Levosert (Levonorgestrel)

Levosert, a hormonal contraceptive delivered via an intrauterine system, is indicated for:

• Long‑acting reversible contraception: provides up to five years of reliable pregnancy prevention.
• Prevention of unintended pregnancy: suitable for women seeking a non‑daily, highly effective method.
• Management of menstrual bleeding patterns: may reduce heavy or irregular bleeding in many users.

• Levonorgestrel released from the intrauterine system acts locally on the cervical mucus, endometrium and sperm. It thickens cervical mucus, impairs sperm motility and function, suppresses endometrial proliferation, and may inhibit ovulation, thereby preventing fertilisation and implantation.

Levosert may cause a range of adverse reactions. Most are mild and resolve with time.

Common Side Effects

• Irregular bleeding or spotting, especially during the first months.
• Amenorrhea (absence of periods) after continued use.
• Pelvic or uterine cramping.
• Breast tenderness or mild hormonal symptoms.
• Headache or mild nausea.

Serious or Rare Side Effects

• Uterine perforation during insertion.
• Expulsion of the device.
• Pelvic infection (e.g., PID) following placement.
• Ectopic pregnancy if contraception fails.
• Rare systemic hormonal effects such as thrombosis.

Before insertion of Levosert, certain precautions should be observed to ensure safety and effectiveness.

• Screen for contraindications: ensure the patient has no active pelvic infection, unexplained vaginal bleeding, or known hypersensitivity to levonorgestrel.
• Assess uterine anatomy: appropriate for a normal uterine cavity size and shape.
• Confirm non‑pregnancy: a negative pregnancy test is required prior to placement.
• Monitor device position: schedule follow‑up visits to check for displacement or expulsion.
• Store at ambient temperature: keep in the original packaging, protect from moisture and direct sunlight.

Levosert may interact with medications that affect levonorgestrel metabolism or hormone levels.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin): may significantly reduce contraceptive efficacy.
• Certain antiretroviral protease inhibitors: can alter hormone concentrations and compromise effectiveness.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inducers (e.g., St. John’s wort, efavirenz): may modestly lower levonorgestrel levels.
• Antifungal azoles and some antibiotics (e.g., griseofulvin): could affect hormone metabolism and require additional contraceptive measures.
• Concurrent hormonal therapies (e.g., estrogen‑containing contraceptives): may increase overall hormonal exposure and warrant clinical review.