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The new contraceptives.


 There are 3 new categories of contraceptives: contraceptive implant systems, new intrauterine contraceptives, and new barrier methods. The implant system Norplant (6 silastic rods each with 38 mg levonorgestrel) provides effective contraception for 5 years. Its 4-year pregnancy rate is 3.9/100 woman-years. Norplant prevents pregnancy by thickening the cervical mucus, suppressing the endometrium, and affecting the hypothalamic-pituitary-ovarian axis. Ovulation suppression also occurs in about 50% of Norplant acceptors during the first years of use. Fertility returns at about the same rate as that of other hormonal methods. Trained health personnel should insert the rods subdermally during the first 5 days of the menstrual cycle, immediately after an induced abortion, or during the 4th week postpartum. The rods must be removed no later than 5 years after insertion. Contraindications to Norplant are undiagnosed abnormal genital tract bleeding, confirmed or suspected pregnancy, steroid-dependent genital malignancy, severe or acute vascular disease, and acute liver disease. Irregular bleeding is the leading reason for discontinuation. Preinsertion counseling and postinsertion support increase the likelihood of continuation. The first-year continuation rate is about 75%. Norplant causes limited metabolic effects. UK centers provide services and training for Norplant. Another implant system is Norplant 2, a 2-capsule implant which protects against pregnancy for 2-3 years. Intrauterine contraception includes modified design or enhanced bioactivity of IUDs. A new IUD is the levonorgestrel-releasing IUD. Its pregnancy rate is the same as the combined pill. Its key side effect is irregular spotting. Condoms are now being made with natural rubber, polyurethane, or thermoplastic elastomer to alleviate the allergic reactions associated with latex. Other new barrier methods are the female condom and the nonlatex silicone rubber cervical cap.
