Levonorgestrel

How does Levonelle work?

Levonelle contains the progestogen hormone, levonorgestrel, which delays the hormone change that triggers egg release (ovulation) and so reduces the chance of pregnancy after sex.

 

Generic Levonelle

A generic version of Levonelle (levonorgestrel 1.5mg) is also available at a much-reduced cost – £3. Select ‘Levonorgestrel 1.5mg’ when choosing treatment after completing your online assessment.

Generic medicines contain the same active ingredients as branded originals and are equally effective.

 

Who can use Levonelle?

Levonelle is for use by women only. It is suitable for most women.

It is used to prevent pregnancy, after having sex where contraception has not been used successfully, i.e. when:

• No contraception was used.
• The condom split or slipped off.
• The diaphragm or cap was used incorrectly.
• Using the withdrawal method has failed.
• The next implant, coil, or depot injection is delayed.
• In some cases after forgetting to take the regular contraceptive pill, patch, or ring. See NHS information ‘What should I do if I miss a pill?’: combined pill or progestogen-only pill

 

When is Levonelle not indicated?

It can be less effective in overweight women. See below

Some medications may reduce the effectiveness of Levonelle. These include:

• Epilepsy medication.
• Antibiotics to treat tuberculosis.
• HIV treatment.
• Griseofulvin to treat fungal infections.
• St John’s Wort.

Cyclosporin also interacts with Levonelle.

If any of these are used in the 4 weeks before planning to use Levonelle, please discuss alternative emergency contraception with your GP or sexual health clinic.

 

Requesting Levonelle from Dr Fox

Women who would like to obtain an advance supply of Levonelle from Dr Fox, to keep as a standby for use at short notice, MUST first read important medical information and then complete a short yes/no online questionnaire. At the end of the questionnaire, women can request one or two Levonelle tablets, enter a delivery address, and make a payment.

Doctors review each request and issue prescriptions for the Levonelle tablet(s). Medication is posted from a UK-registered pharmacy. The shelf life (expiry date) is usually 2 years.

 

How effective is Levonelle?

Levonelle is licensed to be taken up to 72 hours (3 days) after intercourse (sex). 1-2 in a hundred women will still get pregnant after taking Levonelle.

Recent studies suggest Levonelle is less reliable in women who are overweight. Women with a BMI (Body Mass Indicator) result of 26 or above should either take a double dose of two Levonelle tablets or order ellaOne instead.

Overweight women taking a double dose of Levonelle, though recommended by the FSRH (Faculty of Sexual and Reproductive Health), is ‘off-label’ and is not mentioned in the patient information leaflet. If a medicine is used for an off-label (unlicensed) purpose the manufacturer is not liable in case of adverse events. Doctors take the responsibility for the prescribing.

 

Other options for emergency contraception

The most reliable form of emergency contraception is having an IUD (copper coil) fitted and this can then also provide ongoing contraception. They can be fitted by some GPs and at sexual health clinics.

 

Local NHS Sexual Health Clinics

• England
• Wales
• Scotland
• Northern Ireland

An alternative pill is ellaOne which, like Levonelle, delays ovulation, but can be taken up to 120 hours (5 days) after sex.

 

Taking Levonelle

Levonelle is a single tablet. The dose should be taken as soon as possible after unprotected intercourse, no later than 72 hours (3 days) after.

If vomiting occurs within 3 hours a repeat dose should be taken.

As the time of ovulation can be unpredictable, even in women with regular cycles, emergency contraception is often taken regardless of the day of the cycle when a woman has unprotected sexual intercourse. Levonelle should not be used more than once in the same cycle without advice from a doctor or family planning clinic.

Levonelle should not be used more than once in the same cycle without advice from a doctor or sexual health clinic.

Levonelle should not be taken at the same time, or in the same cycle, as ellaOne.

 

Side effects of Levonelle

Levonelle has the potential to cause side effects, although these are usually not severe and do not occur in most cases. The commonest side effects are dizziness, nausea, mild lower abdominal pain, bleeding not related to periods, and fatigue.

More information on the side effects of Levonelle can be found in the manufacturer’s Patient Information Leaflet supplied with the medication.

 

Warnings

Levonelle may cause spotting or bleeding between periods and your next period may arrive early or late and may be shorter or longer than usual. If your period is not ‘normal’ or it doesn’t arrive until more than 5 days after expected, then you should take a pregnancy test.

There is no increased risk of ectopic pregnancy (pregnancy outside the uterus/womb) after taking a morning-after pill. However, ectopic pregnancy can still occur. Take a pregnancy test and seek medical advice if there is unusual abdominal pain and vaginal bleeding 4-5 weeks after taking Levonelle as there is a chance these could be symptoms of an ectopic pregnancy.

 

Sexually transmitted infections

Levonelle does not protect against sexually transmitted infections. Only condoms can protect you from sexually transmitted infections. If you may be at risk, see a GP or sexual health clinic for full checks.

 

Breastfeeding

The active ingredient, levonorgestrel 1.5mg, is excreted in breast milk. Take Levonelle immediately after feeding and don’t feed your baby for the next 8 hours with breast milk. Use a breast pump and dispose of the unwanted milk.

 

Contraception and Levonelle

Levonelle is a ‘morning after pill’ for emergency use AFTER unprotected intercourse. It should be used only when other contraception has not been used or has failed, not to replace routine regular contraception, which is more reliable and effective.

Women taking a contraceptive pill, who need to take Levonelle after missing one or more pills in a cycle, should NOT stop taking their contraceptive pill after taking Levonelle.

If using the contraceptive patch or vaginal ring, that should be started again immediately after taking Levonelle.

Start/restart the hormonal contraception within 12 hours. Use condoms as well for 7 days with the patch, the ring, and the combined pill (9 days of condom use for Qlaira); Use condoms as well for 2 days with the progestogen-only pill (mini pill).

Long-acting reversible methods of contraception (LARC) such as injections, implants, IUD (copper coil), and IUS (hormone coil) are the most reliable forms of contraception and may suit you better if you have found yourself in need of emergency contraception.

 

Pregnancy and Levonelle

Studies have shown no evidence that Levonelle will cause harm to the foetus if it is taken by a woman who is already pregnant. It is recommended women who know or suspect they are pregnant should not take Levonelle. If Levonelle is taken inadvertently during pregnancy, discuss this with your doctor or midwife.