Factors associated with elective norplant removal in black and white women

• Published in: Journal of the National Medical Association Vol. 89; no. 4; pp. 237 - 240
• Main Authors: OPARA, J. U, ERNST, F. A, GASKIN, H, SMITH, L, NEVELS, H. V
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ Slack 01.04.1997; National Medical Association
• Subjects: Adult; African Americans; Biological and medical sciences; Contraceptive Agents, Female - administration & dosage; Contraceptive Agents, Female - adverse effects; Counseling; Drug Implants; European Continental Ancestry Group; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Levonorgestrel - administration & dosage; Levonorgestrel - adverse effects; Medical sciences; Non tumoral diseases; Patient Compliance; Surveys and Questionnaires; Removal; Human; Prevention; Costs; Physician patient relation; Etiology; Secondary effect; Intrauterine contraceptive device; Female; Contraception; Predictive factor; Female genital diseases; Americas; Organization And Administration; United States; Tennessee; Research Methodology; North America; Sampling Studies; Bleeding; Contraceptive Agents > side effects; Ethnic Groups; Population Characteristics; Counseling; Clinic Activities; Population; Research Report; Program Activities; Demographic Factors; Contraceptive Implants > side effects; Programs; Cultural Background; Levonorgestrel > side effects; Whites > women; Blacks > women; Contraceptive Methods > side effects; Family Planning; Diseases; Menstruation Disorders; Studies; Surveys; Northern America; Developed Countries; Contraceptive Agents, Progestin > side effects; Contraception Termination; Signs And Symptoms; Contraceptive Agents, Female > side effects
• ISSN: 0027-9684; 1943-4693

Premature removal of contraceptive implants (Norplant [levonorgestrel implants], Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) is a cause of a sizable national medical expenditure in the United States. Understanding the factors that influence the decision to remove the implants and being able to predict which users are likely to elect discontinuation prematurely could provide useful information for counseling patients as they are considering contraceptive implants so that potentially enormous long-term savings could be achieved. This study surveyed 98 women who had Norplant inserted and removed between January 1991 and December 1994. Data were collected from chart review, and when necessary, a questionnaire was used to extract information not found in the chart. The chi-squared statistic and t-test were used to compare demographic variables. All but one subject received comprehensive pre-implant counseling. The main reason given for electively removing the Norplant prematurely was irregular menstrual bleeding (60%). Pre-implant counseling did not influence the decision for removal. These results indicate the importance of clarifying patients' doubts regarding menstrual bleeding irregularities during follow-up visits rather than relying on the information patients received during preimplant counseling.