d-Norgestrel. Norgestrel. Dexnorgestrel

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:

• Ethinylestradiol + Levonorgestrel (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Levonorgestrel Emergency Contraceptive (Safe substance and/or breastfeeding is the best option.)