Levosert (Levonorgestrel)

• Levosert, a levonorgestrel‑based intrauterine system, is used for hormonal contraception.
• Contraception (long‑acting reversible contraceptive): provides >99% effective prevention of pregnancy for up to five years.
• Heavy menstrual bleeding: reduces menstrual blood loss and may improve anemia.
• Endometriosis‑associated pain: alleviates dysmenorrhea and related pelvic discomfort.

• Levosert releases levonorgestrel directly into the uterine cavity at approximately 20 µg per day. The progestogen binds to progesterone receptors in the endometrium, causing glandular atrophy and thickening of cervical mucus, which impedes sperm penetration. It also suppresses the hypothalamic‑pituitary‑ovarian axis, reducing the frequency of ovulation. The localized delivery minimizes systemic exposure while maintaining contraceptive efficacy.

Levosert may be associated with local and systemic adverse reactions, most of which are mild and self‑limiting.

Common Side Effects

• Irregular bleeding or spotting: unpredictable uterine bleeding patterns, especially during the first months.
• Amenorrhea: absence of menstrual periods after prolonged use.
• Pelvic or abdominal pain: mild cramping or discomfort.
• Headache: occasional tension‑type headaches.

Serious or Rare Side Effects

• Uterine perforation: rare injury to the uterine wall during insertion.
• Expulsion of the device: unexpected loss of the IUS requiring re‑evaluation.
• Pelvic inflammatory disease: infection that may develop after insertion.

Before prescribing Levosert, clinicians should evaluate the following precautions to ensure safe use.

• Contraindications: active pelvic infection, unexplained vaginal bleeding, or known hypersensitivity to levonorgestrel.
• Pregnancy status: must be negative before insertion; pregnancy category X indicates it should not be used during pregnancy.
• Breastfeeding: consider risk‑benefit; levonorgestrel is excreted in breast milk in low amounts.
• Uterine abnormalities: avoid in women with fibroids, uterine malformations, or significant cervical stenosis that may impede placement.
• Future fertility: fertility typically returns promptly after removal, but patients should be counseled.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Levosert can interact with other medicines that affect hormonal pathways or hepatic metabolism.

Major Interactions (Avoid)

• Antiepileptic enzyme inducers (e.g., carbamazepine, phenytoin, rifampicin): may reduce levonorgestrel levels and contraceptive efficacy.
• Antiretroviral drugs (e.g., efavirenz, nevirapine): can lower hormone concentrations, increasing risk of unintended pregnancy.

Moderate Interactions (Monitor Closely)

• Antifungal azoles (e.g., ketoconazole): may increase levonorgestrel exposure, requiring monitoring for side effects.
• St. John’s wort: may modestly decrease hormone levels.
• Hormonal therapies (e.g., estrogen‑containing contraceptives): concurrent use may alter bleeding patterns.