Who can use Jadelle?
Almost any fertile woman without contraindications (see below) who wants to avoid pregnancy may use Jadelle. The method is suitable for women who are seeking continuous, yet reversible contraception; who want to space their children; who cannot use methods that contain estrogen; who do not want to be sterilized; and/or who desire a method that is convenient and not related to sexual intercourse.
Who should not use Jadelle?
Jadelle should not be used by women who are pregnant or who have any of these contraindications: active thrombophlebitis or thromboembolic disorders, such as blood clots in the legs, lungs, or eyes; undiagnosed abnormal genital bleeding; acute liver disease; noncancerous or cancerous liver tumors; known or suspected breast cancer; a history of idiopathic intracranial hypertension; or hypersensitivity to levonorgestrel or any of the other components of the rods (e.g., silicone elastomer). Women who have had previous blood clots or other thromboembolic disorders should consult with their health care providers about whether to use the method.
Is Jadelle effective for women of differing weights?
Yes. Even among heavier women, annual pregnancy rates for Jadelle users over three years and five years are well below those of oral contraceptives. A comparative five-year study of Jadelle and Norplant users showed no significant effect of weight on pregnancy risk.
What do women like most about Jadelle?
Discussions with women using Jadelle in various countries show they like the method's reliability, convenience, effectiveness, and reversibility. Other advantages mentioned are the method's long-term duration and the fact that the rods are placed in the arm.
What do women dislike about Jadelle?
The side effect that women like least is menstrual irregularity, which can mean heavy or prolonged bleeding, spotting, or no bleeding at all. This kind of irregular bleeding occurs because the method contains no estrogen. While such irregular bleeding is usually no cause for alarm, it can be troublesome for some women. In addition, women complain about side effects common to other hormonal methods, such as weight gain, headaches, acne, and mood changes. Some rod users are anxious about possible pain and complications from the insertion and removal procedures. Since the Jadelle system is not user-controlled, it is important that women be able to request removal and receive it promptly from competent providers.
How does Jadelle work?
Pregnancy is prevented in Jadelle users by a combination of mechanisms. The most important are the inhibition of ovulation and the thickening of the cervical mucus, making it impermeable to sperm. Other mechanisms may add to these contraceptive effects.
What is Jadelle made of?
The outer part of the Jadelle rod is silicone rubber tubing, similar to the material used in catheters and heart valves since the 1950s. It also is the same kind of material used in Norplant capsules, another contraceptive implant system. The rods release levonorgestrel, a synthetic progestin that has been used in combined oral contraceptives and in progestin-only pills for more than 30 years. What is "new" about the rods is their delivery system, which can provide contraceptive protection for up to five years.
How do Jadelle rods differ from Norplant capsules?
The Jadelle system consists of two rods, while the Norplant system has six capsules. Because there are fewer implants, Jadelle is easier to insert and remove than Norplant. Rods differ from capsules. Each Jadelle rod is 43 millimeters long and 2.5 millimeters in diameter, slightly longer (one centimeter) and slightly thicker (0.1 millimeter) than each Norplant capsule. Each rod contains 75 mg of levonorgestrel for a total of 150 mg, while the six Norplant capsules each contain 36 mg, for a total of 216 mg. Both the capsules and rods have outside sheaths composed of silicone rubber, but they are made differently. In the Norplant capsule, levonorgestrel crystals are packed within the rubber sheath, which is then sealed at each end. In the Jadelle rod, a core of mixed levonorgestrel and elastomer (a polymer having the elastic properties of natural rubber) is enclosed within the rubber sheath, which is then sealed at each end with medical adhesive.
When was Jadelle approved?
Jadelle was approved for marketing as a three-year method in the United States in 1996 and in Finland in 1997. In 2000, Finland approved the extension of use of the method to five years. In 2003, the FDA approved extension of use to five years.
How many Jadelle users continue past the first year?
In the clinical studies on which approval was based, cumulative continuation rates were 88.3 percent after the first year, 60.6 percent after three years, and 41.5 percent at five years. These figures may vary. Younger women have lower continuation rates; older women, whose families are completed, have higher continuation rates.
Why do women discontinue using this method?
Women discontinue using Jadelle because of side effects, because they want to become pregnant, or for other personal reasons. Studies conducted by the Population Council indicate that, over a three-year period, 14.1 per 100 women stopped using Jadelle because of menstrual irregularities and 14.7 per 100 women discontinued for other medical reasons; 9.7 per 100 women did not continue for the full three years because they were planning a pregnancy. Medical occurrences most frequently cited as reasons for removal were headaches, depression, weight gain, or hair loss.
Why is counseling important?
Studies have shown that women who receive good counseling are more satisfied with the method they adopt and are more likely to continue using it. Contraceptive users who believe they have been fully and accurately informed about their choices will feel more confident about their methods and their providers. Inadequate counseling about Jadelle may result in early removals and loss of contraceptive protection.
What topics should be covered in counseling?
The Jadelle user should know the most important facts before the rods are inserted: how the method works, any discomfort she might feel following the insertion procedure, what side effects she might encounter, the likelihood of failure, how to recognize warning signs of possible complications, and when to have the rods removed. She should also learn how the method compares with other available contraceptives. Jadelle users should know that most insertions and removals are easily accomplished when performed by trained health care providers and are not painful for most women.
Does the age of the user matter?
Although women from ages 18 to 40 years participated in the clinical trials, women younger and older than those ages also can use Jadelle. If there are no contraindications, the rods may be used by women throughout their reproductive years. Several studies of Norplant use by teenagers in the United States have shown the method to be effective and well accepted. Although there are no studies specific to older women, women can use Jadelle as they approach menopause.
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