levonorgestrel: clinical use

Prescribing considerations

• Identify the intended formulation and indication: oral emergency contraception and Jaydess are not interchangeable.
• Before oral emergency use, assess possible existing pregnancy, menstrual history, further unprotected intercourse, severe malabsorption, significant liver disease, ectopic-pregnancy risk and enzyme-inducing medicines.
• The selected oral product contains lactose.
• Before Jaydess insertion, exclude pregnancy, assess pelvic infection and STI risk, investigate unexplained bleeding and confirm that uterine anatomy permits correct placement.
• Counsel that neither formulation protects against sexually transmitted infections.

Contraindications and cautions

• Oral product: hypersensitivity to levonorgestrel or an excipient.
• Jaydess: pregnancy; current or recurrent pelvic inflammatory disease; acute cervicitis or vaginitis; recent postpartum endometritis or infected abortion; unresolved cervical intraepithelial neoplasia; uterine or cervical malignancy; progestogen-sensitive tumour; unexplained uterine bleeding; cavity-distorting uterine abnormality; acute liver disease or liver tumour; or hypersensitivity.

Monitoring

• After Jaydess insertion, review placement and threads, then reassess periodically or when clinically indicated.
• Investigate missing threads, new heavy bleeding, pain, pregnancy symptoms or suspected expulsion using examination and imaging where appropriate.
• If pregnancy occurs with Jaydess, establish pregnancy location promptly.
• Review troublesome bleeding, infection symptoms or significant mood changes.

Clinical pharmacology

Levonorgestrel is a synthetic progestogen. Oral emergency use primarily inhibits or delays ovulation before implantation. Jaydess produces high local endometrial exposure, thickens cervical mucus and impairs sperm function while maintaining low systemic exposure relative to its local effect.

Formulation and product differences

• The oral emergency product is a lactose-containing tablet intended for occasional use.
• Jaydess is a sterile, single-use, T-shaped intrauterine system with removal threads and a silver ring for imaging identification.
• Jaydess requires trained insertion and removal and is not established for emergency contraception, heavy menstrual bleeding or endometrial protection during oestrogen therapy.

Tablet

Route: Oral

Strengths: 1500 micrograms, 1.5 mg