Contraception with Levonorgestrel Subdermal Implants ($Norplant^R$) in Benin-City, Nigeria: A 12-year Review

Abstract

The case notes of 377 clients who accepted Norplant out of 11961 acceptors of family planning methods in the Department of Obstetrics and Gynaecology University of Benin Teaching Hospital, between January 1985 and December 1996 were retrieved and analysed at the end of 2004, for socio-demographic characteristics of the clients, side effects and complications reported and reasons for discontinuation in relation to duration of use. The daily register of the acceptors were analysed for new acceptors of other methods during the same period and confirmed with their case notes. The acceptance incidence of Norplant was 3.2%. The mean age and parity of the acceptors were 32.2 ± 4.5years and 3.9 ± 1.8 respectively. The duration of use ranged between 6 months and 13 years. 65% of the acceptors reported menstrual abnormalities. 48% of them reported reduced bleeding pattern, while 7.5% (25) discontinued method under 4years of use because of increased bleeding episodes. Other side effects reported were headache 6%, weight gain 3%, mastalgia 1.8%, decreased libido 1.8%, abdominal pain 1.5% and hypertension 1.2%. 20.4% (68) discontinued the use under 4years because of desire to have another baby. 38.6% (129) had implants removed at 5years, while 20.1% (67) continued the use for 6-13years before removal and replacement with another set. Husband's request for removal constituted 7.2% (24). The effectiveness was 100% as no pregnancy was reported during the study period. The continuation rate at 5years was 58.7%. 43 clients were however lost to follow up. Norplant was found to be an effective and acceptable method of long-term reversible contraception with minimal side effects. The low incidence was attributed to the fact that the implants were donor driven and not included in the country contraceptive logistic system. Norplant acceptors who continued the use after 5years did so, because they enjoyed it and did not want to part with them without replacement of new sets. Les dossiers ont été analysés pour identifier les caractéristiques socio-démographiques des clientes, les effets secondaires et les complications signalées et les raisons pour l'arrêt par rapport à la durée de l'emploi. Le registre quotidien d'accepteurs a été analysé pour identifier les nouveaux accepteurs d'autres méthodes pendant la même période avant de les confirmer avec leurs dossiers. L'incidence de l'acceptation de Norplant était de 3,2%. L'âge moyen et la parité des accepteurs étaient de 32,2 ± 4, 5 ans et 3, 9 ± 1, 8 respectivement. La durée de l'emploi variait entre six mois et 13 ans. 65% des accepteurs ont signalé les anomalies menstruelles. 48% parmi elles ont signalé une habitude d'une hémorragie réduite, alors que 7,5%(25) ont arrêté l'emploi de la méthode en moins de quatre ans à cause des crises d'hémorragie. Autres effets secondaires signalés étaient maux de tête 6%, prise de poids 3%, mastalgie 1,8%, baisse de la libido 1,8%, douleur abdominale 1,5%, hypertension 1,2%. 20,4% (68) ont arrête l'emploi en moins de 4 ans parce qu'elles voula...

Levonorgestrel effects on serum androgens, sex hormone–binding globulin levels, hair shaft diameter, and sexual function

“…Previous studies have suggested a small incidence of decreased sexual desire (<2.0%) in users of an LNG-SI (21,22). We were unable to find any evidence of changes in sexual function.…”

“…Combination oral contraceptives and LNG SC implants (LNG-SI) have been shown to decrease sexual desire in a small percentage of women (21)(22)(23). One of the difficulties with this assessment is that desire is more subjective than objective.…”

Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda

“…Further, no data on continuation of contraceptive use were collected beyond nine months postpartum. However, studies from other countries indicate that continuation rate for hormonal implants are high [17][18][19][20] .…”

Contraceptive practices in Nigeria: Literature review and recommendation for future policy decisions

“…41 Other studies on Norplant acceptability, effectiveness, common side effects, and reasons for discontinuation among Nigerian women have been carried out in Benin city, 42 Zaria, 43 and Calabar. 44 These studies showed a promising future for implant contraceptives in Nigeria, particularly in the Hausa and Muslim communities of northern Nigeria where contraceptive use has been generally low.…”