Levonortis (Levonorgestrel)

Levonorgestrel, delivered via the Levonortis intrauterine system, acts on the hormonal regulation of the menstrual cycle to provide contraceptive and therapeutic effects.

• Long‑term contraception: provides continuous prevention of pregnancy for several years.
• Management of heavy menstrual bleeding: reduces menstrual blood loss and improves anemia.
• Endometrial hyperplasia: induces regression of hyperplastic endometrial tissue.

• Levonorgestrel is a synthetic progestogen that binds to progesterone receptors in the endometrium, ovary and cervical mucus. Receptor activation suppresses the mid‑cycle luteinising hormone surge, preventing ovulation. It also thins the endometrial lining and increases the viscosity of cervical mucus, creating a hostile environment for sperm penetration and implantation. These combined actions maintain a contraceptive state for the duration of device placement.

Levonortis may be associated with a range of adverse reactions, which are generally categorized by frequency and severity.

Common Side Effects

• Irregular bleeding or spotting.
• Amenorrhea (absence of periods).
• Pelvic or abdominal cramping.
• Headache.
• Breast tenderness.
• Nausea.

Serious or Rare Side Effects

• Uterine perforation during insertion.
• Pelvic inflammatory disease.
• Ectopic pregnancy if contraception fails.
• Severe allergic reaction (anaphylaxis).
• Device expulsion.
• Hormone‑related mood changes.

Before prescribing Levonortis, clinicians should consider several safety measures.

• Screen for contraindications: assess for active pelvic infection, pregnancy, or known hypersensitivity.
• Monitor bleeding patterns: counsel patients on expected changes and when to seek care.
• Assess uterine anatomy: ensure appropriate uterine size and shape before insertion.
• Educate on device expulsion: advise patients to report missing strings or unusual discharge.
• Store at room temperature: keep in original packaging, protect from moisture and direct sunlight.

Levonortis can interact with other medicines that affect hormone metabolism or uterine environment.

Major Interactions (Avoid)

• Enzyme‑inducing anticonvulsants (e.g., carbamazepine, phenytoin): may reduce levonorgestrel efficacy.
• Rifampin and rifabutin: decrease hormone levels, compromising contraceptive effect.
• Certain protease inhibitors (e.g., ritonavir): may alter levonorgestrel metabolism.

Moderate Interactions (Monitor Closely)

• Antifungal azoles (e.g., ketoconazole, itraconazole): may increase levonorgestrel concentrations.
• St. John’s wort: may modestly reduce effectiveness.
• Some antibiotics (e.g., tetracycline): generally no significant effect but monitoring is advised.