Last update March 29, 2022

Levonorgestrel (oral, implant, IUD)

Very Low Risk

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.  It is also marketed orally associated with ethinyl estradiol.

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. (Hopelian 2021,Gainer 2007, Betrabet 1987, Toddywalla 1980, Nilsson 1977, Saxena 1977)

No short and long-term growth and development problems have been observed in infants of levonorgestrel-treated mothers. (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), although TSH was not below the normal limit.

Levonorgestrel and progestogens are generally considered contraceptive drugs of choice during breastfeeding since they neither alter the quantity and composition of milk nor cause side effects and they do not affect the growth and development of infants or the duration of lactation. (Hopelian 2021, Goulding 2018, Polakow 2013, Bahamondes 2013, Urzica 2013, Kapp 2010, Shaamash 2005, Moretti 2000, Dorea 2000, 1999 y 1998, WHO 1994)

Published study results have shown protection against breast bone mass loss with the use of progestin-only contraceptives. (Costa 2012, Caird 1994)

Early postpartum versus 4-6 week insertion of a levonorgestrel-containing intrauterine device or implant is not associated with decreased frequency or duration of lactation or effects on infant growth (Abdelhakim 2019, Averbach 2019, Turok 2017), nor in the composition of breast milk (Hopelian 2021). One author found shorter duration of breastfeeding with early IUD insertion. (Chen 2011)

Early versus late IUD insertion has a higher risk of IUD expulsion; Breastfeeding is associated with a lower risk of IUD expulsion. (Armstrong 2022)

During lactation progestin-only contraceptives are preferable to those combined with estrogen and, in this case, those with a lower dose of estrogen. (CDC 2016, 2013 y 2010, WHO 2015, Altshuler 2015, Berens 2015, CLM 2012)

For the first 4-6 weeks postpartum, non-hormonal methods are the first choice, followed by IUDs and progestogen implants. (Berens 2015, Mwalwanda 2013, Rowe 2013)

Progesterone implants and IUDs are more effective at preventing pregnancy than oral progestin-only pills. (Sackey 2019)

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)

The American Academy of Pediatrics states that this medication is usually compatible with breastfeeding. (AAP 2001)

WHO List of Essential Medicines 2002: compatible with breastfeeding after the 6th postnatal week. (WHO 2002)


See below the information of these related products:

Alternatives

  • Diaphragm ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Intrauterine Device ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Preservative ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Levonorgestrel (oral, implant, IUD) is also known as


Levonorgestrel (oral, implant, IUD) in other languages or writings:

Group

Levonorgestrel (oral, implant, IUD) belongs to this group or family:

Tradenames

Main tradenames from several countries containing Levonorgestrel (oral, implant, IUD) in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 312 daltons
Protein Binding 97 %
VD 1.8 - 2.3 l/Kg
pKa 17.91 -
Tmax 1 - 2 hours
24 - 45 hours
M/P ratio 0.4 -
Theoretical Dose 0.00005 - 0.00015 mg/Kg/d
Relative Dose 0.1 - 1 %

References

  1. Armstrong MA, Raine-Bennett T, Reed SD, Gatz J, Getahun D, Schoendorf J, Postlethwaite D, Fassett MJ, Peipert JF, Saltus CW, Merchant M, Alabaster A, Zhou X, Ichikawa L, Shi JM, Chiu VY, Xie F, Hunter S, Wang J, Ritchey ME, Chillemi G, Im TM, et al. Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion. JAMA Netw Open. 2022 Feb 1;5(2):e2148474. Abstract Full text (link to original source)
  2. Hopelian NG, Simmons RG, Sanders JN, Ward K, Jenkins SM, Espey E, Turok DK. Comparison of levonorgestrel level and creamatocrit in milk following immediate versus delayed postpartum placement of the levonorgestrel IUD. BMC Womens Health. 2021 Jan 21;21(1):33. Abstract Full text (link to original source)
  3. Roy M, Hazra A, Merkatz R, Plagianos M, Alami M, Gaur LN, Aruldas K, Sussman H, Variano B, Sitruk-Ware R; Progesterone Vaginal Ring Study Group at Participating Centers.. Progesterone vaginal ring as a new contraceptive option for lactating mothers: Evidence from a multicenter non-randomized comparative clinical trial in India. Contraception. 2020 Sep;102(3):159-167. Abstract Full text (link to original source)
  4. Averbach S, Kakaire O, McDiehl R, Dehlendorf C, Lester F, Steinauer J. The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial. Contraception. 2019 Feb;99(2):87-93. Abstract Full text (link to original source)
  5. Sackeim MG, Gurney EP, Koelper N, Sammel MD, Schreiber CA. Effect of contraceptive choice on rapid repeat pregnancy. Contraception. 2019 Mar;99(3):184-186. Abstract
  6. Abdelhakim AM, Sunoqrot M, Amin AH, Nabil H, Raslan AN, Samy A. The effect of early vs. delayed postpartum insertion of the LNG-IUS on breastfeeding continuation: a systematic review and meta-analysis of randomised controlled trials. Eur J Contracept Reprod Health Care. 2019 Oct;24(5):327-336. Abstract
  7. 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
  8. Turok DK, Leeman L, Sanders JN, Thaxton L, Eggebroten JL, Yonke N, Bullock H, Singh R, Gawron LM, Espey E. Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial. Am J Obstet Gynecol. 2017 Dec;217(6):665.e1-665.e8. Abstract Full text (link to original source)
  9. 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)
  10. 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)
  11. 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)
  12. WHO. Department of Reproductive Health and Research World Health Organization. Medical eligibility criteria for contraceptive use: 20 years of global guidance. WHO/RHR/15.07. 2015 Abstract Full text (link to original source) Full text (in our servers)
  13. 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)
  14. Altshuler AL, Gaffield ME, Kiarie JN. The WHO's medical eligibility criteria for contraceptive use: 20 years of global guidance. Curr Opin Obstet Gynecol. 2015 Abstract Full text (link to original source) Full text (in our servers)
  15. 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)
  16. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  17. 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)
  18. 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)
  19. 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
  20. 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
  21. Urzica D, Gales C, Zamfir C, Nechifor M. The influence of oral steroidal contraceptives on magnesium concentration in breast milk. Magnes Res. 2013 Abstract
  22. CLM - Comité de Lactancia Materna de la AEP. Preguntas frecuentes sobre lactancia materna. Folleto. 2012 Full text (link to original source) Full text (in our servers)
  23. 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
  24. 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)
  25. Kapp N, Curtis K, Nanda K. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception. 2010 Abstract
  26. 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)
  27. 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)
  28. 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
  29. 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)
  30. 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
  31. Díaz S. Contraceptive implants and lactation. Contraception. 2002 Abstract
  32. 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
  33. 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
  34. 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)
  35. Meckstroth KR, Darney PD. Implant contraception. Semin Reprod Med. 2001 Abstract
  36. 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)
  37. Harwood B, Mishell DR Jr. Contraceptive vaginal rings. Semin Reprod Med. 2001 Abstract
  38. Kunz J. [Levonorgestrel releasing intrauterine spiral--contraception and therapeutic indications]. Praxis (Bern 1994). 2001 Abstract
  39. Dórea JG. Oral contraceptives do not affect magnesium in breast milk. Int J Gynaecol Obstet. 2000 Abstract
  40. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  41. Meckstroth KR, Darney PD. Implantable contraception. Obstet Gynecol Clin North Am. 2000 Abstract
  42. Dorea JG, Miazaki ES. The effects of oral contraceptive use on iron and copper concentrations in breast milk. Fertil Steril. 1999 Abstract
  43. Dorea JG, Myazaki E. Calcium and phosphorus in milk of Brazilian mothers using oral contraceptives. J Am Coll Nutr. 1998 Abstract
  44. Coukell AJ, Balfour JA. Levonorgestrel subdermal implants. A review of contraceptive efficacy and acceptability. Drugs. 1998 Abstract
  45. 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
  46. 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
  47. 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
  48. Caird LE, Reid-Thomas V, Hannan WJ, Gow S, Glasier AF. Oral progestogen-only contraception may protect against loss of bone mass in breast-feeding women. Clin Endocrinol (Oxf). 1994 Dec;41(6):739-45. Abstract
  49. WHO. 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
  50. 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
  51. Shaaban MM. Contraception with progestogens and progesterone during lactation. J Steroid Biochem Mol Biol. 1991 Abstract
  52. 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
  53. 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
  54. 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
  55. 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
  56. 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
  57. 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
  58. 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
  59. 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
  60. 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
  61. 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
  62. Shaaban MM, Salem HT, Abdullah KA. Influence of levonorgestrel contraceptive implants, NORPLANT, initiated early postpartum upon lactation and infant growth. Contraception. 1985 Abstract
  63. Prema K. Duration of lactation and return of menstruation in lactating women using hormonal contraception and IUDs. Contracept Deliv Syst. 1982 Abstract
  64. Heikkilä M, Luukkainen T. Duration of breast-feeding and development of children after insertion of a levonorgestrel-releasing intrauterine contraceptive device. Contraception. 1982 Abstract
  65. Heikkilä M, Haukkamaa M, Luukkainen T. Levonorgestrel in milk and plasma of breast-feeding women with a levonorgestrel-releasing IUD. Contraception. 1982 Abstract
  66. Cumming FJ. Effect of oral contraceptive use on ascorbic acid and vitamin A in lactation. J Hum Nutr. 1981 Abstract
  67. 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
  68. Saxena BN, Shrimanker K, Grudzinskas JG. Levels of contraceptive seroids in breast milk and plasma of lactating women. Contraception. 1977 Abstract
  69. 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

Total visits

437,260

Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write us at elactancia.org@gmail.com

e-lactancia is a resource recommended by Academy of Breastfeeding Medicine - 2015 of United States of America

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM