Levonortis (Levonorgestrel)

Levonortis, a levonorgestrel‑based intrauterine system, acts on the reproductive hormone pathway to prevent pregnancy and control uterine bleeding.

• Contraception: Provides highly effective, reversible birth control for up to several years.
• Heavy menstrual bleeding: Reduces menstrual blood loss and improves quality of life in women with menorrhagia.
• Endometrial protection: Alters the endometrium to prevent implantation and stabilises the uterine lining during treatment.

• Levonorgestrel released locally from the intrauterine system binds to progesterone receptors in the ovary, endometrium and cervical mucus. This suppresses ovulation, thickens cervical mucus to impede sperm passage, and induces endometrial atrophy, thereby preventing fertilisation and implantation.

Levonortis may cause a range of adverse reactions, most of which are related to local hormonal effects or the device itself.

Common Side Effects

• Irregular bleeding or spotting: unpredictable menstrual patterns during the first months.
• Amenorrhea: absence of periods after prolonged use.
• Pelvic or abdominal cramping: mild to moderate discomfort after insertion.
• Breast tenderness or headache: hormonal fluctuations may cause these symptoms.

Serious or Rare Side Effects

• Uterine perforation: rare injury to the uterine wall during insertion.
• Device expulsion: the system may be partially or fully expelled without warning.
• Pelvic infection: risk of infection shortly after placement.
• Ectopic pregnancy: occurs if contraception fails and implantation is outside the uterus.
• Severe allergic reaction: rash, swelling or anaphylaxis in hypersensitive individuals.

Before using Levonortis, clinicians should assess patient suitability and counsel on expected outcomes.

• Pregnancy status: confirm the patient is not pregnant before insertion.
• Uterine abnormalities: evaluate for fibroids, septa or congenital malformations that may impede placement.
• Bleeding disorders: consider risk of excessive bleeding during insertion.
• Infection risk: screen for active pelvic infections and treat before device placement.
• Follow‑up: schedule regular examinations to verify correct positioning.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Levonortis may interact with medications that alter levonorgestrel metabolism or affect uterine environment.

Major Interactions (Avoid)

• Rifampin and other strong CYP3A4 inducers: may reduce contraceptive efficacy.
• St. John’s wort: herbal CYP3A4 inducer that can lower levonorgestrel levels.
• Anticonvulsants (phenytoin, carbamazepine, phenobarbital): increase hepatic metabolism of levonorgestrel.
• Efavirenz (HIV antiretroviral): may decrease hormone concentrations.
• Griseofulvin: enzyme inducer that can compromise device effectiveness.

Moderate Interactions (Monitor Closely)

• Ketoconazole and other azole antifungals: may increase levonorgestrel exposure, requiring monitoring for side effects.
• Selective serotonin reuptake inhibitors (SSRIs): can affect menstrual bleeding patterns.
• Tetracycline antibiotics: minimal effect but should be noted during prolonged courses.