those with vaginal bleeding should first see a physician. However, since it does not contain estrogen like some birth control pills, older women, women who smoke, and women with high blood pressure are not restricted from using the system. Side effects After three months of using, women may need to schedule a follow-up appointment to monitor blood pressure and discuss any concerns. Side effects may include irregular menstrual periods for the first approximately three months, including periods lasting longer than normal, bleeding or spotting between periods, heavy bleeding, or going with no period for the mentioned period of time. Sometimes, pain, itching or infection at the site of the implant will occur. Ovarian cysts may also occur, but usually do not require treatment, although they can cause pain even if benign. Technique Insertion Levonorgestrel-releasing implant is implanted under the skin in the upper arm of a woman, by creating a small incision and inserting the capsules in a fanlike shape. Insertion usually takes 15 minutes and the capsules can sometimes be seen under the skin, although usually they look like small veins. They can also be felt under the skin. Once inserted, the contraceptive works within 24 hours and lasts up to five years. Removal Levonorgestrel-releasing implant can be removed by creating a second incision and withdrawing the capsules. It is normally removed when the five-year period is over, or if: Pregnancy is desired Different birth control is preferred Complications arise Normally removal is not complicated; removal difficulties have been reported with a frequency of 6.2%, based on 849 removals. Removal difficulties include: multiple incisions, capsule fragments remaining, pain, multiple visits, deep placement, lengthy removal procedure, or other. If desired, a new implant can be inserted at the time of removal. History It was developed by Sheldon J. Segal and Horacio Croxatto at the Population Council beginning in 1966, with the first clinical trial in Chile in 1974. It was first approved in Finland on November 23, 1983, where it was manufactured by Leiras Oy Pharmaceuticals. The original Norplant consisted of a set of six small (2.4 mm × 34 mm) silicone capsules, each filled with 36 mg of levonorgestrel implanted under the skin in the upper arm and effective for five years. The original (six-capsule) Norplant production has been phased out; USAID's contract ran until December 2006. The original (six capsule) Norplant was approved by the U.S. Food and