RESUMO
PIP: The Norplant contraceptive implant is a long-term, reversible method containing levonorgestrel (LNG) and became available in Portugal as of January 1996. It consists of six silastic capsules, which contain a 36 mg dose of LNG, and when inserted under the skin it provides a continuous release of LNG at the rate of 30 mcg. It is inserted during the first days of the menstrual cycle and provides protection against pregnancy for 5 years. It has been demonstrated that after removal 40-50% of the women become pregnant at the end of 3 months, about 80% at the end of 1 year, and 90% at the end of 2 years. It is particularly suited for women who are contraindicated to use estrogens or the IUD. Norplant can be used as soon as 6 weeks after delivery and while breast feeding. The associated pregnancy rate varies between 0.2 and 1.3 per 100 women-years. Its continuation rate is 60-90% at the end of 1 year and 50% at the end of 5 years. In users, alterations of the menstrual cycle, including amenorrhea, can occur; cycle normalization usually occurs within 9-12 months. A retrospective study was carried out concerning tubal ligations performed during 1993-94 at the Dr. Daniel de Matos Maternity Ward to confirm precise indications for sterilization and to study Norplant as a possible alternative. A total of 312 ligations were performed during this period. About 53% underwent sterilization because of medical contraindication to pregnancy, and the rest did not want any more pregnancies since they were 35 years old or older. The previous method of contraception used was, in order of frequency: coitus interruptus, hormonal methods, barrier and spermicidal methods, and IUDs. Only six patients had postoperative complications. Norplant as an effective long-term contraceptive is recommended in situations where a large degree of social, economic, and family instability exists.^ieng
