What does levonorgestrel do: Levonorgestrel: MedlinePlus Drug Information

14.06.197701.11.2021 by alexxlab

Содержание

Levonorgestrel/Ethinyl Estradiol-Ee 13 Week Contraceptive – Oral

Pronunciation: LEE-voe-nor-JES-trel/ETH-in-il es-tra-DYE-ole

Important: How To Use This Information

This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Warning

Do not use this medication if you smoke cigarettes/use tobacco and are over 35 years old. Smoking raises your risk of stroke, heart attack, blood clots, and high blood pressure from hormonal birth control (such as the pill, patch, ring). The risk of these serious problems increases with age and with the number of cigarettes you smoke. Do not smoke or use tobacco.

Uses

This combination hormone medication is used to prevent pregnancy. It contains 2 hormones: a progestin (levonorgestrel) and an estrogen (ethinyl estradiol). It works mainly by preventing the release of an egg (ovulation) during your menstrual cycle. It also makes vaginal fluid thicker to help prevent sperm from reaching an egg (fertilization) and changes the lining of the uterus (womb) to prevent attachment of a fertilized egg. If a fertilized egg does not attach to the uterus, it passes out of the body.

Besides preventing pregnancy, birth control pills may make your periods more regular, decrease blood loss and painful periods, decrease your risk of ovarian cysts, and also treat acne.

Using this medication does not protect you or your partner against sexually transmitted diseases (such as HIV, gonorrhea, chlamydia).

How To Use

Read the Patient Information Leaflet provided by your pharmacist before you start using this product and each time you get a refill. The leaflet contains very important information on when to take your pills and what to do if you miss a dose. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually once daily. Pick a time of day that is easy for you to remember, and take your pill at the same time each day.

It is very important to continue taking this medication exactly as prescribed by your doctor. Follow the package instructions to find the first tablet, start with the first tablet in the pack, and take them in the correct order. Do not skip any doses. Pregnancy is more likely if you miss pills, start a new pack late, or take your pill at a different time of the day than usual.

Taking this medication after your evening meal or at bedtime may help if you have stomach upset or nausea with the medication. You may choose to take this medication at another time of day that is easier for you to remember. No matter what dosing schedule you use, it is very important that you take this medication at the same time each day, 24 hours apart. Ask your doctor or pharmacist if you have any questions.

Begin taking this medication on the first Sunday following the beginning of your menstrual period. If your period begins on a Sunday, begin taking this medication on that day. Your pill pack contains 84 estrogen/progestin pills and 7 estrogen-only pills. Take one estrogen/progestin pill daily for 84 days in a row. The day after you finish all the combination pills, start taking one estrogen-only pill daily for 7 days in a row. You should have your period during the week you are taking the estrogen-only pills. The day after you take the last estrogen-only pill, start a new pack whether or not you have your period. If you do not get your period, consult your doctor.

If this is the first time you are using this medication, use an additional form of non-hormonal birth control (such as condoms, spermicide) for the first 7 days to prevent pregnancy until the medication has enough time to work. If you start on the first day of your period, you do not need to use back-up birth control the first week.

Ask your doctor or pharmacist about how to switch from other forms of hormonal birth control (such as patch, other birth control pills) to this product. If any information is unclear, consult the Patient Information Leaflet or your doctor or pharmacist.

Side Effects

Nausea, vomiting, headache, bloating, breast tenderness, swelling of the ankles/feet (fluid retention), or weight change may occur. Vaginal bleeding between periods (spotting) may occur, especially during the first few months of use. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

You should not have your period during the 3 months that you are taking the combination pills. Instead, you will have your period once every 3 months, during the week that you are taking the estrogen-only pills. This effect is normal with this product. However, if you do not have your period while taking the estrogen-only pills, contact your doctor for a pregnancy test.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including:

lumps in the breast
mental/mood changes (such as new/worsening depression)
severe stomach/abdominal pain
unusual changes in vaginal bleeding (such as continuous spotting, sudden heavy bleeding, missed periods)
dark urine
yellowing eyes/skin

This medication may rarely cause serious (sometimes fatal) problems from blood clots (such as deep vein thrombosis, heart attack, pulmonary embolism, stroke). Get medical help right away if any of these side effects occur:

chest/jaw/left arm pain
confusion
sudden dizziness/fainting
pain/swelling/warmth in the groin/calf
trouble speaking
sudden shortness of breath/rapid breathing
unusual headaches (including headaches with vision changes/lack of coordination, worsening of migraines, sudden/very severe headaches)
unusual sweating
weakness on one side of the body
vision problems/changes (such as double vision, partial/complete blindness)

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

rash
itching/swelling (especially of the face/tongue/throat)
severe dizziness
trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Drug Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include:

aromatase inhibitors (such as anastrozole, exemestane)
ospemifene
tamoxifen
tizanidine
tranexamic acid
certain combination products used to treat chronic hepatitis C (ombitasvir/paritaprevir/ritonavir with or without dasabuvir)

Some drugs may cause hormonal birth control to work less well by decreasing the amount of birth control hormones in your body. This effect can result in pregnancy. Examples include griseofulvin, modafinil, rifamycins (such as rifampin, rifabutin), St. John’s wort, drugs used to treat seizures (such as barbiturates, carbamazepine, felbamate, phenytoin, primidone, topiramate), HIV drugs (such as nelfinavir, nevirapine, ritonavir), among others.

Tell your doctor when you start any new drug, and discuss if you should use additional reliable birth control. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

This medication may interfere with certain laboratory tests (such as blood clotting factors, thyroid), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this medication.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include severe nausea and vomiting, sudden/unusual vaginal bleeding.

Notes

Do not share this medication with others.

Keep all regular medical and laboratory appointments. You should have regular complete physical exams which include laboratory and medical tests (such as blood pressure, breast exam, pelvic exam, Pap smear) to monitor your progress and check for side effects. Follow your doctor’s instructions for examining your breasts, and report any lumps right away. Consult your doctor for more details.

Missed Dose

Refer to the product package information for advice on missed doses. You may need to use back-up birth control (such as condoms, spermicide) to prevent pregnancy. Ask your doctor or pharmacist if you have any questions.

If you often forget to take your pills as directed, contact your doctor to discuss switching to another form of birth control.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Levonorgestrel – StatPearls – NCBI Bookshelf

Continuing Education Activity

Objectives:

Summarize the mechanism of action of levonorgestrel.
Review the effective and correct administration of levonorgestrel for morning-after birth control.
Describe the contraindications for using levonorgestrel.
Explain the importance of collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients receiving treatment with levonorgestrel.

Access free multiple choice questions on this topic.

Indications

Levonorgestrel, also known as the morning-after pill, is a first-line oral emergency contraceptive pill with approval from the World Health Organization to prevent pregnancy. It is FDA-approved to be used within 72 hours of unprotected sexual intercourse or when a presumed contraceptive failure has occurred. There have been cases of off-label efficacy for up to 96 hours.[1] A prescription is not needed, and it is available over the counter at local pharmacies. The FDA has also approved levonorgestrel availability for all age groups due to its lack of life-threatening contraindications and side-effect profile.[2] Levonorgestrel can be used as an oral combination pill with estradiol as a long-term option for birth control and is available in other forms, such as implants or transdermal patches. There is a levonorgestrel-releasing intrauterine device considered to be a “low maintenance” birth control option for women that is efficacious for up to five years.[3] It has also been used off-label effects to treat endometrial hyperplasia, menorrhagia, endometriosis, and menopausal hormone therapy.

Mechanism of Action

Levonorgestrel (LNG—17alpha-ethynyl-18-methylestr-4-en-17beta-ol-3-one) is a second-generation synthetic progestogen that is the active component of the racemic mixture of norgestrel. It binds to progesterone and androgen receptors, where it can delay gonadotropin-releasing hormone from being released from the hypothalamus. This action blunts the luteinizing hormone surge that occurs during the pre-ovulation stage. Ultimately, it can delay or inhibit ovulation by preventing fertilization via inhibiting follicular rupture and releasing a viable egg from the ovaries. Optimal efficacy is achievable when it is taken in the pre-ovulation stage as well. Levonorgestrel also induces the thickening of cervical mucus, which helps by interfering with sperm motility and passage. There has been no evidence in recent studies that levonorgestrel significantly affects the endometrium to alter it to prevent pregnancy.[4]

Studies have shown that levonorgestrel is not subject to significant first-pass metabolism. Levonorgestrel undergoes metabolism via hydroxylation, conjugation, and reduction in the liver. Its bioavailability varies from 85 to 100%.[5]

Administration

For emergency contraceptive use, the recommended dose is 1.5 mg oral tablet within 72 hours. There is also a 0.75 mg oral tablet that can be given with a second 0.75 mg dose if needed 24 hours later. A 3 mg oral levonorgestrel is for patients concomitantly taking a CYP3A4 cytochrome p450 liver enzyme-inducing drug, e.g., rifampicin, St. John’s wort, carbamazepine, or phenobarbital due to these agents increasing hepatic clearance of levonorgestrel. Vomiting can occur within two hours of administration, at which case the patient would need to repeat the initial dose taken.[6]

For the long-term birth control options, the levonorgestrel intrauterine T-shaped device has 52 mg of levonorgestrel covered by a rate-controlling membrane that regulates the rate of release of hormones. 2, but not significant enough to restrict this subset of patients from using levonorgestrel, which appears to be due to the lower bioavailability of a standard 1.5 mg dose given of levonorgestrel, free plus albumin-bound, in these patients. The most common side effects are menstrual abnormalities, amenorrhea, dysmenorrhea, oligomenorrhea, headaches, and acne. Other side effects that can occur are nausea and vomiting. Importantly, this drug does not protect any patient from sexually transmitted infections and diseases, and the advice to patients is to use condoms for protection from such.[7][8]

For the intrauterine device, there is 0.1% of pregnancy occurring within the first year of use. The intrauterine device most commonly causes menstrual irregularities, including amenorrhea and oligomenorrhea. Other side effects of the intrauterine device are similar to those of the combined oral contraceptive pill route, such as ovarian cysts, weight gain, depression, acne, and low libido.[3]

Drug-Drug Interactions:

The following may diminish the therapeutic effect of progestins: acitretin, anticoagulants, antidiabetic agents, barbiturates, carbamazepine, fosphenytoin, griseofulvin, mifepristone, phenytoin, primidone, retinoic acid derivatives, and St. John’s wort.

The following may decrease the serum concentration of progestins: aprepitant, artemether, bexarotene, bile acid sequestrants, bosentan, brigatinib, clobazam, CYP3A4 inducers, dabrafenib, darunavir, efavirenz, encorafenib, eslicarbazepine, exenatide, felbamate, fosaprepitant, ixazomib, lamotrigine, lesinurad, lixisenatide, lopinavir, lorlatinib, lumacaftor, metreleptin, mycophenolate, nelfinavir, nevirapine, oxcarbazepine, perampanel, rifamycin derivatives, saquinavir, sugammadex, and topiramate.

The following may increase the serum concentration of progestins: atazanavir, cobicistat, tipranavir, and voriconazole.

The following may enhance the thrombogenic effect of progestins: C1-inhibitors and carfilzomib.

Contraindications

There are several contraindications for the emergency contraceptive form, including allergy, hypersensitivity, severe liver disease, pregnancy, and drug-drug interactions with liver enzyme-inducing drugs.[9]

For the intrauterine device, the contraindications include uterine anomalies (fibroids, cysts), breast carcinoma, active cervicitis/vaginitis, suspected cervical dysplasia, and pregnancy.[3]

Emergency contraceptive form: The medication is not for use in women confirmed to be pregnant; however, there is no proof nor reports of adverse effects on the mother or fetus following inadvertent exposure during pregnancy.[10]

Pregnancy for the IUD: Use during pregnancy or suspected pregnancy is contraindicated.

Combined ethinylestradiol and levonorgestrel is pregnancy category X.

Breastfeeding: levonorgestrel is present in breast milk; however, the relative infant dose is 8%. Breastfeeding is acceptable when the relative infant dose of a medication is less than 10%.[11]

Monitoring

Routine examinations with a gynecologist are encouraged for the long-term combined oral pill or intrauterine device birth control options to monitor side effects and possible pregnancy. Levonorgestrel undergoes metabolism by the liver and is subject to impairment in patients with liver dysfunction. Therefore, monitoring liver function tests at the time of administration may be beneficial. Also, drugs containing CYP3A4 cytochrome p450 liver-enzyme inducing properties require close vigilance when a patient takes levonorgestrel. Patients may need to consider another emergency contraceptive method to avoid drug-drug interactions. These liver-enzyme-inducing drugs can cause rapid metabolism and decrease the efficacy of levonorgestrel when there is concomitant use.[12]

Toxicity

There is a lack of research regarding the toxic levels and effects in humans. While there could be toxicity seen in patients with liver disease, there is not enough research to support this. More human trial studies will be necessary. There have been studies that show LD50 to be over 5000 mg/kg in rats when given orally, with a significant decrease in white blood cell counts.[13]

Enhancing Healthcare Team Outcomes

While levonorgestrel is a first-line emergency contraceptive for unwanted pregnancy, communication and teamwork between primary care physicians, gynecologists, obstetricians, pharmacists, nurse practitioners, physician assistants, and nursing staff working together in an interprofessional team approach to care can make a tangible difference in a patient’s experience while taking levonorgestrel. There has been controversy about the morning after pill being available without a prescription and sold over the counter at any local pharmacy. This agent can be deemed a drug that promotes risky sexual behavior and can also be a drug of convenience for both perceived and verifiable contraceptive failures. This issue is how healthcare teams can combine patient education with adequate treatment plans to promote levonorgestrel use in the most effective way without compromising patient safety.[14] [Level 5]

Primary care physicians and gynecologists should routinely ask the patient about pertinent sexual history to help monitor sexual behavior and document any changes.
Maintenance of a strong physician-patient relationship so that the patients trust the physicians and can be open and honest about their sexual practices and potentially risky behavior in a judgment-free atmosphere.
Pharmacists should emphasize the side effects of levonorgestrel, its strict timeline to achieve optimal drug efficacy, and how it will not prevent sexually transmitted infections and diseases.

These examples of interprofessional strategies can optimize the benefits of therapy with levonorgestrel. [Level 5]

References

1.: Chao YS, Frey N. Ulipristal versus Levonorgestrel for Emergency Contraception: A Review of Comparative Clinical Effectiveness and Guidelines [Internet]. Canadian Agency for Drugs and Technologies in Health; Ottawa (ON): Nov 29, 2018. [PubMed: 30883064]
2.: David M, Berends L, Bartley J. Current Opinion of Obstetricians on the Prescription of Emergency Contraception: A German-American Comparison. Geburtshilfe Frauenheilkd. 2012 Nov;72(11):1004-1008. [PMC free article: PMC4168318] [PubMed: 25258456]
3.: Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009 Jun;5(3):561-74. [PMC free article: PMC2724187] [PubMed: 19707273]
4.: Kahlenborn C, Peck R, Severs WB. Mechanism of action of levonorgestrel emergency contraception. Linacre Q. 2015 Feb;82(1):18-33. [PMC free article: PMC4313438] [PubMed: 25698840]
5.: Basaraba CN, Westhoff CL, Pike MC, Nandakumar R, Cremers S. Estimating systemic exposure to levonorgestrel from an oral contraceptive. Contraception. 2017 Apr;95(4):398-404. [PMC free article: PMC5376510] [PubMed: 28041990]
6.: Black KI, Hussainy SY. Emergency contraception: Oral and intrauterine options. Aust Fam Physician. 2017 Oct;46(10):722-726. [PubMed: 29036770]
7.: Festin MPR, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies. Contraception. 2017 Jan;95(1):50-54. [PMC free article: PMC5357708] [PubMed: 27527670]
8.: Shen J, Che Y, Showell E, Chen K, Cheng L. Interventions for emergency contraception. Cochrane Database Syst Rev. 2019 Jan 20;1:CD001324. [PMC free article: PMC7055045] [PubMed: 30661244]
9.: Back DJ, Orme ML. Pharmacokinetic drug interactions with oral contraceptives. Clin Pharmacokinet. 1990 Jun;18(6):472-84. [PubMed: 2191822]
10.: Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 Jul 29;65(3):1-103. [PubMed: 27467196]
11.: Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000 Jul 13;343(2):118-26. [PubMed: 10891521]
12.: Coricovac D, Farcas C, Nica C, Pinzaru I, Simu S, Stoian D, Soica C, Proks M, Avram S, Navolan D, Dumitru C, Popovici RA, Dehelean CA. Ethinylestradiol and Levonorgestrel as Active Agents in Normal Skin, and Pathological Conditions Induced by UVB Exposure: In Vitro and In Ovo Assessments. Int J Mol Sci. 2018 Nov 14;19(11) [PMC free article: PMC6275072] [PubMed: 30441863]
13.: Kim SK, Shin SJ, Yoo Y, Kim NH, Kim DS, Zhang D, Park JA, Yi H, Kim JS, Shin HC. Oral toxicity of isotretinoin, misoprostol, methotrexate, mifepristone and levonorgestrel as pregnancy category X medications in female mice. Exp Ther Med. 2015 Mar;9(3):853-859. [PMC free article: PMC4316989] [PubMed: 25667641]
14.: Brandão ER. [Long-acting reversible contraception methods in the Brazilian Unified National Health System: the debate on women’s (in)discipline]. Cien Saude Colet. 2019 Mar;24(3):875-879. [PubMed: 30892508]

Here’s How Emergency Contraception Actually Works

Worth noting: Some research shows that levonorgestrel may be less effective for people with high BMIs. However, the FDA has maintained that there is not enough research to require a change in how the drug is labeled or prescribed in the United States. Also, as previously reported in an in-depth SELF article on the subject, “less effective” doesn’t necessarily mean “not effective.”

The most crucial factor when it comes to effectiveness is how soon you take levonorgestrel after sex. Despite the nickname “the morning-after pill,” you should take levonorgestrel as soon as possible after unprotected sex. “Hormonal methods are more effective the sooner they are administered,” Tina Raine-Bennett, M.D., M.P.H., an ob/gyn and senior research scientist at Kaiser Permanente department of obstetrics and gynecology and division of research, tells SELF. That way, if the hormonal changes that induce ovulation are impending, the levonorgestrel has more time to stop them before an egg is released.

Since the timing of ovulation is so important here, levonorgestrel is less effective in cases where that LH surge has already begun. At that point, the release of an egg is imminent, which increases the odds of pregnancy. “If people could know exactly when they ovulate each month, it would be much easier to determine if emergency contraception is needed,” Wing Kay Fok, M.D., M.S., clinical assistant professor of obstetrics and gynecology at Stanford University, tells SELF. “But since most people’s menstrual cycles are not perfectly regular, we recommend emergency contraception after any unprotected sex, and as soon as possible.” And, because levonorgestrel just works to prevent or delay ovulation, it won’t do anything to stop an existing pregnancy.

When you do take levonorgestrel, you may experience side effects such as irregular bleeding, abdominal discomfort, fatigue, headache, nausea, and vomiting. “These side effects are generally mild and go away on their own,” Kelly Cleland, M.P.H., a research specialist at Princeton University, coordinator of the American Society for Emergency Contraception, and consulting associate at the reproductive health advocacy organization Gynuity, tells SELF. However, if you vomit within two hours of taking levonorgestrel, you may need to take another dose. Call your health care provider to ask their opinion.

This is how ulipristal acetate works to prevent pregnancy.

The other main type of morning-after pill is ulipristal acetate (ella), which is taken as a single 30-milligram pill. It also works by hampering ovulation, but in a different way than levonorgestrel.

The mechanism isn’t entirely understood, but it appears that ulipristal acetate modifies progesterone receptors in the follicle that surrounds the developing egg in the ovary, ultimately barring the release of the egg into the fallopian tubes, meaning ovulation is delayed or prevented.

Ulipristal acetate is designed to be taken within 120 hours (five days) of unprotected sex. Unlike levonorgestrel, its efficacy does not decrease significantly over that time period. “Ulipristal acetate … continues to delay follicular rupture closer to the time of ovulation,” Dr. Raine-Bennett explains. Its apparent mechanism (preventing the rupture of a follicle containing a mature egg) is capable of working even after LH has begun to rise, so it can be effective closer to the time of ovulation than levonorgestrel.

What Kind of Emergency Contraception Is Best For Me?

Emergency contraception is a safe way to prevent pregnancy after unprotected sex. There are a few types of emergency contraception, and some work better than others.

What kinds of emergency contraception are there?

There are 2 ways to prevent pregnancy after you have unprotected sex:

Option 1: Get a Paragard (copper) IUD within 120 hours (five days) after having unprotected sex. This is the most effective type of emergency contraception. The copper IUD works as well on day one as it does on day five.

Option 2: Take an emergency contraception pill (AKA the morning-after pill) within 120 hours (five days) after having unprotected sex. There are 2 types of morning-after pills:

A pill with ulipristal acetate. There’s only one brand, called ella.
- ella is the most effective type of morning-after pill.
- You need a prescription from a nurse or doctor to get ella emergency contraception, but you can get a fast medical consultation and prescription with next-day delivery online.
- You can take ella up to 120 hours (five days) after unprotected sex — but it’s best to take it as soon as you can.
- If you weigh 195 pounds or more, ella may work less well.
A pill with levonorgestrel. Brand names include: Plan B One Step, Take Action, My Way, Option 2, Preventeza, AfterPill, My Choice, Aftera, EContra, and others.
- You can buy levonorgestrel morning-after pills over the counter without a prescription in most drugstores, pharmacies, and superstores.
- These types of morning-after pills work best when you take them within 72 hours (3 days) after unprotected sex, but you can take them up to five days after. The sooner you take them, the better they work.
- If you weigh 155 pounds or more, levonorgestrel morning-after pills may not work.

You can use emergency contraception to prevent pregnancy if:

you didn’t use a condom or other birth control method when you had vaginal sex
you made a mistake with your regular birth control (forgot to take your birth control pills, change your patch or ring, or get your shot on time) and had vaginal sex
your condom broke or slipped off after ejaculation (cumming)
your partner didn’t pull out in time
you were forced to have unprotected vaginal sex

If you use emergency contraception correctly after you have unprotected sex, it makes it much less likely that you’ll get pregnant. Emergency contraception pills are safe, don’t cause any long-term side effects, and won’t affect your ability to get pregnant in the future. But using them as your only regular birth control isn’t a great idea because they’re not as effective — or as affordable — as regular, non-emergency birth control methods (like the implant, pill, or condoms).

If you have sex (or think you might have it in the future), take our quiz to help you find the best method of birth control for you.

What kind of emergency contraception is best for me?

The best emergency contraception (EC) for you depends on a few things:

How long it’s been since you had unprotected sex — you have up to five days after unprotected sex to use emergency contraception.
- Plan B works better the sooner you take it. Plan B doesn’t work nearly as well after three days (72 hours).
- It’s better to take ella as soon as you can. But ella is more effective than Plan B, no matter when you take it.
- The copper IUD is the best at preventing pregnancy, and it works as well on day five as it does on day one.
How much you weigh
- Plan B may not work if you weigh 155 pounds or more.
- ella may work less well if you weigh 195 pounds or more.
- The copper IUD works just as well no matter how much you weigh.
Which kind of EC is easiest for you to get
- Plan B is usually the easiest — anyone can buy it over-the-counter without a prescription at most drugstores, pharmacies, and superstores, no matter your age or gender.
- ella can be harder to get than Plan B because you need a prescription. You can call your doctor or nurse for a prescription, go to your local Planned Parenthood health center, or buy it online. Depending on where you live you may also be able to order ella online through the Planned Parenthood Direct app.
- The copper IUD can be hard to get within five days because you need an appointment for a nurse or doctor to put it in.
Whether you’re breastfeeding
- Plan B and the copper IUD won’t affect your breastmilk.
- If you use ella, you’ll need to pump and throw away your breastmilk for 36 hours after taking it.

This quiz can help you figure out the best EC for you.

If you can’t get the most effective types of emergency contraception, remember that using whichever method you can get is still better than not using anything at all. And timing is really important — you only have up to five days after unprotected sex to use emergency contraception, and sooner is better. In fact, many people get the morning-after pill ahead of time and keep it at home, so they can take it as soon as possible if they need it.

Don’t use two different kinds of morning-after pills (like Plan B and ella) at the same time or within five days of each other, because they may counteract each other and not work at all.

If you have questions about emergency contraception, you can talk with an educator on our Chat/Text line, or call your local Planned Parenthood health center.

How long do I have to get emergency contraception?

You can use emergency contraception up to five days (120 hours) after unprotected sex. So it’s important to act quickly so you have the best options possible. It can take time to get emergency contraception, so the sooner you start looking for it, the better.

The Paragard (Copper) IUD and ella are just as effective throughout the five days. Plan B, My Way, Take Action, and other levonorgestrel morning-after pills work less well after three days (72 hours).

Is the morning-after pill safe?

Morning-after pills are safe — millions of people have used different kinds of emergency contraception for more than 30 years. There have been no reports of serious complications. Morning-after pills don’t cause any long-term side effects, and they won’t change your ability to get pregnant in the future.

How many times can I use the morning-after pill?

Taking the morning-after pill multiple times is safe and won’t hurt you. But it’s not a good idea to use the morning-after pill as your regular, go-to method of birth control. This is because:

The morning-after pill doesn’t prevent pregnancy as well as other types of birth control like the IUD, implant, pill, shot, or ring.
Taking the morning-after pill over and over again is usually more expensive and less convenient than being on a regular method of birth control.
Morning-after pill side effects — like bleeding between periods or nausea — are temporary and harmless, but they can be annoying.

So it’s totally safe to take the morning-after pill as many times as you need to — it’s just not the best way to prevent unintended pregnancies long-term. Birth control that you use before or during sex (like the IUD, implant, pill, condoms, etc.) is way more effective, affordable and convenient.

Don’t use two different kinds of morning-after pills (like Plan B and ella) at the same time or within five days of each other, because they may counteract each other and not work at all.

One of the most convenient things about getting a Paragard (copper) IUD as emergency contraception is that it keeps giving you super effective birth control for up to 12 years (or until you want it taken out). So once you get an IUD, you won’t have to worry about pregnancy again (until you stop using the IUD).

How does emergency contraception work?

Pregnancy doesn’t happen right after you have sex — that’s why it’s possible to prevent pregnancy a few days after you do it. It’s all about timing.

Sperm can live inside your body for up to six days after sex, waiting for an egg to show up. If you ovulate during that time, the sperm can meet up with your egg and cause pregnancy. Morning-after pills work by temporarily stopping your ovary from releasing an egg. It’s kind of like pulling the emergency brake on ovulation. Where you’re at in your menstrual cycle and how soon after unprotected sex you take the morning-after pill can affect how well it prevents pregnancy. Morning-after pills won’t work if your body has already started ovulating.

This is why timing is so important, especially if you’re using Plan B and other levonorgestrel morning-after pills. (ella works closer to the time of ovulation than levonorgestrel morning-after pills like Plan B.) Most people don’t know exactly when they ovulate, so it’s best to use emergency contraception as soon as possible — no matter where you are in your menstrual cycle or whether or not you think you’re about to ovulate.

The Paragard IUD prevents pregnancy for up to five days after unprotected sex because sperm doesn’t like copper. So the copper in the Paragard IUD makes it hard for sperm to swim well enough to get to your egg.

The morning-after pill is NOT the same thing as the abortion pill (also called medication abortion or RU-486). The morning-after pill doesn’t cause an abortion. It won’t work if you’re already pregnant, and it won’t harm an existing pregnancy. Emergency contraception (including the IUD) is birth control, not abortion. It doesn’t end a pregnancy — it prevents one.

How much does the morning-after pill or copper IUD cost?

Plan B One-Step usually costs about $40-$50. Other brands of levonorgestrel morning-after pills like Take Action, My Way, Option 2, Preventeza, AfterPill, My Choice, Aftera, and EContra generally cost less — about $11-$45. You can sometimes get these pills for cheaper online, but they may not come in time if you need a morning-after pill right now. So you can buy it online ahead of time and put it in your medicine cabinet in case you need it in the future. Though there are many different brands of levonorgestrel morning-after pills, they all work the same way no matter how much they cost.

If you have health insurance or Medicaid, there’s a good chance you can get morning-after pills for free — you just have to ask your nurse or doctor for a prescription so your health insurance will cover them (even though you don’t need a prescription to buy these types of morning-after pills over-the-counter). Read more about using health insurance to pay for emergency contraception.

ella usually costs about $50 or more at the pharmacy or drugstore — but it’s usually free if you have health insurance or Medicaid. ella costs $90 when you order it online (this price includes the medical consultation and overnight shipping). ella is the only brand of this type of morning-after pill. ella is more effective than Plan B and other levonorgestrel pills, especially if you weigh more than 155 pounds.

Getting an IUD costs anywhere between $0-$1,300. That’s a pretty wide range, but the good news is that IUDs are free or low cost with many health insurance plans, Medicaid, and some other government programs. And even if an IUD costs a lot up front, they usually end up saving you money in the long run because they give you really effective birth control for up to 12 years.

Option 2 – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Levonorgestrel belongs to the family of medications known as progestins. Progestins are female sex hormones that are used in birth control pills and often in combination with the hormone estrogen.

Levonorgestrel is a progestin-only emergency birth control pill intended for use within 72 hours of unprotected sexual intercourse. It should only be used by women whose regular birth control methods have failed or who may have had intercourse without birth control. It is not a substitute for correct use of regular birth control.

This medication is believed to prevent pregnancy primarily by delaying ovulation or preventing fertilization of the egg. It may also prevent implantation of the egg by altering the endometrium (inner lining of the uterus). It is important to realize that once implantation has occurred and pregnancy is established, levonorgestrel cannot cause an abortion or harm the fetus. No serious complications have been reported with this medication.

This medication reduces the risk of pregnancy among users from around 8% to around 1% after unprotected sexual intercourse. It is most effective in the first 24 hours after intercourse.

It should be noted that this medication does not protect against HIV infection (AIDS) or other sexually transmitted infections.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Option 2 is no longer being manufactured for sale in Canada. For brands that may still be available, search under levonorgestrel. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The 1.5 mg tablet contained in the kit should be taken as soon as possible within 72 hours of unprotected sexual intercourse. The medication is most effective if taken within 12-24 hours of unprotected sexual intercourse.

Because this medication is often associated with nausea, your doctor may also want you to take medication to prevent nausea at the same time as taking these pills. If you vomit within 2 hours of taking the tablet, you should contact your health care provider as you may need to take another dose. This medication can be used at any time during the menstrual cycle. It can be taken with or without food. Taking it with food may help reduce the nausea.

Most women have their expected menstrual period within 7 days of their normal time after using this medication. If you don’t have your menstrual period within 7 days of when it is expected, you should have a pregnancy test done.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as recommended by your doctor. Levonorgestrel is not intended to be used routinely as birth control.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

are allergic to levonorgestrel or any ingredients of this medication
are or may be pregnant
have undiagnosed abnormal vaginal bleeding

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

abdominal pain
breast tenderness
diarrhea
dizziness
fatigue
headache
irregular, altered, or heavier menstrual bleeding
migraine
nausea
vomiting

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

cramping or severe abdominal pain before your next normal period
itching
painful menstruation
skin rash
vaginal discharge
very heavy vaginal bleeding

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Decreased effectiveness: This medication may be less effective for women who weigh more than 165 pounds (75 kg) . Regardless of body weight, this medication should be taken as soon after unprotected intercourse as possible to ensure the most reliable outcome. If you weigh more than 165 pounds, you may wish to contact your doctor or pharmacist for advice about emergency contraception.

Diabetes: Although few women have experienced loss of blood glucose control when taking progestin-only pills, women with diabetes should monitor their blood glucose carefully after taking this medication.

Liver problems: The safety of using this medication has not been established for people with liver disease. If you have liver disease, discuss with your doctor whether any special monitoring is needed.

Migraine: After taking a dose of levonorgestrel, you may experience a severe headache or a migraine.

Sexually transmitted infections: This medication does not protect against sexually transmitted infections, including HIV or AIDS. For protection against these infections, latex condoms should be used.

Pregnancy: This medication should not be used during pregnancy. It will not terminate a pregnancy that has already been established.

Breast-feeding: Small amounts of progestin pass into the breast milk of women taking progestin-only pills. No adverse effects have been found with taking this medication while breast-feeding, either in the quality and quantity of milk or in the growth and development of the infant.

What other drugs could interact with this medication?

There may be an interaction between levonorgestrel and any of the following:

acitretin
antibiotics (ampicillin, cotrimoxazole, tetracycline, clarithromycin)
apixaban
aprepitant
barbiturates (e.g., pentobarbital, phenobarbital)
bosentan
cannabis
carbamazepine
cholestyramine
colestipol
clobazam
cobicistat
cyclosporine
dabigatran
dabrafenib
darunavir
deferasirox
diabetes medications (e.g., canagliflozin, glyburide, insulin, metformin, rosiglitazone)
edoxaban
efavirenz
eslicarbazepine
exenatide
fosaprepitant
fosphenytoin
heparin
HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
isotretinoin
lamotrigine
low-molecular-weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
lumacaftor and ivacaftor
mifepristone
modafinil
mycophenolate
nevirapine
octreotide
oxcarbazepine
perampanel
phenytoin
primidone
rifampin
rifabutin
rivaroxaban
St. John’s wort
sarilumab
selegiline
siltuximab
thalidomide
tocilizumab
topiramate
tranexamic acid
triazolam
tretinoin
ulipristal
voriconazole
warfarin

Because only one tablet of levonorgestrel is taken, the effects of these medications on how the levonorgestrel works is likely to be minimal. If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,
change one of the medications to another,
change how you are taking one or both of the medications, or
leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, decongestants, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Option-2

How effective is Plan B, and how long is it effective for?

Whether you forgot to take the pill or the condom broke, you still have an option for preventing pregnancy—but you have to act fast. Plan B One-Step is a morning-after pill that can prevent pregnancy after unprotected sex or birth control failure. Emergency contraception can offer peace of mind, but many women still wonder: How effective is Plan B?

How Plan B works

Plan B is a progesterone drug that contains the hormone levonorgestrel. Levonorgestrel prevents pregnancy in different ways, depending on where you are in your menstrual cycle. It can temporarily stop the release of an egg from an ovary or prevent a fertilized egg from attaching to the uterus. Plan B works if taken within 72 hours after a regular birth control method fails or within 72 hours after unprotected intercourse.

Once absorbed into the bloodstream, which usually takes a couple of hours, levonorgestrel starts to affect the ovaries or uterine lining. Although it’s rare, some women may throw up within two hours of taking a Plan B pill. If this happens to you, it’s best to follow up with your healthcare provider and ask whether or not you should take a second dose.

You can take Plan B at any time during your cycle, but it’s only meant to be used as an emergency contraceptive pill. Because taking an emergency contraceptive affects your hormones and fights your body’s natural functions, it can often cause side effects. Here are some of the most common side effects that women experience:

Nausea
Lower abdominal pain
Breast tenderness
Fatigue
Spotting/changes in menstrual bleeding
Dizziness
Headache

If you’ve taken Plan B and start to experience severe lower abdominal pain three to five weeks after taking it, you should seek medical advice as soon as possible. Having this specific side effect in this timeframe may mean that you have an ectopic pregnancy, which is a pregnancy that happens outside the uterus. Ectopic pregnancies can be life-threatening, which is why it’s so important to talk to a healthcare professional right away if you experience this symptom.

How effective is Plan B?

Plan B is a very effective emergency contraception pill. It works well to prevent pregnancy within three days of an unprotected sex act, but is most effective (>97%) when taken within 24 hours of the incident, says Madeline Sutton, OB-GYN, a medical epidemiologist and former Commissioned Corps Officer at the CDC. A morning-after pill like Plan B can prevent pregnancy 75% to 89% of the time if you take it within three days of unprotected sex.

Even though there’s no limit to how many times you can take Plan B, taking more than one dose won’t make it more effective. If you have unprotected sex again the day after taking Plan B, then you should take another dose. Take one pill for every act of unprotected sex, but remember that Plan B is not a substitute for regular birth control. Talk to your healthcare provider about the most appropriate form of birth control for you.

Who should

not take Plan B?

Even though Plan B is very effective, it isn’t right for everyone and is less effective under the following circumstances:

It’s less effective the longer you wait to take it, so take it as soon as possible.
It’s not effective if you’re already ovulating.

If you have a BMI that’s 30 or greater, a copper IUD or the Ella morning-after pill may be better options for you. The Paragard (copper) IUD is almost 99.9% effective at preventing pregnancy if it is put in within five days after unprotected sex, and once inserted, can prevent pregnancy for up to 12 years.

Ella emergency contraception works to prevent pregnancy up to five days after sex and lowers the risk of pregnancy by about 85%. However, you should not take Plan B or other morning-after pills containing levonorgestrel if you have taken Ella since your last period.

Note: Unlike the Plan B pill, the Ella morning-after pill requires a prescription from a doctor to obtain. The Paragard IUD is available by prescription and through your doctor or family planning clinic. You’ll need your OB-GYN to insert the IUD, so if you decide to go that route, call the office as soon as possible and explain the situation so they can bring you in quickly to insert the IUD.

Plan B interactions

Certain medications and herbs may also decrease the effectiveness of Plan B because they contain enzymes that reduce the concentration of progestins in the blood. Examples of such medicines and herbal products include:

Barbiturates
Bosentan
Carbamazepine
Felbamate
Griseofulvin
Oxcarbazepine
Phenytoin
Rifampin
St. John’s wort
Topiramate

Plan B does not prevent STDs

Another thing to be aware of is that Plan B doesn’t protect against sexually transmitted infections. The only way to protect yourself from HIV/AIDS, genital herpes, chlamydia, hepatitis, or other STDs is to correctly and consistently use latex condoms or practice abstinence. Some vaccines can prevent hepatitis B and HPV but will not protect against other STDs. The CDC recommends that children get their first dose of the HPV vaccine at age 11 to 12, but the vaccine is also recommended for everyone up to age 26 (and certain adults ages 27 to 45 years, depending on risk) if they haven’t been vaccinated.

RELATED: Should you get the hepatitis B vaccine?

How do you know if Plan B worked?

The only way to know if Plan B has prevented pregnancy is to wait for your next period. If your period arrives more than a week late, you may want to consider taking a pregnancy test. Some women will experience light bleeding after taking Plan B and may take this as a sign that it’s worked to prevent pregnancy. However, spotting is an expected side effect of the morning-after pill and isn’t an indication that it has or has not prevented pregnancy. Getting your period and/or a negative pregnancy test is the only way to know for sure.

Plan B is not an abortion pill and will not end a pregnancy if you’re already pregnant. If you’ve accidentally taken Plan B after you’re already pregnant, it’s good to know that there is no evidence to suggest that it’s harmful to developing babies. If it doesn’t work and you become pregnant, it’s unlikely that it will cause harm to you or your baby. Talking with your healthcare provider is the best way to learn about family planning methods that will work best for you.

How long is Plan B effective?

It’s best to take Plan B as soon as possible since it works best within the first three days. You can take it up to five days after unprotected sex, but it won’t work as well by the fifth day. Once ingested, it’s only effective for a maximum of about five days. After this amount of time, the hormones that were in the pill will have left the body. The maximum amount of time that it stays in the body coincides with the amount of time that sperm can live inside the female reproductive tract—about five to six days.

Bottom line—You can still get pregnant after taking Plan B

It’s important to note that you can still get pregnant even after taking Plan B. Also, if you take Plan B after unprotected sex and then have unprotected sex again, you’ll need to take another pill. A long-term form of birth control is the best way to prevent pregnancy. Long-term birth control options include the birth control pill, IUDs, implants, shots, patches, latex condoms, and vaginal rings (if used every time you have sex).

Where to buy Plan B

Adults can buy Plan B One-Step over-the-counter without a prescription at most drugstores and pharmacies. You can also get it from family planning centers or health department clinics.

Unfortunately, Plan B can be quite expensive at about $38 to $58 per pill. Most insurance companies will cover the cost if a healthcare provider prescribes it as an emergency contraceptive. If you’re not able to get a prescription, you may be able to get it for free or at a lower price from Planned Parenthood.

Another way to save money on the morning-after pill is SingleCare’s drug coupon. These coupons could give you discounts of up to 80% off, but you will need to seek a prescription from your provider first. SingleCare offers discounts on other forms of birth control, too. Learn how to find free birth control without health insurance here.

Levonorgestrel | Healthgrades | (tablet)

For more information or to speak to a healthcare professional, call 1-800-422-8689 or visit our website at www.mywaypill.com

Levonorgestrel Tablet

Emergency Contraceptive

What You Need to Know

What is Levonorgestrel Tablet?

Levonorgestrel Tablet is emergency contraception that helps prevent pregnancy after birth control failure or unprotected sex. It is a backup method of preventing pregnancy and should not be used as regular birth control.

What Levonorgestrel Tablet is not.

Levonorgestrel Tablet will not work if you are already pregnant and will not affect an existing pregnancy. Levonorgestrel Tablet will not protect you from HIV infection (the virus that causes AIDS) and other sexually transmitted diseases (STDs).

When should I use Levonorgestrel Tablet?

The sooner you take emergency contraception, the better it works. You should use Levonorgestrel Tablet within 72 hours (3 days) after you have had unprotected sex .

Levonorgestrel Tablet is a backup or emergency method of birth control you can use when:

your regular birth control was used incorrectly or failed
you did not use any birth control method

When not to use Levonorgestrel Tablet.

Levonorgestrel Tablet should not be used:

as a regular birth control method, because it’s not as effective as regular birth control.
if you are already pregnant, because it will not work.
if you are allergic to levonorgestrel or any other ingredients in Levonorgestrel Tablet.

When should I talk to a doctor or pharmacist?

Ask a doctor or pharmacist before use if you are taking efavirenz (HIV medication) or rifampin (tuberculosis treatment) or medication for seizures (epilepsy). These medications may reduce the effectiveness of Levonorgestrel Tablet and increase your chance of becoming pregnant. Your doctor may prescribe another form of emergency contraception that may not be affected by these medications.

How does Levonorgestrel Tablet work?

Levonorgestrel Tablet is one tablet with levonorgestrel, a hormone that has been used in many birth control pills for several decades. Levonorgestrel Tablet contains a higher dose of levonorgestrel than birth control pills, but works in a similar way to prevent pregnancy. It works mainly by stopping the release of an egg from the ovary. It is possible that Levonorgestrel Tablet may also work by preventing fertilization of an egg (the uniting of sperm with the egg) or by preventing attachment (implantation) to the uterus (womb).

How can I get the best results from Levonorgestrel Tablet?

You have 72 hours (3 days) to try to prevent pregnancy after birth control failure or unprotected sex. The sooner you take Levonorgestrel Tablet, the better it works.

How effective is Levonorgestrel Tablet?

If Levonorgestrel Tablet is taken as directed, it can significantly decrease the chance that you will get pregnant. About 7 out of every 8 women who would have gotten pregnant will not become pregnant.

How will I know Levonorgestrel Tablet worked?

You will know Levonorgestrel Tablet has been effective when you get your next period, which should come at the expected time, or within a week of the expected time. If your period is delayed beyond 1 week, it is possible you may be pregnant. You should get a pregnancy test and follow up with your healthcare professional.

Will I experience any side effects?

some women may have changes in their period, such as a period that is heavier or lighter or a period that is early or late. If your period is more than a week late, you may be pregnant.

if you have severe abdominal pain, you may have an ectopic pregnancy, and should get immediate medical attention.
when used as directed, Levonorgestrel Tablet is safe and effective. Side effects may include changes in your period, nausea, lower stomach (abdominal) pain, tiredness, headache, dizziness, and breast tenderness.
if you vomit within 2 hours of taking the medication, call a healthcare professional to find out if you should repeat the dose.

What if I still have questions about Levonorgestrel Tablet?

If you have questions or need more information, call 1-800-422-8689, or visit our website at www.mywaypill.com

Other Information

Keep out of reach of children:

In case of overdose, get medical help or contact a Poison Control Center right away at 1-800-222-1222.

Do not use if the blister seal is opened.

Store at room temperature 20–25°C (68–77°F).

Active ingredient: levonorgestrel 1.5 mg

Inactive ingredients: colloidal silicon dioxide, pregelatinized starch, lactose monohydrate magnesium stearate, and talc

Manufactured by:

Novel Laboratories, Inc

Somerset, NJ 08873

P16223000102 Rev. 09/2017

1-800-422-8689 www.mywaypill.com

First “ah”, and after “oh”: the action of postinor and escapel

Pleasure is followed by reckoning – this is how you can frighten lovers who turn on the brain not before, but after sex. By neglecting contraception, they run the risk of contracting a sexually transmitted infection and untimely becoming parents. If nothing will save you from the first, then you can try to fix the second – take an emergency pill.

Postcoital contraceptive drugs include postinor and escappel. They act quickly and give almost one hundred percent results due to the high content of the active active ingredient, namely levonorgestrel.

What happens in the female body?

The action of levonorgestrel is associated with hormonal changes in the menstrual cycle – a mechanism necessary for the implementation of fertility. This mechanism is controlled by hormones produced by the pituitary gland (GTG) and the ovaries. They do not act separately from each other, but are in a certain relationship. A decrease in the concentration of ovarian hormones leads to the active production of GTG, which in turn stimulates their production.If the ovaries have secreted too many hormonal substances, these substances suppress the secretion of GTH.

At the beginning of the menstrual cycle, the pituitary gland actively produces follicle-stimulating hormone, which is necessary for the maturation of the egg and the release of estrogens (female sex hormones). It is estrogens that make the endometrium grow, which is the primary stage in preparing the uterus for implantation of the ovum.

When the oocyte reaches full maturation, a signal from the central nervous system is sent, and, as a result, the hormonal background changes.The pituitary gland stops producing follicle-stimulating hormone and starts producing LH, a luteinizing hormone. Under its action, the bubble in which the egg sits bursts, and it begins its movement: first it enters the abdominal cavity, and then into the fallopian tube, where it is fertilized.

A bursting vesicle (follicle) is transformed into a corpus luteum, which works to produce progesterone. The task of the hormone is to stop the growth of the endometrium and force it to secrete. From this moment, the second phase of the cycle begins.

How do postinor and escapel show themselves?

The action of postinor and escapel is directly related to hormonal changes during the menstrual cycle, namely, with quantitative changes in progesterone. Emergency contraceptive pills contain a synthetic analogue of this hormone – the substance levonorgestrel. By the way, it is present in the composition of contraceptive drugs (COCs), but in much smaller quantities. In postinor and escapelle, there is much more levonorgestrel.For comparison: in tri-regol, the content of progesterone analog is in the range of 50 – 125 micrograms, and in postinor – 750 micrograms. This means that taking postcoital contraceptives triggers a hormonal bomb. Its overwhelming power interferes with the “renewal” of the reproductive system, thus preventing pregnancy.

To achieve a 100% effect, a woman has to take not one, but two progesterone pills (one pill in the escapel) with a time difference of 12 hours.

Emergency contraceptives are effective regardless of the day of the menstrual cycle. If the drug is taken in the first phase, levonorgestrel inhibits estrogen production, prevents the proliferation of the uterine lining layer, and prevents the maturation of the egg. If urgent measures are due to unprotected intercourse in the middle of the cycle, then the progesterone analog suppresses ovulation and does not allow LH levels to rise. Reception of postinor or escapel in the second phase of the menstrual cycle entails changes in the state of the endometrium: it ceases to be the optimal substance to support the life of a fertilized egg.

The effectiveness of the above drugs is related to the time of administration: the earlier the woman drank the pills, the higher the chances of not getting pregnant. The instructions say that the drug taken on the first day acts in 90% of cases, on the second day – in 80%, and on the third – only in 60%. If you drink the medicine on the fourth day after intercourse, there will be no contraceptive effect at all, so after three days it is pointless to take postinor or escapel.

Are emergency contraception drugs harmful?

Even a single dose of hormones in prohibitive amounts knocks down the menstrual cycle, so much so that it is restored within a few months, or even a year.In addition, taking postinor or escapel can provoke the development of gynecological diseases, up to infertility. This usually happens to those women who ignore the instructions and turn to emergency contraception several times during the same cycle.

A single pill intake undermines women’s health if the body is weakened. Side effects such as lower abdominal pain and intermenstrual bleeding may occur. Some women experience a long delay, it is possible that pregnancy may occur.Also, a side effect of the drug is manifested in dizziness, diarrhea, nausea and vomiting.

The use of progestogens increases the risk of blood clots, and this directly affects blood circulation in the vessels. As a result, complications can occur, including cerebrovascular accident.

Of course, taking emergency contraceptives is less evil than abortion. And yet you need to strictly follow the instructions so that a one-time mistake does not become a punishment for life.

How POSTINOR works – Postinor

POSTINOR prevents pregnancy before it occurs, contains the usual female sex hormone – levonorgestrel. This hormone prevents pregnancy by delaying the maturation of the egg or preventing ovulation (the release of the egg from the ovary) and thus preventing the fertilization of the egg.
Postinor will be effective if you are not yet pregnant (within 3 days after intercourse) and will not harm if you are already pregnant.
The sooner you take POSTINOR, the more effective it will be.

Is POSTINOR an abortion pill?

No, definitely not.
POSTINOR is an “emergency contraceptive pill” or “next day pill” containing levonorgestrel, a common female sex hormone. This hormone prevents pregnancy by delaying the maturation of the egg or preventing ovulation (the release of the egg from the ovary) and thus preventing the fertilization of the egg.
Emergency contraceptives containing levonorgestrel do not have a preventive effect on implantation and do not terminate a pregnancy (according to any definition of pregnancy onset), which means they do not have an abortive effect, do not terminate an existing pregnancy, and do not harm the fetus.

“Abortion” pills (called “medical abortion”) are completely different from emergency contraceptive pills. Abortive pills are taken later, their mechanism of action is different from emergency contraceptive pills: they stop the development of pregnancy after it begins.The abortion pill stops the development of an already existing pregnancy, and then initiates the removal of the products of conception from the uterus. These drugs are legal for early abortion, but not in all countries.
The use of abortion pills is much more strictly regulated than the use of emergency contraceptive pills. Unlike “emergency contraceptive pills,” “abortion pills” are never sold over the counter in pharmacies.

Additional

Frequently asked questions »

Scientists: new generation contraceptive pills are more dangerous for blood vessels – Society

MOSCOW, May 27./ TASS /. Oral contraceptives of new generations are more conducive to the formation of blood clots in blood vessels, scientists have found out, whose article was published in the scientific journal The BMJ.

Risk of developing venous thromboembolism

“This observational study, based on two primary care databases, showed that women who took contraceptives with drospirenone, gestodene, cyproterone, and desogestrel for at least 28 days had a fourfold increased risk of venous thromboembolism.In women who took pills with levonorgestrel, norethisterone and norgestimate, this risk was 2.5 times higher than in women who did not take these substances for a year, “writes Yana Vinogradova from the University of Nottingham (UK). and her colleagues.

In the world, about 9% of women of reproductive age take birth control pills. These drugs are known to increase the risk of blood clots forming in blood vessels. In their composition, these drugs differ, and by the time of their appearance they are conventionally divided into four generations.Second-generation tablets contain substances such as levonorgestrel and norgestimate. The later third and fourth generations include drugs with drospirenone, cyproterone and other substances.

Vinogradova and her colleagues found in the data they analyzed more than 10.5 thousand cases of venous thromboembolism in women aged 15 to 49 years. When processing the data, the researchers also took into account factors such as smoking, alcohol consumption, ethnic group, body weight, and others.The safest pills were those containing levonorgestrel and norgestimate, the most dangerous were desogestrel and cyproterone. The duration of admission did not matter.

The obtained results are not a reason to abandon oral contraceptives, however, different degrees of risk must be taken into account when choosing them, scientists say.

Baby kaput pills can ban

MPs Elena Mizulina (“Fair Russia”) and Sergei Popov (“United Russia”) have prepared a draft law allowing abortions only in public medical institutions and removing this type of medical care from the compulsory medical insurance system and services of private clinics.

A group of deputies has also prepared and will submit to the Chamber a draft law banning the retail sale of drugs intended for the artificial termination of pregnancy, or the so-called “baby-kaput” tablets.

According to TASS Mizulina, the amendments are proposed to make “medical abortions” carried out exclusively within the walls of state medical institutions under the supervision of qualified doctors. ”

“This initiative limits the circulation of medicines for artificial termination of pregnancy”, – said the deputy.According to her, “a frightening trend of growth in medical abortions has been recorded.”

The consequences of such procedures have not yet been thoroughly studied. Such drugs definitely should not be on the free market: only in medical institutions of state health care and by prescription of a doctor

Elena Mizulina

Deputy, head of the committee on family issues of women and children

90 000 What effect hormones have on varicose veins – Dobrobut clinic »

Let’s pay attention to the established statistical data

The prevalence of diseases of the veins of the lower extremities among women is on average 5 times higher than among men; the annual increase in the disease is 2.6% in women and 1.9% in men; the prevalence of CVI signs in pregnant women – up to 70%; in 50% of women during the 1st pregnancy, there are some signs of impaired venous outflow from the legs.The likelihood of CVI development increases 4.5 times in the presence of venous pathology in the mother, 3.5 times with prolonged hormonal therapy, 40% with repeated pregnancy and 2.6 times after three pregnancies.

With weakness of the venous wall, usually congenital, and impaired function of the valve apparatus, a pathological discharge of blood from deep veins into superficial ones occurs, which is the main cause of varicose veins. Of no small importance in the defeat of the saphenous veins are the structural features of the subcutaneous tissue of the limb.In women with well-developed, loose subcutaneous tissue, the saphenous veins are often thin-walled, tortuous. Uneven nodular expansion of thin veins occurs due to compression of their connective tissue bridges, dismembering the subcutaneous base into separate lobules. The possibility of inheriting the specified structure of subcutaneous tissue, primarily from the mother and much less often from the father, is noted. Women have a genetic predisposition to the development of varicose veins, the disease is observed in them 4-5 times more often than in men.Apparently, they are carriers of the “pathological gene”, and the disease will certainly manifest itself in one generation or another. This gene is recessive, linked to the female sex, and its influence may appear even after several generations. The main pathological effect of this gene is manifested in a congenital defect in the structure of the venous wall, in particular its collagen elastic layer (the ratio of collagen and elastic fibers). Such a defect is also manifested in the structure of the entire connective tissue of the body, i.e.Because collagen forms the basis – the “frame” of connective tissue, and this can manifest itself, in the future, in the development of diseases such as rheumatism, osteochondrosis, arthritis and arthrosis, vasculitis. In patients with varicose veins, it is very often possible to find concomitant diseases that have the same nature of occurrence – hernias, hemorrhoids, flat feet. It is also necessary to note certain features of the anatomical structure of the legs in women, such as less muscle mass and more fatty tissue, structural features of the fascial sheaths on the legs, which directly affects the functional load on the veins of the legs, as well as their resistance to various overloads.Regular fluctuations in hormonal levels also play an important role.

Despite the absence of fundamental differences, the veins in the male and female body are in different conditions. Hormonal secretion and its physiological changes (associated with pregnancy, menstrual cycle) explain why in the age period from 20 to 35 years, women suffer from varicose veins 6 times more often than men. This confirms the fact that in 61% of women with new-onset saphenous veins during pregnancy, the disease was preceded by various menstrual irregularities.The appearance of dilated veins is explained by the insufficient content of estrogens in the body and the predominance of corpus luteum hormones, which have a relaxing effect on the vein wall. The role of hormones is also indicated by the fact that before menstruation, women with varicose veins complain of pain in the legs and a feeling of heaviness, which after the end of menstruation are significantly reduced. A burning sensation of the skin is sometimes noted by women who have vascular “asterisks” on their legs

Estrogen and progesterone receptors are found in the venous walls of the reproductive organs – the uterus and mammary glands.However, the manifestations of the interaction between the veins and hormones go far beyond the direct effect on the hormonal receptors of the veins:

Certain substances released by sex hormones can affect the venous wall;
Steroid hormones can disturb the balance in the blood coagulation system.

Another factor associated with the high frequency of hormone therapy (in the form of contraceptives or hormone replacement therapy) also reflects new data on the effect of sex hormones on the vein wall:

The risk of developing superficial and deep venous reflux (reverse blood flow) is significantly increased in women taking hormonal contraceptives;

Substitution therapy during menopause reduces the risk of developing venous disorders, has a positive effect on skin and bone metabolism, in addition, significantly reduces the risk of thrombotic complications.

Very often, gynecologists have recently sent for a consultation with a phlebologist patients taking oral contraceptives and who have signs of venous insufficiency of the legs, when they cannot adequately assess the severity and danger of venous pathology. From the point of view of a phlebologist, the selection of a method of contraception should be balanced, a specialist should be guided by the principle of “risk-benefit”, and the decision should be made collectively. Of the many existing hormonal contraceptive drugs, it is necessary to choose those that are safer for blood vessels.

Main effects of hormones on veins:

ESTROGENS

PROGESTERONE

Direct effect on receptors

– vasodilatation

– thickening of the venous wall due to the thickening of all layers due to the deposition of immune complexes

– venous stasis due to a relaxing effect on smooth muscle fibers of the venous wall

Indirect effects

– regulation of glycemia (decreased glucose tolerance)

-regulation of lipids (increase in the synthesis of lipoproteins in the liver)
-changing the ratio of coagulation factors
-increased fibrinogen
-hyperagregation of platelets

– increase in the liver of protein synthesis of the blood coagulation system

– changes in fibrinolysis processes

With regard to the presence of signs and manifestations of venous insufficiency, in the presence of only certain complaints and concerns, if necessary, taking combined oral contraceptives (COCs) can be combined with a course of phlebotropic drugs.When the presence of changes in the skin vessels (asterisks, mesh) is noted, without signs of damage to the superficial veins, which is confirmed by ultrasound, it will be necessary to warn the patient about the negative and direct effect of the hormones taken on the vessels and the possible progression of changes, but this will only be a probability. Given that such vascular changes are in the nature of a cosmetic defect, the decision on taking COCs lies with the gynecologist and the patient herself. If such a patient has undergone a course of sclerotherapy, it will be mandatory to recommend adherence to a constant, seasonal regimen of compression therapy, without correlation with hormonal therapy.

In the case when the patient has varicose veins, this situation is very twofold. First, according to the latest evidence-based studies, varicose veins are not a contraindication for COC use for various purposes. However, this fact does not negate the pronounced negative effect of hormones on the veins, i.e. they can stimulate disease progression. Secondly, the presence of varicose veins is an indication for surgical treatment, with or without COCs.Therefore, in such a situation, it is necessary to solve the primary problem – to treat varicose veins, and then you can safely take COCs. A mandatory risk assessment for the use of OC should also include a comprehensive assessment of risk factors for the development of venous or thrombotic complications, which include age, and overweight, and smoking, and hereditary predisposition, and past diseases, and multiple (3 or more) or frequent pregnancies, and gynecological status, and features of the mode of life and work. But with any surgical treatment, it becomes necessary to stop, at least temporarily, the intake of hormonal drugs.In addition, it is very important to take into account the patient’s age, the presence of concomitant indications for taking hormonal drugs, for example, the need for hormone replacement therapy (HRT) in the pre- and postmenopausal period, as well as the birth history (number of pregnancies and childbirth) and further plans of the woman in relation of offspring.

The most serious complications when taking contraceptives can be vascular complications in the form of thrombosis, and their formation is dose-dependent. The more estrogen the drug contains, the higher the risk of developing thrombosis.When taking some contraceptives, smoking is prohibited, it causes the risks of developing strokes and heart attacks, so you need to select drugs taking into account your bad habits. A woman who smokes under the age of 35 can use combined oral contraceptives. If a woman is 35 years of age or older and smokes <15 cigarettes a day, these drugs are usually not recommended if there are other methods of contraception available and acceptable to her. If a woman is over 35, she smokes more than 15 cigarettes a day - she should not use combined oral contraceptives, as it is dangerous to her health, mainly due to the risk of myocardial infarction and stroke.

And yet, the gynecologist should still evaluate the methods and modes of contraception in the presence of varicose veins, of course, taking into account the recommendations of the phlebologist. In such a situation, it will be necessary to pass tests for sex hormones with the determination of hormonal levels, which will make it possible to rationally choose the drug. Regular detailed examinations of the gynecologist and a thorough examination once a year, as well as dynamic observation of the phlebologist with control of the ultrasound picture, will also be necessary.When selecting drugs, preference should be given to low-dose or micro-dose multiphase COCs containing third-generation progestogens.

New generation drugs not only protect a woman from unplanned pregnancy, but also have a beneficial effect on the body and mood of the woman as a whole: they have few side reactions, do not disrupt lipid metabolism, do not affect body weight, do not prevent fluid retention in the body, do not increase the risk of developing cardiovascular diseases, provide adequate control of the menstrual cycle and, therefore, the lowest frequency of menstrual dysfunctions, eliminate premenstrual symptoms and pain on the days of menstruation, have a positive effect on skin condition, hair growth, mood and general health of a woman.

Based on the foregoing, the following types of hormonal contraception can be distinguished, which are preferred for varicose veins:

Minipili are preparations containing microdoses of hormones. A daily constant intake is required.
Subcutaneous implants – silicone capsules containing hormones – gestagens. Sewn in through a small incision in the forearm. The effect lasts 5 years.
Hormone ring – for vaginal use, containing microscopic doses of hormones.Introduced once a month.
Injectable preparations – prolonged-acting progestogens. The effect lasts for 3 months. The injections must be repeated every 8-12 weeks.

So, what are the final conclusions

The use of oral contraceptives in the absence of varicose veins cannot be regarded as a risk factor for its development. By themselves, female sex hormones are not the cause of the disease. Rather, these drugs can contribute to the progression of an existing disease and the development of complications, and will also significantly reduce the effectiveness of the treatment, since they act in the opposite direction in relation to venotonic and blood thinning agents.Therefore, each woman should make a decision on the use of just such a method of contraception after consulting a specialist and determining the presence of risk factors.

If there is a hereditary predisposition, as well as other risk factors for varicose veins, for example, standing or sedentary work, then it is better to refrain from taking oral hormones, especially if there is an alternative, and in cases with methods of contraception, it is always there.

In case of already existing varicose veins, the decision on the appointment of hormonal drugs is made only by a doctor.In this case, it is strictly contraindicated to independently use oral contraceptives, since in the presence of varicose veins, the likelihood of thrombosis in the vessels of the lower extremities or hemorrhoidal veins sharply increases.

Thus, contraceptive pills for varicose veins should not be used to prevent unwanted pregnancy, hormones can only be used to treat gynecological pathology, if the potential benefits outweigh the risks.With severe varicose veins, hormone treatment, as a rule, is not prescribed at all, and if it is necessary to resort to it, then only “under the cover” of antiplatelet agents or anticoagulants.

Contraception is prescribed taking into account many external and internal factors, and above all, the selection is based on age. It is clear that the selection of drugs for contraception remains the prerogative of gynecologists.

Preparations for adolescents (under 19 years of age)

For adolescent girls, the main use for use are combined oral preparations that contain minimal doses of estrogen and progesterone, the so-called third-generation drugs.The most suitable for teenage girls are “Trikvalar”, “Triziston”, “Tri-regol”. In addition, single-phase drugs such as “Marvelon”, “Silest”, “Femoden” or “Mersilon” can be used. They can perfectly regulate the flow of menstruation and even out the unstable cycle.

Preparations for young women

Preparations for women of the most active reproductive period from 19 to 33-35 years old can be used in a fairly wide range – they can use almost all of the known contraceptives.in addition to oral contraceptive drugs among women of this age, intrauterine devices, condoms, and injectable contraceptive drugs can be used. In addition, it has been proven that contraceptive drugs are usually used not only for their main effect (to protect against unplanned pregnancy), but also for therapeutic purposes, they are used for prophylactic purposes in diseases such as secondary infertility, oncological pathology, inflammatory processes in the genital system, and also helps to align the menstrual cycle.

To protect young women from unwanted pregnancy, the most recommended drugs with microdoses of hormones, such drugs as “Yarina”, “Janine” or “Regulon”.

Drugs after 35 years

Which of the drugs are most recommended for women who have crossed the age of 35? Often, doctors say that women at this age should protect themselves from unwanted pregnancy with intrauterine devices, since at the age of over 35 there are already many acquired diseases in which hormonal drugs may be contraindicated.So, the issue of oral contraception is very difficult for pathologies of the cervix, endometriosis, for endocrine pathologies – overweight, hyperthyroidism, diabetes mellitus. In addition, many women today smoke, which also complicates the selection of drugs. The drugs will be prescribed only with the guaranteed absence of the fact that there are even the slightest contraindications.

Preference at this age is given to combined oral contraception of the third generation and three-phase drugs – “Tri-regol”, “Femoden”, “Triziston”, “Trikvilar”, “Silest”, “Marvelon”.Also, this group of patients is perfectly suited for drugs with a low content of hormones, drugs “mini-drank”. Hormonal contraception is combined with the parallel therapeutic effect of modern oral contraceptives. So, the drug “Femulen” can be used in women with thrombophlebitis, previous strokes or heart attacks, hypertension, migraine-like headaches and many of the gynecological diseases.

Preparations for women after 45 years

After 45 years, many of the women have a second round of sexuality – as they say, “baba berry again”, and then the question of pregnancy is no less acute than at a young age.Although at this age, the functions of their own ovaries begin to gradually fade away, the likelihood of an unwanted pregnancy decreases sharply, but it is still quite possible. Many women still successfully ovulate and can become pregnant, bear and give birth, but not many dare to do so. Pregnancies at this age are associated with many difficulties in terms of health, there may already be a fairly large set of chronic pathologies in the form of diseases of the heart or blood vessels, problems with the kidneys or liver, problems in the functioning of the reproductive organs.The same diseases can cause contraindications not only for pregnancy, but also for taking oral contraceptives.

In addition, a woman’s smoking or other bad habits may become an obstacle to prescribing drugs at this age. Often, women over 40-45 years old do not plan pregnancy and, if they occur, they are interrupted, which has an extremely negative effect on their health. Medical abortion at this age can have extremely negative consequences for a woman’s health.There may be complications such as uterine fibroids, the development of cancer, severe premenopause and menopause. The likelihood of developing such diseases makes the issue of contraception quite acute. Contraceptive drugs are prescribed to women not only to protect against pregnancy, but also to prevent and treat osteoporosis, uterine or ovarian cancer.

In the period after 45 years, the prescription of such drugs as low-dose oral tablets, mini-pills, implants and injectable forms of hormones that have a long effect is considered to be especially correct.Combined oral contraceptive drugs are prohibited in women over 45 with smoking, heart and vascular diseases with thrombosis, heart attacks and strokes, diabetes mellitus, liver problems, and severe obesity of a woman.

We wish you good health, if you have any questions, do not hesitate to contact our specialists for advice and they will professionally help you deal with your problems.

The article was prepared by a vascular surgeon of the highest category, phlebologist Gerasimov Vladimir Vladimirovich.

To receive information about treatment and make an appointment, call the Dobrobut MS Contact Center:

044 495 2 888 or 097 495 2 888

Phlebologist consultation
Varicose veins during pregnancy

Clinical Trial Contraception: Levonorgestrel-Releasing IUD (Mirena) – Clinical Trials Registry

Detailed Description	The United States (USA) has the highest rate of unwanted pregnancies of any developed country.Of the 6.4 million pregnancies in the United States each year, nearly half are unplanned (49%). About half of them (22% of all pregnancies) result in unplanned births, and 20% of all pregnancies end in abortion. Postpartum women are particularly susceptible, with an unwanted pregnancy rate of 10–44% in the first year after birth. These unintended pregnancies occur despite the recommendation to choose a contraceptive method prior to hospital discharge. Given the high incidence of unwanted pregnancies in the United States, especially in the postpartum period, women need reliable, effective, and long-term contraceptives such as the IUD for postpartum women.Post-placental administration of intrauterine contraception will help solve this need. The IUD is a very effective but underutilized method of postpartum contraception. Although the rate of expulsion with postplacental placement is higher than with interval placement, the benefits of highly effective contraception available immediately postpartum may outweigh the risks of expulsion. To date, there have been no randomized trials of postplacental administration of the LNG-IUD in the United States. One pilot study in the United States of 20 subjects who evaluated ultrasound-guided post-placental LNG-IUD insertion showed an acceptable ejection rate of 10% and no infection at 10-week follow-up, making post-placental LNG-IUD insertion safe for further study.This is a randomized controlled trial comparing the use of a levonorgestrel-releasing intrauterine device (LNG-IUS) for post-placental placement after vaginal delivery or delayed placement 6–8 weeks after delivery. One hundred and sixty-eight women receiving antenatal care at Magee-Womens Hospital, Pittsburgh, PA who are interested in using the LNG-IUD for contraception will be registered during pregnancy. The IUD will be inserted within 10 minutes after delivery of the placenta to women who are randomized for immediate insertion.Delayed IUD insertion will be performed during the first postpartum visit 6-8 months later. weeks. All subjects will be observed in person at 6-8 weeks and 6 months after delivery. A telephone interview will be conducted 3 months after delivery in all subjects. Subjects who are not eligible for inclusion due to ineligibility criteria after randomization will be referred to their chief gynecologist or midwife for delayed IUD insertion. They will contact you by phone in 3 and 6 months to assess quality of life, contraception use, and unwanted pregnancy rates.

Detailed Description

The United States (USA) has the highest rate of unwanted pregnancies of any developed country.Of the 6.4 million pregnancies in the United States each year, nearly half are unplanned (49%). About half of them (22% of all pregnancies) result in unplanned births, and 20% of all pregnancies end in abortion. Postpartum women are particularly susceptible, with an unwanted pregnancy rate of 10–44% in the first year after birth. These unintended pregnancies occur despite the recommendation to choose a contraceptive method prior to hospital discharge. Given the high incidence of unwanted pregnancies in the United States, especially in the postpartum period, women need reliable, effective, and long-term contraceptives such as the IUD for postpartum women.Post-placental administration of intrauterine contraception will help solve this need. The IUD is a very effective but underutilized method of postpartum contraception. Although the rate of expulsion with postplacental placement is higher than with interval placement, the benefits of highly effective contraception available immediately postpartum may outweigh the risks of expulsion. To date, there have been no randomized trials of postplacental administration of the LNG-IUD in the United States. One pilot study in the United States of 20 subjects who evaluated ultrasound-guided post-placental LNG-IUD insertion showed an acceptable ejection rate of 10% and no infection at 10-week follow-up, making post-placental LNG-IUD insertion safe for further study.This is a randomized controlled trial comparing the use of a levonorgestrel-releasing intrauterine device (LNG-IUS) for post-placental placement after vaginal delivery or delayed placement 6–8 weeks after delivery. One hundred and sixty-eight women receiving antenatal care at Magee-Womens Hospital, Pittsburgh, PA who are interested in using the LNG-IUD for contraception will be registered during pregnancy. The IUD will be inserted within 10 minutes after delivery of the placenta to women who are randomized for immediate insertion.Delayed IUD insertion will be performed during the first postpartum visit 6-8 months later. weeks. All subjects will be observed in person at 6-8 weeks and 6 months after delivery. A telephone interview will be conducted 3 months after delivery in all subjects. Subjects who are not eligible for inclusion due to ineligibility criteria after randomization will be referred to their chief gynecologist or midwife for delayed IUD insertion. They will contact you by phone in 3 and 6 months to assess quality of life, contraception use, and unwanted pregnancy rates.

Individual selection of contraceptives in Es Klass Clinics. Modern contraception in Stavropol

Today there are a huge number of contraceptives. Any woman can go to a pharmacy and buy a contraceptive she likes. But, despite the availability of drugs, you should not purchase them, because your friend praises this tool or your good friend advised.

Without understanding the mechanism of action of contraceptives, you can harm your health.Therefore, in choosing a contraceptive that is right for you, the main rule is a mandatory visit to a doctor.

Gynecologists of Es Class Clinics Stavropol, based on examinations and analyzes, will help you choose the best method of protection, taking into account the individual characteristics of your body and contraindications.

Consider the main groups of contraceptives:

Oral or contraceptive pills are the most common method of contraception today.Around the world, about one hundred and fifty million women use the contraceptive pill.

The mechanism of action of hormonal tablets depends on the substances of which they are composed. Modern hormonal contraception serves not only to protect against unwanted pregnancies. In addition to the contraceptive, hormonal pills have a healing effect. Taking hormonal contraceptives makes it easier for women to develop inflammatory diseases.

Oral contraception has a number of advantages over other methods of contraception:

The effectiveness of protection against unwanted pregnancy is higher than 99%
For women of all ages, depending on the composition, there are “own” oral contraceptive pills
Regulate the menstrual cycle
Reduces the volume of blood loss during menstruation.Also, menstruation becomes painless 90 105
Used for the prevention of mastopathy, ovarian cancer, endometriosis, ovarian cysts
Cosmetic effect – improves skin condition

But – contraceptive pills must be taken every day: missing even one pill can lead to a decrease in the effect and the onset of pregnancy.

The intrauterine device (IUD) allows you to forget about the need to take contraceptive pills every day.This method of protection against unwanted pregnancy is based on the introduction of special devices into the uterine cavity that prevent the fertilization of the egg. The spiral is installed for a period of 3 to 5 years.

Hormonal intrauterine system “Mirena”

It occupies an intermediate position between the IUD and oral contraceptives. “Mirena” is similar in shape to an ordinary T-shaped spiral. The difference lies in the presence of a container with the hormone levonorgestrel. The Mirena system daily releases a small amount of levonorgestrel into the woman’s body (10 times less than one oral contraceptive pill).

“Mirena” provides reversible contraception, and at the request of the patient can be removed by the gynecologist at any time.

Efficiency – 98%
Menstruation becomes more comfortable for a woman – scanty and painless
Myomatous nodes decrease; foci of endometriosis are resolved
The dose of hormones is very small
Pregnancy is indicated the next month after the removal of Mirena
It is possible to install a hormonal intrauterine system in women who are breastfeeding.

Vaginal hormone rings

Vaginal hormone rings are made from hypoallergenic materials and are impregnated with hormonal agents, from which a small amount of hormones that suppress ovulation are regularly released.
High contraceptive efficiency
A woman sets the ring on her own once a month (from one menstrual cycle to the next)

Ethinylestradiol + Levonorgestrel – instructions for use

Levonorgestrel

Absorption

After oral administration, levonorgestrel is rapidly and completely absorbed, the maximum plasma concentration (C _max), equal to 3-4 ng / ml, is reached after about 1 hour.The oral bioavailability of levonorgestrel is almost complete.

Distribution

Levonorgestrel binds to plasma albumin and sex hormone-binding globulin. Free form in blood plasma is only about 1.3% of the total concentration of levonorgestrel; about 64% are specifically bound to globulin that binds sex hormones and about 35% are nonspecifically bound to albumin. The induction of sex hormone binding globulin synthesis by ethinyl estradiol affects the binding of levonorgestrel to plasma proteins, causing an increase in the fraction associated with sex hormone binding globulin and a decrease in the fraction associated with albumin.The apparent volume of distribution (V _d) of levonorgestrel is about 184 liters after a single dose.

Biotransformation

Levonorgestrel is extensively metabolized. The main metabolites in blood plasma are unconjugated and conjugated forms of 3α, 5β-tetrahydrolevonorgestrel. According to in vitro and in vivo studies, the main enzyme involved in the metabolism of levonorgestrel is CYP3A4. Plasma clearance is 1.3–1.6 ml / min / kg.

Excretion

Plasma levonorgestrel concentration decreases in two phases. The half-life (T _½) in the terminal phase is 20-23 hours. Levonorgestrel is not excreted unchanged, metabolites are excreted by the kidneys and through the intestines in a ratio of approximately 1: 1 with T _½ about 24 hours.

Equilibrium concentration

As a result of daily intake, the concentration of levonorgestrel in the blood plasma increases approximately 3-4 times, reaching an equilibrium concentration (C _ss) in the second half of the cycle of use.The pharmacokinetics of levonorgestrel is influenced by the concentration of sex hormone-binding globulin in the blood plasma, which increases by about 1.7 times when levonorgestrel is used together with ethinyl estradiol. At C _ss, the clearance rate is reduced to about 0.7 ml / min / kg.

Ethinylestradiol

Absorption

Ethinylestradiol is rapidly and completely absorbed after oral administration. C _max in blood plasma, equal to approximately 95 pg / ml, is achieved in 1-2 hours.During absorption and the first passage through the liver, ethinyl estradiol is metabolized, as a result of which its oral bioavailability averages about 45% (individual differences within 20–65%).

Distribution

Ethinylestradiol is almost completely (approximately 98%), albeit nonspecifically, bound to albumin. Ethinylestradiol induces the synthesis of sex hormone-binding globulin. The apparent V _d of ethinyl estradiol is 2.8–8.6 l / kg.

Biotransformation

Ethinylestradiol undergoes presystemic conjugation both in the mucous membrane of the small intestine and in the liver. The main metabolic pathway is aromatic hydroxylation. The clearance rate from blood plasma is 2.3–7 ml / min / kg.

Elimination

The decrease in the concentration of ethinyl estradiol in the blood plasma is biphasic; the first phase is characterized by T _½ about 1 hour, the second – 10–20 hours. It is not excreted unchanged from the body.Ethinylestradiol metabolites are excreted by the kidneys and through the intestines in a ratio of 4: 6 with T _½ about 24 hours.

Equilibrium concentration

With daily oral intake, the concentration of ethinyl estradiol in the blood plasma slightly increases, reaching C _max 114 pg / ml at the end of the cycle.

What does levonorgestrel do: Levonorgestrel: MedlinePlus Drug Information

Levonorgestrel/Ethinyl Estradiol-Ee 13 Week Contraceptive – Oral

Important: How To Use This Information

Warning

Uses

How To Use

Side Effects

Precautions

Drug Interactions

Overdose

Notes

Missed Dose

Storage

Levonorgestrel – StatPearls – NCBI Bookshelf

Continuing Education Activity

Indications

Mechanism of Action

Administration

Contraindications

Monitoring

Toxicity

Enhancing Healthcare Team Outcomes

References

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Additional

Frequently asked questions »

Scientists: new generation contraceptive pills are more dangerous for blood vessels – Society

Risk of developing venous thromboembolism

Baby kaput pills can ban

Let’s pay attention to the established statistical data

Main effects of hormones on veins:

So, what are the final conclusions

Preparations for adolescents (under 19 years of age)

Preparations for young women

Drugs after 35 years

Preparations for women after 45 years

Clinical Trial Contraception: Levonorgestrel-Releasing IUD (Mirena) – Clinical Trials Registry

Individual selection of contraceptives in Es Klass Clinics. Modern contraception in Stavropol

Ethinylestradiol + Levonorgestrel – instructions for use

Levonorgestrel

Absorption

Distribution

Biotransformation

Excretion

Equilibrium concentration

Ethinylestradiol

Absorption

Distribution

Biotransformation