Last update: Dec. 13, 2019

Levonorgestrel

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

Progestin containing contraceptive drug that is used as a single dose for oral, subcutaneous implant, intrauterine device (IUD), or emergency contraception administration.
Also marketed in association with ethinylestradiol

Levonorgestrel is a progestin, and active metabolite isomer of norgestrel, both derived from nortestosterone.
It is excreted in breast milk in clinically non-significant amount (Gainer 2007, Betrabet 1987, Toddywalla 1980, Nilsson 1977, Saxena 1977), and nono short and long-term growth and development problems have been observed in infants whose mothers were treated (Shaaban 2019 y 2013, Polakow 2013, Shaamash 2005, Schiappacasse 2002, WHO 1994, McCann 1989). The plasma levels of these infants were undetectable or very low (Bassol 2002, Patel 1994, (Betrabet 1987, Nilsson 1977).

A decrease in TSH has been observed in mothers carrying 6 months of levonorgestrel implants and in their breastfed infants (Bassol 2002); TSH was not below the normal limit.

Levonorgestrel and progestogens are generally considered contraceptive drugs of choice during lactation since they neither alter the quantity and composition of milk nor cause side effects on both growth of infants and the duration of breastfeeding (Shaaban 2019, Goulding 2018, Polakow 2013, Bahamondes 2013, Shaamash 2005).
Published study results have shown protection against breast bone mass loss with the use of progestin-only contraceptives (Costa 2012).

Early insertion, postpartum versus the 4th-6th week, of an intrauterine device with levonorgestrel is associated with decreased breastfeeding duration (Chen 2011).
For the first 6 weeks postpartum, non-hormonal methods are of choise. There is a debate on the role of progestin-related drugs in decreasing milk production when used before lactation has been fully established.

Several medical societies, experts and expert consensus, consider the use of this medication to be safe during breastfeeding (CDC 2016, 2013 y 2010, Phillips 2016, Berens 2015, WHO-OMS 2015, Mwalwanda 2013, FFPRHC 2004, Halderman 2002, Díaz 2002); levonorgestrel oral pills being acceptable from the first postpartum day.
The American Academy of Pediatrics states that this medication is usually compatible with breastfeeding (AAP 2001).
WHO List of Essential Medicines 2002: rates it as compatible with breastfeeding after the 6th postnatal week (WHO 2002).


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Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Levonorgestrel is also known as


Levonorgestrel in other languages or writings:

Group

Levonorgestrel belongs to this group or family:

Tradenames

Main tradenames from several countries containing Levonorgestrel in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 312 daltons
Protein Binding 97 %
Tmax 1 - 2 hours
T1/2 24 - 45 hours
M/P ratio 0,4 -
Theoretical Dose 0,00005 - 0,00015 mg/Kg/d
Relative Dose 0,1 - 1 %

References

  1. Shaaban OM, Abbas AM, Mahmoud HR, Yones EM, Mahmoud A, Zakherah MS. Levonorgestrel emergency contraceptive pills use during breastfeeding; effect on infants' health and development. J Matern Fetal Neonatal Med. 2019 Aug;32(15):2524-2528. Abstract
  2. Goulding AN, Wouk K, Stuebe AM. Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed. Breastfeed Med. 2018 Jan/Feb;13(1):75-80. Abstract
  3. Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception. 2016;94:226-52. Abstract Full text (link to original source) Full text (in our servers)
  4. CDC - 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. CDC - MMWR Recommendations & Reports. 2016 Abstract Full text (link to original source) Full text (in our servers)
  5. Berens P, Labbok M; Academy of Breastfeeding Medicine. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  6. WHO. Department of Reproductive Health and Research World Health Organization. Medical Eligibility Criteria for Contraceptive Use. WHO/RHR/15.07. 2015 Abstract Full text (link to original source) Full text (in our servers)
  7. OMS. Criterios médicos de elegibilidad para el uso de anticonceptivos Quinta edición. Who Library. 2015 Full text (link to original source) Full text (in our servers)
  8. Berens P, Labbok M; Academy of Breastfeeding Medicine. Protocolo clínico de la ABM n.º 13: Anticoncepción durante la lactancia, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source) Full text (in our servers)
  9. CDC. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep. 2013 Abstract Full text (link to original source) Full text (in our servers)
  10. Bahamondes L, Bahamondes MV, Modesto W, Tilley IB, Magalhães A, Pinto e Silva JL, Amaral E, Mishell DR Jr. Effect of hormonal contraceptives during breastfeeding on infant's milk ingestion and growth. Fertil Steril. 2013 Abstract Full text (link to original source) Full text (in our servers)
  11. Shaaban OM, Hassen SG, Nour SA, Kames MA, Yones EM. Emergency contraceptive pills as a backup for lactational amenorrhea method (LAM) of contraception: a randomized controlled trial. Contraception. 2013 Abstract
  12. Polakow-Farkash S, Gilad O, Merlob P, Stahl B, Yogev Y, Klinger G. Levonorgestrel used for emergency contraception during lactation-a prospective observational cohort study on maternal and infant safety. J Matern Fetal Neonatal Med. 2013 Feb;26(3):219-21. Abstract
  13. Mwalwanda CS, Black KI. Immediate post-partum initiation of intrauterine contraception and implants: a review of the safety and guidelines for use. Aust N Z J Obstet Gynaecol. 2013 Abstract
  14. Costa ML, Cecatti JG, Krupa FG, Rehder PM, Sousa MH, Costa-Paiva L. Progestin-only contraception prevents bone loss in postpartum breastfeeding women. Contraception. 2012 Abstract
  15. Chen BA, Reeves MF, Creinin MD, Schwarz EB. Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration. Contraception. 2011 Abstract Full text (in our servers)
  16. Centers for Disease Control and Prevention (CDC). U S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep. 2010 Abstract Full text (link to original source) Full text (in our servers)
  17. Gainer E, Massai R, Lillo S, Reyes V, Forcelledo ML, Caviedes R, Villarroel C, Bouyer J. Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception. Hum Reprod. 2007 Jun;22(6):1578-84. Epub 2007 Mar 2. Abstract Full text (in our servers)
  18. Shaamash AH, Sayed GH, Hussien MM, Shaaban MM. A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Contraception. 2005 Abstract
  19. FFPRHC: Faculty of Family Planning & Reproductive Health Care. Guidance (July 2004): Contraceptive choices for breastfeeding women. J Fam Plann Reprod Health Care. 2004 Abstract Full text (link to original source) Full text (in our servers)
  20. Halderman LD, Nelson AL. Impact of early postpartum administration of progestin-only hormonal contraceptives compared with nonhormonal contraceptives on short-term breast-feeding patterns. Am J Obstet Gynecol. 2002 Abstract
  21. Díaz S. Contraceptive implants and lactation. Contraception. 2002 Abstract
  22. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  23. Schiappacasse V, Díaz S, Zepeda A, Alvarado R, Herreros C. Health and growth of infants breastfed by Norplant contraceptive implants users: a six-year follow-up study. Contraception. 2002 Abstract
  24. Bassol S, Nava-Hernandez MP, Hernandez-Morales C, Trujillo-Macias AM, Lopez-Lozano MR, Recio R. Effects of levonorgestrel implant upon TSH and LH levels in male infants during lactation. Int J Gynaecol Obstet. 2002 Abstract
  25. Harwood B, Mishell DR Jr. Contraceptive vaginal rings. Semin Reprod Med. 2001 Abstract
  26. Kunz J. [Levonorgestrel releasing intrauterine spiral--contraception and therapeutic indications]. Praxis (Bern 1994). 2001 Abstract
  27. Meckstroth KR, Darney PD. Implant contraception. Semin Reprod Med. 2001 Abstract
  28. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  29. Dórea JG. Oral contraceptives do not affect magnesium in breast milk. Int J Gynaecol Obstet. 2000 Abstract
  30. Meckstroth KR, Darney PD. Implantable contraception. Obstet Gynecol Clin North Am. 2000 Abstract
  31. Dorea JG, Miazaki ES. The effects of oral contraceptive use on iron and copper concentrations in breast milk. Fertil Steril. 1999 Abstract
  32. Dorea JG, Myazaki E. Calcium and phosphorus in milk of Brazilian mothers using oral contraceptives. J Am Coll Nutr. 1998 Abstract
  33. Coukell AJ, Balfour JA. Levonorgestrel subdermal implants. A review of contraceptive efficacy and acceptability. Drugs. 1998 Abstract
  34. Díaz S, Zepeda A, Maturana X, Reyes MV, Miranda P, Casado ME, Peralta O, Croxatto HB. Fertility regulation in nursing women. IX. Contraceptive performance, duration of lactation, infant growth, and bleeding patterns during use of progesterone vaginal rings, progestin-only pills, Norplant implants, and Copper T 380-A intrauterine devices. Contraception. 1997 Abstract
  35. Kelsey JJ. Hormonal contraception and lactation. J Hum Lact. 1996 Abstract
  36. WHO Progestogen-only contraceptives during lactation: I. Infant growth. World Health Organization Task force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development and Research Training in Human Reproduction. Contraception. 1994 Abstract
  37. Patel SB, Toddywalla VS, Betrabet SS, Kulkarni RD, Patel ZM, Mehta AC, Saxena BN. At what 'infant-age' can levonorgestrel contraceptives be recommended to nursing mothers? Adv Contracept. 1994 Abstract
  38. [No authors listed] Progestogen-only contraceptives during lactation: II. Infant development. World Health Organization, Task Force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development, and Research Training in Human Reproduction. Contraception. 1994 Abstract
  39. Gellén J, Borthaiser Z, Nyári T, Földesi I. [Changes in serum levels of lipid and lipoprotein fractions during breast feeding under the effect of hormonal contraceptives]. Orv Hetil. 1992 Abstract
  40. Shaaban MM. Contraception with progestogens and progesterone during lactation. J Steroid Biochem Mol Biol. 1991 Abstract
  41. McCann MF, Moggia AV, Higgins JE, Potts M, Becker C. The effects of a progestin-only oral contraceptive (levonorgestrel 0.03 mg) on breast-feeding. Contraception. 1989 Abstract
  42. World Health Organization (WHO) Task Force on Oral Contraceptives. Effects of hormonal contraceptives on breast milk composition and infant growth. Stud Fam Plann. 1988 Abstract
  43. Betrabet SS, Shikary ZK, Toddywalla VS, Toddywalla SP, Patel D, Saxena BN. ICMR Task Force Study on hormonal contraception. Transfer of norethisterone (NET) and levonorgestrel (LNG) from a single tablet into the infant's circulation through the mother's milk. Contraception. 1987 Abstract
  44. Shikary ZK, Betrabet SS, Patel ZM, Patel S, Joshi JV, Toddywala VS, Toddywala SP, Patel DM, Jhaveri K, Saxena BN. ICMR task force study on hormonal contraception. Transfer of levonorgestrel (LNG) administered through different drug delivery systems from the maternal circulation into the newborn infant's circulation via breast milk. Contraception. 1987 Abstract
  45. Affandi B, Karmadibrata S, Prihartono J, Lubis F, Samil RS. Effect of Norplant on mothers and infants in the postpartum period. Adv Contracept. 1986 Abstract
  46. Shikary ZK, Betrabet SS, Toddywala WS, Patel DM, Datey S, Saxena BN. Pharmacodynamic effects of levonorgestrel (LNG) administered either orally or subdermally to early postpartum lactating mothers on the urinary levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) in their breast-fed Contraception. 1986 Abstract
  47. Shikary ZK, Betrabet SS, Toddywala WS, Patel DM, Datey S, Saxena BN. Pharmacodynamic effects of levonorgestrel (LNG) administered either orally or subdermally to early postpartum lactating mothers on the urinary levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) in their breast-fed male infants. Contraception. 1986 Abstract
  48. Shaaban MM, Odlind V, Salem HT, Abdullah KA, Gomaa AA. Levonorgestrel concentrations in maternal and infant serum during use of subdermal levonorgestrel contraceptive implants, Norplant, by nursing mothers. Contraception. 1986 Abstract
  49. Shaaban MM, Salem HT, Abdullah KA. Influence of levonorgestrel contraceptive implants, NORPLANT, initiated early postpartum upon lactation and infant growth. Contraception. 1985 Abstract
  50. Díaz S, Herreros C, Juez G, Casado ME, Salvatierra AM, Miranda P, Peralta O, Croxatto HB. Fertility regulation in nursing women: VII. Influence of NORPLANT levonorgestrel implants upon lactation and infant growth. Contraception. 1985 Abstract
  51. Abdulla KA, Elwan SI, Salem HS, Shaaban MM. Effect of early postpartum use of the contraceptive implants, NORPLANT, on the serum levels of immunoglobulins of the mothers and their breastfed infants. Contraception. 1985 Abstract
  52. Prema K. Duration of lactation and return of menstruation in lactating women using hormonal contraception and IUDs. Contracept Deliv Syst. 1982 Abstract
  53. Heikkilä M, Haukkamaa M, Luukkainen T. Levonorgestrel in milk and plasma of breast-feeding women with a levonorgestrel-releasing IUD. Contraception. 1982 Abstract
  54. Heikkilä M, Luukkainen T. Duration of breast-feeding and development of children after insertion of a levonorgestrel-releasing intrauterine contraceptive device. Contraception. 1982 Abstract
  55. Cumming FJ. Effect of oral contraceptive use on ascorbic acid and vitamin A in lactation. J Hum Nutr. 1981 Abstract
  56. Toddywalla VS, Mehta S, Virkar KD, Saxena BN. Release of 19-nor-testosterone type of contraceptive steroids through different drug delivery systems into serum and breast milk of lactating women. Contraception. 1980 Mar;21(3):217-23. Abstract
  57. Nilsson S, Nygren KG, Johansson ED. d-Norgestrel concentrations in maternal plasma, milk, and child plasma during administration of oral contraceptives to nursing women. Am J Obstet Gynecol. 1977 Abstract
  58. Saxena BN, Shrimanker K, Grudzinskas JG. Levels of contraceptive seroids in breast milk and plasma of lactating women. Contraception. 1977 Abstract

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