Levosert (Levonorgestrel)

Levosert, containing levonorgestrel, is used as a hormonal contraceptive delivered via an intrauterine system.

• Contraception (long‑acting reversible contraceptive): provides continuous pregnancy prevention for up to five years.
• Family planning: offers a reversible, hormone‑based method for women seeking long‑term birth control.
• Management of heavy menstrual bleeding: may reduce the duration and volume of menstrual bleeding in eligible users.

• Levonorgestrel released from the intrauterine system acts locally on the endometrium and cervical mucus. It thickens cervical mucus, impairs sperm motility and function, suppresses endometrial proliferation, and may inhibit ovulation, collectively preventing fertilization and implantation. The device delivers a steady low dose directly to the uterine cavity, minimizing systemic exposure while maintaining effective contraceptive action throughout the approved duration.

Levosert may be associated with a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Irregular vaginal bleeding or spotting.
• Amenorrhea (absence of periods) after initial months.
• Pelvic or abdominal cramping.
• Breast tenderness or enlargement.

Serious or Rare Side Effects

• Uterine perforation during insertion.
• Device expulsion or displacement.
• Pelvic inflammatory disease or severe infection.

Prior to insertion of Levosert, clinicians should evaluate several safety considerations.

• Pregnancy testing: confirm the patient is not pregnant before device placement.
• Uterine abnormalities: assess for fibroids, septa, or congenital malformations that may affect insertion.
• Active infection: defer insertion if pelvic infection or sexually transmitted disease is present.
• Bleeding disorders: review history of coagulopathy or anticoagulant use to mitigate excessive bleeding risk.
• Medication review: consider drugs that may reduce contraceptive effectiveness, such as enzyme‑inducing agents.
• Store at ambient temperature: keep the device in its original packaging, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Enzyme‑inducing antiepileptics (e.g., carbamazepine, phenytoin, phenobarbital): may lower levonorgestrel levels and reduce efficacy.
• Rifampicin or other strong hepatic inducers: can decrease hormone concentration, increasing risk of unintended pregnancy.

Moderate Interactions (Monitor Closely)

• Antifungal azoles (e.g., ketoconazole, itraconazole): may increase levonorgestrel exposure, requiring monitoring for side effects.
• Certain antiretrovirals (e.g., ritonavir): may modestly affect hormone levels.
• Herbal supplements such as St. John’s wort: can induce metabolism and potentially lower contraceptive effectiveness.