Levosert (Levonorgestrel)

Levosert, a levonorgestrel‑based intrauterine system, is indicated for hormonal contraception.

• Contraception: provides up to five years of highly effective pregnancy prevention.
• Heavy menstrual bleeding: reduces menstrual blood loss and improves bleeding patterns.
• Endometrial protection in estrogen therapy: induces endometrial atrophy to lower bleeding risk.

• Levonorgestrel is released locally from the intrauterine system at approximately 20 µg per day. The hormone binds to progesterone receptors in the endometrium, suppressing ovulation, thickening cervical mucus, and causing endometrial atrophy, collectively creating an environment that prevents fertilisation and implantation.

Levosert may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Irregular vaginal bleeding or spotting.
• Amenorrhea (absence of periods).
• Pelvic or uterine cramping.
• Breast tenderness or enlargement.
• Acne or skin changes.
• Mood swings or headache.

Serious or Rare Side Effects

• Uterine perforation during insertion.
• Pelvic inflammatory infection.
• Expulsion of the device.
• Ectopic pregnancy if contraception fails.
• Ovarian cyst formation or rupture.
• Severe allergic reaction to device components.

Before prescribing Levosert, clinicians should assess patient suitability and counsel on potential risks.

• Confirm uterine cavity size: ensure appropriate fit of the intrauterine system.
• Exclude current pregnancy: verify negative pregnancy test before insertion.
• Avoid in active pelvic infection: postpone insertion until infection resolves.
• Counsel on bleeding pattern changes: inform patients that irregular bleeding is common initially.
• Review thromboembolic risk: consider medical history of clotting disorders.
• Store at room temperature: keep in original packaging, protect from moisture and direct sunlight.

Levosert may interact with other medicines that affect hormone metabolism or efficacy.

Major Interactions (Avoid)

• Rifampicin and other enzyme inducers: may reduce levonorgestrel levels, decreasing contraceptive effectiveness.
• Anticonvulsants such as phenytoin, carbamazepine, or phenobarbital: can lower hormone concentrations.
• Efavirenz (HIV antiretroviral): may diminish contraceptive protection.

Moderate Interactions (Monitor Closely)

• Ketoconazole and other strong antifungals: may increase levonorgestrel exposure, requiring monitoring for side effects.
• St. John's wort: may modestly reduce hormone levels, warranting additional contraceptive measures.