Levonorgestrel (Intrauterine)

Overview

Although Levonorgestrel can be used as an oral form of contraception, Levonorgestrel intrauterine devices can be also be used as a long-term form of birth control. Depending on which type of intrauterine device is used, Levonorgestrel can prevent the patient from becoming pregnant for up to three or five years.

As a female hormone, Levonorgestrel changes the cervix and makes it more difficult for sperm to reach an egg. Furthermore, Levonorgestrel affects the development of eggs which prevents them from being fertilized. As a result, the patient cannot conceive and should not fall pregnant whilst using a Levonorgestrel intrauterine device.

Unlike other forms of birth control, Levonorgestrel intrauterine devices are implanted in the uterus. The devices release small amounts of Levonorgestrel regularly, which ensures it continually prevents against pregnancy.

As the device typically prevents conception for up to three or five years, it is most suited to patients who are sure they don't want to conceive within this timeframe. If patients are planning to become pregnant in the near future, an alternative form of short-term contraception may be more appropriate.

Although Levonorgestrel is an effective method of birth control, no form of contraception can be fully guaranteed. In addition to this, the Levonorgestrel intrauterine device does not protect patients from contracting sexually transmitted infections or diseases. Due to this, patients may wish to use an additional form of contraception when engaging in sexual activity.

As well as being used as a form of birth control, the Levonorgestrel intrauterine device can be used to treat heavy menstrual bleeding. Although the device will prevent the patient from becoming pregnant when it is in place, once it has been removed the patient may go on to conceive. This makes the Levonorgestrel intrauterine device a first-choice treatment for women who are suffering from heavy menstrual bleeding but who would like to have children in the future. Often most effective for patients who have already had at least one child, the Levonorgestrel intrauterine device can relieve heavy bleeding and the associated symptoms.

Conditions Treated

  • Heavy menstrual bleeding
  • Acts as a form of birth control

Type Of Medicine

  • Hormonal intrauterine device

Side Effects

Although the Levonorgestrel device is implanted in the uterus, it may still cause patients to experience some side-effects. Often, these are more pronounced when the device has been implanted recently but may be reduced over time. For example, patients may experience the following side-effects once the Levonorgestrel device has been implanted:

  • Blemishes on the skin
  • Thinning of the hair
  • Depression
  • Swelling of the stomach area
  • Pimples
  • Swelling of the abdominal area
  • Back pain
  • Redness of the skin
  • Breast pain or tenderness
  • Loss in sexual desire, ability, performance or drive
  • Pressure in the stomach
  • Decreased interest in sexual intercourse
  • Bloated or full feeling
  • Increased weight
  • Nausea
  • Hair loss
  • Welts, itching or hives
  • Rash on the skin
  • Increased hair growth, particularly on the face
  • Skin rash, may be scaly, encrusted and oozing

If the above side-effects are not severe or bothersome to the patient, they may not require additional medical treatment. However, if the side-effects persist or are severe, patients should seek medical advice.

Furthermore, patients will need to obtain immediate medical treatment from a nurse or doctor if they experience any of the following side-effects after the Levonorgestrel intrauterine device has been implanted:

  • Pelvic pain
  • Irregular, missed or absent menstrual periods
  • Pain during sexual intercourse
  • Heavier or longer menstrual periods
  • Pain
  • Mild bloating
  • Cramps
  • Nervousness
  • Stopping of menstrual bleeding
  • Headache
  • Unexpected or unusually heavy menstrual bleeding
  • Blurred vision
  • Uterine bleeding between menstrual periods
  • Dizziness
  • Vaginal spotting or bleeding
  • Heavy bleeding
  • Pale skin
  • Itching of the genital or vaginal area
  • Weak, fast pulse
  • Pounding in the ears
  • Fast or slow heartbeat
  • Lightheadedness, dizziness or fainting
  • Swelling
  • Confusion
  • Thick, white vaginal discharge with mild or no odor
  • Chills
  • Troubled breathing with exertion
  • Fast heartbeat
  • Unusual bruising or bleeding
  • Cold, pale or clammy skin
  • Unusual weakness or tiredness
  • Fever
  • White or brownish vaginal discharge
  • Shallow, rapid breathing
  • Foul-smelling vaginal discharge
  • Sudden increase in shoulder or stomach pain
  • Aching or dull stomach or abdominal pain
  • Sweating
  • Large or unusual amount of vaginal bleeding
  • Bloody or clear discharge from the nipple
  • Inverted nipple
  • Dimpling of the breast skin
  • Sharp pain on insertion
  • Lump under the arm or in the breast
  • Shivering fever
  • Increased urge to urinate
  • Severe stomach or abdominal cramping or pain
  • Pain during urination
  • Sore on the skin of the breast which does not heal
  • Large, hive-like swelling on the eyelids, tongue, lips, hands, throat, feet, legs or sex organs
  • Persistent scaling or crusting of the nipple
  • Unexpected, heavy vaginal bleeding
  • Swelling or redness of the breast

In addition to this, patients should obtain medical advice if they experience any other adverse effects whilst using the Levonorgestrel intrauterine device. If patients do experience adverse effects which are not listed above, they can also notify the Food and Drug Administration on 1-800-FDA-1088. This helps the FDA to collate up-to-date records of the side-effects associated with Levonorgestrel intrauterine systems.

Dosage

Once the Levonorgestrel device is in place, it will release the hormone in relatively low amounts on a regular basis. However, the exact amount of hormone released will depend on the type of device which has been implanted. When devices are first inserted, they can release doses which range from 14mcg per day to 20mcg per day.

Generally, the device will release a lower amount of Levonorgestrel over time. For example, a popular brand of Levonorgestrel intrauterine devices releases 20mcg per day, with just 10mcg per day being released after five years. Due to this reduction, the patient would need to have the device replaced within five years.

A nurse or doctor will discuss the patient's medical history, current health and their expectations to determine which type of Levonorgestrel device is appropriate for them. Patients will then have the device fitted by a healthcare practitioner in a clinical setting. Usually, patients will need to have a follow-up consultation within four to twelve weeks of the device being fitted. After this, patients should have at least once check-up every twelve months but their physician may ask them to attend consultations more regularly.

During this time, patients can also check that the Levonorgestrel device is in place. Every device has a one or two-inch plastic string attached which will hang down into the vagina. Although this string can't be seen and isn't noticed during sexual intercourse, it does enable the patient to check that the device is still in place.

In order to do this, patients should wash their hands thoroughly, squat low to the ground and gently place their index finger into their vagina. Patients should be able to feel the string coming from the device, but not the plastic device itself.

Patients are usually advised to check the placement of their Levonorgestrel device every few days after the device has been implanted and then after every period. If patients cannot feel the string or can feel the plastic device, the Levonorgestrel intrauterine system is not in the appropriate place. Due to this, the patient may not be protected from pregnancy and should seek urgent medical treatment so that the device can be re-implanted and a pregnancy test can be carried out.

Before having the Levonorgestrel device implanted, patients may be tested to ensure that they do not have an active infection. Generally, the Levonorgestrel device is implanted during the patient's period, immediately following a first-trimester abortion or immediately after a miscarriage. This timing ensures that the patient is not pregnant when the device is fitted.

Potential Drug Interactions:

Whilst some medications can be used in conjunction with one another, it is not always safe to use more than one medicine at a time. As some drugs can interact with one another, using more than one medication at a time could lead to unwanted complications and may be harmful to the patient.

As the Levonorgestrel intrauterine device releases hormones, it is possible for it to interact with other medications. Due to this, patients may not be treated with the following medicine if they already have a Levonorgestrel device in place:

  • Tranexamic Acid

Similarly, the following medicines are not usually prescribed if the patient has a Levonorgestrel intrauterine device fitted:

  • Carbamazepine
  • Lumacaftor
  • Ceritinib
  • Pitolisant
  • Dabrafenib
  • Lixisenatide
  • Darunavir
  • Lesinurad
  • Eliglustat
  • Tizanidine
  • Idelalisib
  • Theophylline
  • Isotretinoin
  • Ulipristal
  • Sugammadex

In addition to this, patients may have an increased risk of experiencing side-effects if they take or use any of the following medications whilst a device is implanted:

  • Acitretin
  • Nelfinavir
  • Alprazolam
  • Mycophenolic Acid
  • Amprenavir
  • Perampanel
  • Aprepitant
  • Phenobarbital
  • Atazanavir
  • Phenytoin
  • Bacampicillin
  • Oxcarbazepine
  • Betamethasone
  • Prednisolone
  • Bexarotene
  • Licorice
  • Bosentan
  • Lamotrigine
  • Colesevelam
  • Rifampin
  • Cyclosporine
  • Primidone
  • Delavirdine
  • Rifabutin
  • Eslicarbazepine Acetate
  • Rosuvastatin
  • Etravirine
  • Ritonavir
  • Fosamprenavir
  • Rifapentine
  • Fosaprepitant
  • Rufinamide
  • Fosphenytoin
  • Telaprevir
  • Griseofulvin
  • Troleandomycin
  • Modafinil
  • Troglitazone
  • Mycophenolate Mofetil
  • Topiramate
  • Selegiline
  • Voriconazole
  • St John's Wort
  • Warfarin
  • Tacrine

Patients should also be aware that some medicines, such as Levonorgestrel, can interact with other substances. If patients have a Levonorgestrel intrauterine system fitted, they should avoid consuming the following substance:

  • Caffeine

In addition to this, patients should tell their doctor if they are using any other medicines, vitamins or supplements before their Levonorgestrel device is implanted. Once the device has been fitted, patients should obtain medical advice before using any new medicines, supplements or vitamins.

Warnings

Before having a Levonorgestrel intrauterine system implanted, patients should discuss their medical history and current health with their physician. There are some conditions which can affect the suitability of treatment with a Levonorgestrel device and these may include:

  • Unusual or abnormal vaginal bleeding
  • Stroke
  • Migraine headaches
  • High blood pressure (Hypertension)
  • Ovarian cysts
  • Abnormally-shaped uterus
  • Cancer of the cervix or uterus
  • Uterine fibroids
  • Breast cancer
  • Infection
  • Genital tract infections (e.g. cervicitis, endometriosis etc.)
  • Pelvic infection
  • Liver disease
  • Pelvic inflammatory disease
  • Diabetes
  • Blood clots
  • Heart attack
  • Bleeding problems
  • Heart disease

Levonorgestrel intrauterine systems may be prescribed to female teenage patients as a form of birth control. However, Levonorgestrel devices should only be used if menstruation has started. As Levonorgestrel intrauterine systems are used to prevent heavy menstrual bleeding and pregnancy, they are never used to treat children.

When patients have a Levonorgestrel device in place, they may be more at risk of having an ectopic pregnancy. This is a life-threatening condition which requires emergency medical treatment. An ectopic pregnancy can also cause complications which may make it more difficult for patients to become pregnant in the future. If patients are concerned about this risk, they should discuss the possible complications with their physician before the Levonorgestrel device is fitted.

If patients believe they have become pregnant whilst the Levonorgestrel device is in place, they should contact their physician straight away.

In some cases, a Levonorgestrel device can move or slip out of place without the patient realizing it. If so, the patient will not be protected against pregnancy and may experience complications. In order to prevent this, patients should check the placement of their Levonorgestrel device on a regular basis and seek medical help if necessary.

After a Levonorgestrel intrauterine system has been fitted, patients may experience cramping and blood spotting. This can continue for the first few weeks after a Levonorgestrel device has been implanted. However, if these symptoms are severe or do not go away, patients should seek medical help. In rare instances, the Levonorgestrel device can make a hole in the uterus when it is fitted. If patients are concerned that this has happened to them, they should obtain medical help straight away.

Having a Levonorgestrel device fitted can increase the patient's risk of developing pelvic inflammatory disease. This can cause scarring on the female organs which, in turn, increases the risk of an ectopic pregnancy occurring. Patients with pelvic inflammatory disease may also find it more difficult to get pregnant in the future. If patients are concerned about this risk, they should discuss it with their doctor before a Levonorgestrel device is implanted.

If patients experience any of the following symptoms when a Levonorgestrel intrauterine system is implanted, they may be suffering from an infection and should seek immediate medical help:

  • Chills
  • Fever
  • Cramps
  • Flu-like symptoms
  • Bleeding
  • Pain
  • Fluid leaking from the vagina

A Levonorgestrel device will not protect the patient from contracting HIV/AIDS, chlamydia, herpes or any other sexually transmitted disease or infection. If the patient or their partner begins to engage in sexual activity with other people, they should consider using an additional form of contraception. Similarly, if the patient or their partner(s) test positive for any sexually transmitted infections, they should seek medical help and inform their physician.

Although Levonorgestrel devices are intended to protect against pregnancy for up to three or five years, patients should contact their physician if they wish to have the device removed earlier than this. Patients should never attempt to remove a Levonorgestrel device themselves.

Levonorgestrel can have an effect on the patient's blood sugar levels. In some cases, the hormone can mask the symptoms of low blood sugar, including a rapid pulse or heart rate. If patients have unusual blood or urine sugar tests results or believe they may have abnormal blood sugar levels, they should seek medical advice.

If patients are due to undergo any medical testing or procedures, they should tell the relevant healthcare practitioners that they have a Levonorgestrel device fitted.

Levonorgestrel intrauterine systems should not be used by patients who are already pregnant due to the risk to the unborn fetus. If the patient suspects they might be pregnant, they should inform the relevant healthcare practitioner before the Levonorgestrel device is fitted.

If patients are planning to breastfeed whilst the Levonorgestrel device is implanted, they should seek medical advice before doing so. When the hormone is released by the device, it can be excreted in breast milk and can, therefore, be passed on to the infant. Due to this, patients may be advised not to breastfeed when using this medication. However, some forms of Levonorgestrel devices may pose more of a risk than others. Due to this, patients should discuss the risk with their physician before breastfeeding.

If patients have any known allergies or have ever exhibited an allergic reaction to any substances before, they should tell their doctor before the Levonorgestrel intrauterine system is implanted. This includes allergies to other medicines, plastics, preservatives, dyes, foods and/or animals. In rare cases, patients may develop an allergic reaction after the Levonorgestrel device has been implanted and, if so, they will require urgent medical treatment. An allergic reaction may include the following symptoms:

  • Wheezing
  • Difficulty swallowing
  • Difficulty breathing
  • Hives
  • Swelling of the hands, face, throat, lips, mouth or tongue
  • Hoarseness
  • Shortness of breath
  • Itching
  • Rash on the skin
  • Chest tightness

Storage

Prior to implantation, Levonorgestrel intrauterine systems should be kept in a sterile environment. As patients will have their Levonorgestrel device fitted in a clinical setting, such as a treatment center, physician's office or a hospital, they will not be required to store the device at home.

Summary

For many patients, a Levonorgestrel intrauterine system is an effective form of birth control and provides relief from heavy menstrual bleeding. Unlike other forms of birth control, such as the contraceptive pill, patients do not have to remember to take medication every day when they are using the Levonorgestrel device.

Although the Levonorgestrel intrauterine system is a reversible form of contraception, it is intended to prevent pregnancy for up to three or five years. Due to this, the Levonorgestrel device may be most suited to patients who are not planning on becoming pregnant in the foreseeable future.