Levosert One (Levonorgestrel)

Levonorgestrel delivered via Levosert One is used within the hormonal contraceptive pathway to prevent pregnancy and manage menstrual disorders.

• Contraception (long‑acting reversible contraceptive): provides up to three years of reliable pregnancy prevention.
• Heavy menstrual bleeding: reduces menstrual blood loss and improves anemia associated with excessive bleeding.
• Endometrial protection in estrogen therapy: helps prevent estrogen‑induced endometrial proliferation when combined with systemic estrogen.

• Levonorgestrel is released locally from the intrauterine system at approximately 20 µg per day. The hormone binds to progesterone receptors in the endometrium, suppressing its proliferation, thickening cervical mucus to impede sperm penetration, and altering tubal motility, thereby preventing fertilisation and implantation.

Levosert One may be associated with a range of adverse reactions.

Common Side Effects

• Irregular bleeding or spotting
• Amenorrhea (absence of periods)
• Pelvic or abdominal cramping
• Device expulsion or displacement
• Vaginal discharge
• Headache or mild nausea

Serious or Rare Side Effects

• Uterine perforation during insertion
• Pelvic inflammatory infection
• Ectopic pregnancy if contraception fails
• Severe allergic reaction (anaphylaxis)
• Hormonal side effects such as severe depression or mood changes

Before insertion and during use, certain precautions should be observed.

• Pregnancy testing: confirm a negative pregnancy test prior to insertion.
• Uterine abnormalities: evaluate for fibroids, septa, or other malformations.
• Active infection: screen for pelvic inflammatory disease and treat before placement.
• Breastfeeding: discuss benefits and risks with the patient.
• Follow‑up removal: schedule device removal or replacement at the end of the intended duration.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Levonorgestrel released from an intrauterine system has limited systemic interactions, but certain drugs may affect its efficacy.

Major Interactions (Avoid)

• Rifampicin and other strong CYP3A4 inducers: may markedly reduce contraceptive effectiveness.
• Antiretroviral protease inhibitors (e.g., ritonavir): can alter hormone levels and compromise efficacy.
• Ketoconazole and other potent antifungal agents: may decrease levonorgestrel activity.

Moderate Interactions (Monitor Closely)

• Certain antibiotics (e.g., tetracycline): minimal effect but monitor for breakthrough bleeding.
• St. John’s wort (hypericum perforatum): may modestly reduce hormone levels.
• Combined estrogen‑containing therapies: may increase risk of thromboembolic events; monitor patient closely.