Implantable Contraceptives
There are two implantable contraceptives in general use in the United States: Norplant, a long- term, reversible contraceptive system; and Depo- Provera, an injectable contraceptive that lasts about 3 months as used in the United States. As with other high- maintenance implantables, medical care practitioners have a duty to keep track of patients with implantable contraceptives. They should use the same tracking system for patients with implantable contraceptives as for patients with implanted devices such as pacemakers. The patient should be given written information about the importance of follow- up care and the symptoms that should prompt an immediate call to the medical care practitioner.
The patient should be contacted before the date when the contraceptive is scheduled to lose effectiveness. If the patient cannot be contacted, the physician should send a certified letter to the patient’s last known address and document that it was either received or returned. Patients with Norplant should be seen at least once a year for evaluation of potential side effects and must be seen at the end of five years to remove or replace the implants. Patients with Depo-Provera will be seen quarterly to renew the implant. When patients with either contraceptive are seen, they should be carefully checked for sexually transmitted diseases, especially HIV. Although implantable contraceptives do not facilitate pelvic infections as did IUDs, they do facilitate the spread of sexually transmitted diseases by giving the false sense that they provide protection during intercourse. Medical care practitioners should be careful to educate patients that implantable contraceptives do nothing to protect against HIV and that patients must also use condoms if they are to be avoid sexually transmitted diseases. This should be fully documented in the consent form for implantable contraceptives.