Levosert (Levonorgestrel)

Levosert, a levonorgestrel‑releasing intrauterine system, is used within the hormonal contraceptive pathway for long‑term birth control.

• Contraception: Provides up to five years of highly effective reversible birth control for women of reproductive age.

• Levosert releases levonorgestrel locally within the uterine cavity at approximately 20 µg per day. The hormone thickens cervical mucus, impairs sperm motility and viability, suppresses endometrial proliferation, and may inhibit ovulation, collectively preventing fertilisation and implantation while offering sustained contraceptive effect.

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

Common Side Effects

• Irregular bleeding or spotting: changes in menstrual pattern are frequent during the first months.
• Amenorrhea: absence of periods may develop with continued use.
• Pelvic or abdominal pain: mild cramping is reported after insertion.
• Ovarian cysts: functional cysts may form and resolve spontaneously.
• Breast tenderness: mild discomfort may occur.
• Mood changes: some users notice alterations in mood or libido.

Serious or Rare Side Effects

• Uterine perforation: a rare event during insertion that may require surgical management.
• Device expulsion: the IUS may be expelled partially or completely, reducing efficacy.
• Pelvic infection: severe infection can develop if pre‑existing infection is present at insertion.
• Ectopic pregnancy: occurs if contraception fails; it is a medical emergency.
• Severe allergic reaction: anaphylaxis or hypersensitivity to levonorgestrel or device components.

Before insertion, clinicians should evaluate individual risk factors and counsel patients on expected outcomes.

• Pregnancy contraindication: the device must not be used in women who are pregnant.
• Active pelvic infection: defer insertion until infection is fully treated.
• Uterine abnormalities: assess for fibroids, septa, or malformations that could impede placement.
• Breast cancer history: avoid use in women with current or past estrogen‑sensitive malignancies.
• Hormonal sensitivity: discuss potential mood or bleeding changes with patients.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Levosert’s hormonal component can be affected by other medicines that alter steroid metabolism.

Major Interactions (Avoid)

• Enzyme‑inducing anticonvulsants (e.g., carbamazepine, phenytoin): may reduce contraceptive efficacy.
• Rifampin and other strong CYP450 inducers: can lower levonorgestrel levels, increasing risk of pregnancy.

Moderate Interactions (Monitor Closely)

• St. John’s wort (hypericum perforatum): may decrease hormone effectiveness.
• Azole antifungals (e.g., ketoconazole): can increase levonorgestrel concentrations, potentially enhancing side effects.
• Protease inhibitor antiretrovirals: may raise hormone levels, requiring clinical observation.