JADELLE
JADELLE is the registered trademark of Leiras Oy for two-rod subdermal
levonorgestrel implants. Norplant is the registered trademark of The
Population Council for subdermal levonorgestrel implants.
What is JADELLE
Two Silastic7 rods containing
75 mg of levonorgestrel (LNG)
which are inserted just under
the skin (subdermal) of a
womans upper arm.
JADELLE: Mechanisms of Action
Suppress ovulation
Decrease tubal motility
Change endometrium
Thicken cervical mucus
Comparison of Mean Levels of
Levonorgestrel
JADELLE
Norplant-2
400
300
pg/ml
200
100
0
0
12
18
24
30
Month
Source: Sivin et al 1997.
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JADELLE: Contraceptive Benefits
!
Highly effective (0.051,2 pregnancies per 100 women during the
first year of use)
Rapidly effective (< 72 hours)
Long-term method (up to 3 years protection)
Pelvic examination not required prior to use
Does not interfere with intercourse
Does not affect breastfeeding
1
2
Perfect-use estimate is equal to typical-use estimate.
Trussell et al 1998.
JADELLE: Contraceptive Benefits
continued
!
Immediate return of fertility on removal
Few side effects
Client needs to return to clinic only if problems
No supplies needed by client
Can be provided by trained nonphysician (nurse or midwife)
Contain no estrogen
JADELLE: Noncontraceptive Benefits
!
Decreases ectopic pregnancy
May decrease menstrual cramps
May decrease menstrual bleeding
May improve anemia
Protects against endometrial cancer
Decreases benign breast disease
Protects against some causes of PID
JADELLE: Limitations
!
Causes changes in menstrual bleeding pattern (irregular
bleeding/spotting) in most women
Requires trained provider for insertion and removal
Woman must return to healthcare provider or clinic for
insertion of another set of rods or removal
JADELLE: Limitations continued
!
Woman cannot stop whenever she wants (provider dependent)
Effectiveness may be lowered when certain drugs for epilepsy
(phenytoin and barbiturates) or tuberculosis (rifampin) are
taken
Cost-effectiveness dependent on length of use
Does not protect against STDs (e.g., HBV, HIV/AIDS)
Who Can Use JADELLE
Women:
$ Of any reproductive age
$ Of any parity including nulliparous women
$ Who want highly effective, long-term protection against
pregnancy
$ Who are breastfeeding ( 6 weeks postpartum)
$ Who are postpartum and not breastfeeding
$ Who are postabortion
10
Who Can Use JADELLE continued
Women:
$ With desired family size who do not want voluntary
sterilization
$ With histories of ectopic pregnancy
$ Who have blood pressure < 180/110, blood clotting
problems of sickle cell disease
$ With moderate to severe menstrual cramping
$ Who smoke (any age, any amount)
$ Who prefer not to or should not use estrogen
$ Who cannot remember to take a pill every day
11
JADELLE: Who Should Not Use
(WHO Class 4)
JADELLE should not be used if woman:
$ Is pregnant (known or suspected)
$ Has unexplained vaginal bleeding (only if serious problem
suspected)
$ Has breast cancer
Source: WHO 1996.
12
JADELLE: Conditions Requiring
Precaution (WHO Class 3)
JADELLE is not recommended unless other methods are not
available or acceptable if woman:
$ Is jaundiced (active, symptomatic)
$ Has ischemic heart disease (past or current)
$ Has had breast cancer
$ Has liver neoplasia (hypothetical concern only)
$ Is taking drugs for epilepsy (phenytoin and barbiturates) or
tuberculosis (rifampin)
Source: WHO 1996.
13
JADELLE: Conditions No Longer
Requiring Precaution for Use
JADELLE can be used safely in women who:
$ Have diabetes mellitus (uncomplicated or < 20 years
duration)
$ Have hepatitis (asymptomatic and carriers)
$ Have high blood pressure (< 180/110)
$ Has pre-eclampsia (history of)
$ Smoke (any age, any amount)
$ Will have surgery (with or without prolonged bed rest)
$ Have valvular heart disease (including symptomatic)
$ Have venous thromboembolic diseases (blood clotting)
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When to Insert JADELLE
!
Anytime during the menstrual cycle when you can be
reasonably sure the client is not pregnant
Days 1B7 of the menstrual cycle
Postpartum:
$ after 6 months if using lactational amenorrhea method
(LAM)
$ after 6 weeks if breastfeeding but not using LAM
$ immediately or within 6 weeks if not breastfeeding
Postabortion (immediately or within the first 7 days)
15
JADELLE: Infection Prevention
Recommendations
!
Wash clients entire arm and hand with soap and water prior to
antiseptic prep.
Use sterile or high-level disinfected instruments, surgical
gloves and other items.
After use, decontaminate all items.
Place disposables (needle and syringe) and waste items in a
puncture-proof container prior to disposal.
Clean and final process reusable items by sterilization (or
high-level disinfection).
Source: Tietjen, Cronin and McIntosh 1992.
16
JADELLE: Ten Most Frequently
Reported Conditions
Side Effects
Vaginal Discharge
Headache
Pelvic Pain
Weight Increase
Dizziness
Breast Pain
Genital Itching
Nervousness
Cervicitis
Nausea
Percentage of Women
24.3
23.5
16.7
12.0
10.7
8.3
8.2
7.7
7.5
6.7
Source: Sivin et al 1997.
17
JADELLE: Treatment of Common Side
Effects
Side Effects
Irregular or heavy
bleeding
Headache
Management
Check for gynecologic problem
Counseling and reassurance COCs,
NSAIDs or oral estrogens
Nonnarcotic analgesics
Weight change
Diet history, advice and exercise
Breast tenderness
Support bra
Breast discharge
Decreased nipple stimulation
Acne
Diet, cleansers and topical
antibiotics
18
JADELLE vs. Norplant: Comparison of
Removal Times
Type of Implant
Time (Mean SD)
JADELLE7
165
4.9 3.5 minutes
Norplant7
162
10.4 7.9 minutes
Source: Sivin et al 1997.
19
JADELLE: Client Instructions
!
Keep incision area dry for 48 hours.
Keep pressure bandage on for 48 hours and leave Band-Aid7
on until incision heals (35 days).
Bruising, swelling and tenderness at insertion site are
common.
Routine work can be done immediately. Avoid bumping the
area, carrying heavy loads or applying unusual pressure to
incision site.
After healing, area can be touched and washed with normal
pressure.
20
JADELLE: General Information
!
Contraceptive effectiveness begins 72 hours after insertion
and stops soon after removal.
Changes in menstrual bleeding patterns are common.
Certain drugs may reduce effectiveness of implants. Tell your
provider if you start any new drugs.
Removal of rods is necessary 3 years after insertion.
After removal, the fibrous sheath may be felt.
Use a condom if at risk for STDs.
21
JADELLE: Warning Signs
Return to clinic if any of the following occur:
$ Delayed menstrual period after several months of regular
cycles (may be sign of pregnancy)
$ Severe lower abdominal pain
$ Heavy bleeding
$ Pus or bleeding at insertion site
$ Infection at insertion site
$ Expulsion
$ Migraine headaches
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