Kyleena (Levonorgestrel)

Kyleena, a levonorgestrel‑releasing intrauterine system, is indicated for hormonal contraception.

• Contraception (prevention of pregnancy): provides up to five years of reliable birth control.
• Reversible contraception: fertility typically returns promptly after device removal.
• User‑controlled method: does not require daily dosing or routine compliance.

• Levonorgestrel released from the intrauterine system diffuses into the endometrium and cervical mucus. Locally high concentrations thicken cervical mucus, impair sperm motility and viability, and suppress endometrial proliferation. In some cycles the hormone also inhibits ovulation, collectively preventing fertilisation and implantation. The device delivers approximately 20 µg/day initially, decreasing gradually over the approved five‑year lifespan, ensuring sustained local hormone levels while systemic exposure remains low, which contributes to its favorable safety profile.

Levonorgestrel released from Kyleena may be associated with a range of adverse reactions.

Common Side Effects

• Irregular bleeding: changes in menstrual pattern, spotting or prolonged bleeding.
• Amenorrhea: absence of periods during use.
• Pelvic pain: cramping or discomfort.
• Vaginal discharge: mild discharge.

Serious or Rare Side Effects

• Uterine perforation: rare injury during insertion.
• Expulsion: device may be expelled from the uterus.
• Infection: pelvic inflammatory disease or severe infection.

Before using Kyleena, healthcare providers should consider several precautionary measures.

• Contraindications: avoid in women with active pelvic infection, uterine anomalies, or known hypersensitivity to levonorgestrel.
• Pregnancy status: must not be inserted in pregnant women; confirm negative pregnancy test prior.
• Breastfeeding: discuss risks and benefits; levonorgestrel is excreted in small amounts in breast milk.
• Follow‑up: schedule pelvic exam after insertion to confirm correct placement.
• Smoking: advise smokers to quit, as smoking increases thrombotic risk with hormonal devices.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Levonorgestrel may interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• CYP3A4 inducers: drugs such as rifampin, carbamazepine, phenytoin can reduce levonorgestrel levels, decreasing contraceptive effectiveness.
• Antifungal azoles: strong inhibitors like ketoconazole may increase levonorgestrel exposure, potentially raising side‑effect risk.

Moderate Interactions (Monitor Closely)

• Antiretrovirals: certain protease inhibitors may alter hormone metabolism; monitor for breakthrough bleeding.
• Anticonvulsants: enzyme‑inducing agents may lower hormone levels; consider alternative contraception.
• Herbal supplements: St. John’s wort can decrease levonorgestrel concentrations.