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

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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.

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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)

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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.

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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.

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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

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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.

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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.

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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.

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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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