Active Ingredient: Levonorgestrel
Contraception for up to 3 years.
For this indication, competent medicine agencies globally authorize below treatments:
Intrauterine
13.5 - 13.5 mg
From 13.5 To 13.5 mg once every day
It is recommended that levonorgestrel should only be inserted by physicians/healthcare providers who are experienced in IUS insertions and/ or have undergone training on the levonorgestrel insertion procedure.
Levonorgestrel is to be inserted into the uterine cavity within seven days of the onset of menstruation. Levonorgestrel can be replaced by a new system at any time in the cycle. Levonorgestrel can also be inserted immediately after first trimester abortion.
Postpartum insertions should be postponed until the uterus is fully involuted, however not earlier than six weeks after delivery. If involution is substantially delayed, consider waiting until 12 weeks postpartum.
In case of a difficult insertion and/ or exceptional pain or bleeding during or after insertion, the possibility of perforation should be considered and appropriate steps should be taken, such as physical examination and ultrasound. Physical examination alone may not be sufficient to exclude partial perforation, which may have occurred even if the threads are still visible.
Levonorgestrel can be distinguished from other IUSs by the combination of the visibility of the silver ring on ultrasound and the brown colour of the removal threads. The T-frame of levonorgestrel contains barium sulphate which makes it visible in X-ray examination.
Levonorgestrel is removed by gently pulling on the threads with a forceps. If the threads are not visible and the system is found to be in the uterine cavity on ultrasound exam, it may be removed using a narrow forceps. This may require dilatation of the cervical canal or surgical intervention.
The system should be removed no later than by the end of the third year. If the woman wishes to continue using the same method, a new system can be inserted immediately following removal of the original system.
If pregnancy is not desired, the removal should be carried out within 7 days of the onset of menstruation, provided the woman is experiencing regular menses. If the system is removed at some other time during the cycle or the woman does not experience regular menses and the woman has had intercourse within a week, she is at risk of pregnancy. To ensure continuous contraception a new system should be immediately inserted or an alternative contraceptive method should have been initiated.
After removal of levonorgestrel, the system should be examined to ensure that it is intact.
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