Oral Levonorgestrel

The Basics

What is Oral Levonorgestrel?

Used as an emergency contraceptive or backup birth control.

Brand names for Oral Levonorgestrel

Norplant

How Oral Levonorgestrel is classified

Contraceptives, Contraceptives – Oral and Synthetic, Contraceptives – Postcoital

Oral Levonorgestrel During Pregnancy

Oral Levonorgestrel pregnancy category

Category XNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Oral Levonorgestrel while pregnant

N/A

Taking Oral Levonorgestrel While Breastfeeding

What are recommendations for lactation if you're taking Oral Levonorgestrel?

This record contains information specific to oral levonorgestrel used alone. Those with an interest in a combination oral contraceptive should consult the record entitled, Contraceptives, Oral, Combined. Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[1][2][3][4] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[5][6][7] After use of levonorgestrel as a postcoital contraceptive, nursing can resume 3 to 4 hours after the dose (or after each dose if the two-dose method is used). Postcoital levonorgestrel appears to have no long-term adverse effects on breastfeeding or the infant.[8][9][10][11]

Maternal / infant drug levels

This record contains information specific to oral levonorgestrel used alone. Those with an interest in a combination oral contraceptive should consult the record entitled, Contraceptives, Oral, Combined. Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[1][2][3][4] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[5][6][7] After use of levonorgestrel as a postcoital contraceptive, nursing can resume 3 to 4 hours after the dose (or after each dose if the two-dose method is used). Postcoital levonorgestrel appears to have no long-term adverse effects on breastfeeding or the infant.[8][9][10][11]

Possible effects of Oral Levonorgestrel on milk supply

Among a cohort study of 71 women who took levonorgestrel as a postcoital contraceptive during nursing, none reported any obvious decrease in milk supply after the drug was used.[8]

A study of 1158 postpartum randomized women using the lactational amenorrhea method (LAM) for birth control randomized to be given levonorgestrel as a postcoital contraceptive or given nothing. No difference in the duration of breastfeeding was found between women who used the levonorgestrel and those who did not.[9]

In a nonrandomized, nonblinded study comparing women who were breastfeeding at discharge, 102 postpartum women received depot medroxyprogesterone acetate (dosage not stated) in the early postpartum period (average 51.9 hours postpartum; range 6.25 to 132 hours), 181 received another progestin-only contraceptive and 138 used nonhormonal contraception. No differences in breastfeeding rates were seen at 2 and 6 weeks, but women receiving any hormonal contraceptive were breastfeeding at a lower rate (72.1% vs 77.6%) at 4 weeks postpartum. The authors concluded that progestin-only contraception initiated in the early postpartum period had no adverse effects on breastfeeding rates.[22]

A study analyzed data from a prospective cohort study of U.S. women from May 2005 through June 2007. Women were followed from the third trimester of pregnancy throughout the first year postpartum. Data from the subset of women who professed intrended breastfeed for 3 months or longer postpartum during their third trimester of pregnancy and who were using a contraceptive at 3 months postpartum were analyzed (n = 1349). Women who intended to breastfeed for at least 4 months and were taking a progestin-only oral contraceptive, such as levonorgestrel, were 3.15 times more likely to be breastfeeding (exclusive or nonexclusive) at 4 months than women who used a nonhormonal contraceptive. Women who said they would breastfeed for 3 to 4 months had 4-month breastfeeding rates equivalent to those using a nonhormonal contraceptive. These rates were much higher than those of women who were taking an estrogen-containing, combined oral contraceptive.[23]

In a cohort study, women (n = 100) who used at least one dose of levonorgestrel as a postcoital contraceptive in addition to the lactational-amenorrhea method (LAM) of birth control were compared to mothers used LAM only (n = 100). No difference was found in the mothers’ subjective opinions of their milk supplies.[11]

Possible alternatives to Oral Levonorgestrel

Etonogestrel, Intrauterine Copper Contraceptive, Medroxyprogesterone Acetate, Norethindrone.