Hormonal Implant

The facts: Norplant (the one brand of hormonal implant currently available) is a long-term method of birth control consisting of six thin, flexible plastic tubes the size of matchsticks. These flexible tubes allow the release of the synthetic hormone progestin, which prevents pregnancy. A cut is made into the upper arm, and the six Norplant capsules are inserted after numbing the area with a local anesthetic. Norplant must be inserted within the first seven days after the normal menstrual cycle begins, and protection against pregnancy begins within 24 hours. Norplant protects against pregnancy for five years and must be removed after five years of use (it can also be removed at any point).

How well it works: 99.9 percent effective at preventing pregnancy. Of every 10,000 women who use Norplant for five years, fewer than five will become pregnant.

Pros:
• Does not require any action on a daily basis or prior to intercourse.
• Can decrease menstrual cramps and pain, as well as reduce the risk of endometrial cancer, ovarian cancer, pelvic inflammatory disease and ectopic pregnancies.
• Does not contain estrogen, so women who cannot use certain birth control pills may still be able to use Norplant.
• Can be removed at any time.

Cons:
• Does not protect again HIV and sexually transmitted diseases.
• Insertion and removal requires a minor surgical procedure -- making the initial cost of Norplant higher than other contraceptives.
• In rare instances, implants have been difficult to remove.
• Side effects can include skin irritation at the insertion site, irregular menstrual cycles, spotting, weight gain, breast tenderness, mood changes or changes in sex drive.

Where to get it: Visit your health care provider or a family planning clinic.

Cost: Without public or private insurance coverage, Norplant can cost between $500 and $750 for the medical exam, a pregnancy test, the implant and the insertion. This amounts to $100 to $150 per year over a five-year period. Clinicians will charge an additional fee to remove Norplant -- from $100 to $200. Some insurance plans will pay for Norplant. Medicaid covers the cost of all eligible women living in any of the 50 states.