

Frank DW, Kirton KT, Murchison TE, et al. Mammary and serum hormones in the bitch treated with medroxyprogesterone acetate or progesterone for four years. Fertil Steril 1979; 31: 340.

Bergsjo P and Langernor H. Tubal pregnancies in women using progestin-only contraception. Acta Obstet Gynecol Scand 1974; 53: 377.

Coutinho EB. Clinical experience with implant contraception. Contraception 1978; 18: 411.

Coutinho EB and Da Silva AR. One-year contraception with norgestrienone subdermal silastic implants. Fertil Steril 1974; 25: 170.

Coutinho EB, Da Silva AR, Maltos CER, et al. Contraception with long acting subdermal implants I. An effective and acceptable modality in international clinical trials. Contraception 1978; 18: 315.

Weiner E and Johansson EDB. Plasma levels of d-norgestrel, estradiol and progesterone during treatment with silastic implants containing d-norgestrel. Contraception 1976; 14: 81.

Darney PD, Klaiste CM, Tanner S, et al. Sustained release contraceptives. Curr Prob Obstet Gynaecol Fert 1990; XIII(3): 85- 125.

Darney PD. Hormonal implants: contraception for a new century. Amer J Obstet Gynaecol 1994; 170(5): 1536-1543.

Chez RA. Clinial aspects of three new progestogens. Desogestrel, gestodene and norgestimate. Amer J Obstet Gynaecol 1989; 160:1296-1300.

Mascarenhas L. Long-acting methods of contraception. Br Med J 1994; 308: 991-992.

Olotu E and Mascarenhas L. Subdermal contraceptive implant. Br J Fam Plann 2000; 26(3): 171-179.

Croxatto H. Decision for Norplant programs. Pop Reports 1992; (K) Series (4).

International Medical Advisory Panel, IPPF London statement on Norplant subdermal contraceptive implant system, 1995, 11-7.

Branche VA, Faundes E, Johanson, et al. Anovulation, inadequate teal phase, and poor sperm penetration in cervical mucus during prolonged use of Norplant implant. Contraception 1985; 31: 261-273.

Branche V, Blumenthal PD, Alvarez F, et al. Contraception 1999; 59: 245-256.

Croxatto HB and Makarainen L. The pharmacodynamics and efficacy of Implanon. An overview of the data. Contraception 1998; 58(56): 915-975.

Fraser IS, Tiitinen A, Affandi B, et al. NorplantR consensus statement and background review. Contraception 1998; 57: 1-9.

Sivin I, Nash H and Waldman S. JadelleR Levonorgestrel Rod Implants: A summary of Scientific Data and Lessons Learned from Programatic Experience 2002. The Population Council.

Affandi B, Santoso SSI, Djajadilaga, et al. Five years experience with Norplant. Contraception 1987a; 36(4): 417-428.

Sivin I, Stern J, Diaz S, et al. Rates and outcomes of planned pregnancy after use of Norplant. Norplant II rods, or levononorgetrel releasing or copper (TCU 380mg contrauterine contraceptive devices. Amer J Obstet Gynaecol 1992; 166(4): 1208-1213.

Baird DT and Glasier AF. Menstrual Bleeding Pattern and Contraception. London: IPPF.

Edwards JF and Moore A. Implanon. A review of clinical studies. Br J Fam Plann 1999; 24(54): 3-16.

Coutinho EM, et al. First year clinical experience with uniplant. A multi center study. Contraception 1995; 53: 121-125.

Belsey EM, Machin DD and d'Arcangnes C. Task force on long acting systemic agents for fertility regulation, menstrual bleeding patterns in untreated women. Contraception 1997; 55: 57-65.

Faundes A, Alvarez F, Branche V, Jimenez E and Tejada AS. Hormonal changes associated with bleeding during low dose progestogen contraception delivered by Norplant subdermal implants. Adv Contracep 1991; 7: 1-10.

Fraser IS, Hickey M and Song JA. Comparison of mechanism underlying disturbances of bleeding caused by spontaneous dysfunctional uterine bleeding in women on hormonal contraception. Human Reprod 1996; 11(Suppl 2): 165-178.

Alvarez-sanchez F, Branche V, Thevenin F, Cochon L and Faundes A. Hormonal treatment for bleeding irregularities in Norplant implant users. Am J Obstet Gynecol 1996; 174: 919-922.

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

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

Faundes A, Tejada AS, Branche V, et al. Subjective perception of bleeding and serum ferritin concentration in long term users of implant. Contraception 1987; 35(2): 189-196.

Fakeye O and Balough S. Effect of Norplant contraceptive use on haemoglobin, packed cell volume and menstrual bleeding patterns. Contraception 1989; 39(3): 265-279.

Hatasaka H. Implatable levonorgestrel contraception: 4 years of experience with Norplant. Clin Obstet Gynaecol 1995; 38(4): 859-871.

Nelson LA. Neutralising pH of lidocaine reduces pain during NorplantR system inservtion procedures. Contraception 1995; 51: 299-301.

Speroff L and Darney P. Long Acting Steroid Methods. A Clinical Guide for Contraception. Baltimore: Williams and Wilkins, 1992.

Twickler DM and Schwarz BG. Imaging of the levonorgestrel implanatable contraceptive device. Am J Obstet Gynaecol 1992; 167: 572-573.

Macscarenhas I. Insertion and removal of implanon. Contraception 1998; 58(suppl. 6): 795-835.

Otubu JAM, Towobola OA, Aisien AO, et al. Effects of Norplant contraceptive subdermal implants on serum lipids and lipoproteins. Contraception 47: 149-154.

Konje JC, Otolorin EV and Ladipo OA. The effect of continuous subdermal levonorgestrel on carbohydrate metabolism. Am J Obstet Gynec 1992; 166: 15-19.

Singn K, Vergas OA and Ratnam SS. A 3-year evaluation of metabolic changes in Singaporean Norplant acceptors. Adv Contracep 1990b; 6: 11-12.

Ladipo O and Coutinho EM. Contraceptive implants current opinion. Obstet Gynecol 1999; 6: 564-569.

Hatcher RA, Rinehart W, Blackburn R, Geller JS and Shelton JD. Norplant Implants in the Essentials of Contraceptive Technology. Baltimore: John Hopkins Population Program, 1997; 8-1 to 8-24.

Ladipo OA, et al. NorplantR use by women with sickle cell disease. Inter J Gynaecol Obstet 1993; 41: 85-87.

Nascimento L, M de, Ladipo OA and Coutinho EM. Nomegestro acetate (uniplant) contraceptive implant use by women with sickle cell disease. Cloin Pharm Ther 1998; 64: 433-438.

Diaz S. Contraceptive implants and lactation. Contraception 2002; 65(1): 39-46.

Croxatto HB. Progestin implants for female contraception. Contraception 2002; 65(1): 15-19.

Marik O, Farley TM and Sivin I. Safety and efficacy of Levonogestral implant, intrauterine device and sterilization. Obstet Gynecol 2001; 97(4): 539-547.


  • There are currently no refbacks.