Levonorgestrel-only postcoital contraception

When used early in the cycle, it is thought that progestogen-only emergency contraception (POEC) inhibits ovulation.

Because it is believed to inhibit ovulation by blocking the luteinizing hormone (LH) surge, which in turn prevents follicular development and rupture, it has no effect once the LH surge has begun or after ovulation. This is the reason the FSRH recommends that POEC not be used after ovulation (

It is licensed for use within 72 hours of unprotected sexual intercourse. Although its use beyond 72 hours is unlicensed, it can be considered for use between 72-120 hours if the other forms of emergency contraceptives cannot be used. It may still have some efficacy at this time, although it will be less effective than if it is taken within 72 hours; this use has become less common since the availability of ulipristal. (1)

Pregnancy rates following a single episode of UPSI for women taking levonorgestrel emergency contraception are 0.6 - 2.6%. (1)

Commonly reported adverse effects include headache, nausea, and dysmenorrhoea. Women who vomit less than 3 hours after taking emergency contraception should repeat the dose. (2)

Criteria for eligibility for levonorgestrel emergency contraception:

• Any individual presenting for emergency contraception (EC) between 0 and 96 hours following UPSI or when regular contraception has been compromised or used incorrectly.
• No contraindications to the medication

Dose and frequency of administration

• Levonorgestrel 1.5mg (1 tablet) to be taken as soon as possible up to 96 hours of UPSI. It is now available to buy without prescription over the counter for those aged 16 years or more, in addition to being a prescribed drug.
• Dose for those individuals taking enzyme inducing medicines or herbal products: An individual who requests levonorgestrel whilst using enzyme-inducing drugs, or within 4 weeks of stopping them, can be advised to take a total of 3mg levonorgestrel (two 1500mcg tablets) as a single dose and within 96 hours of UPSI
• Dose for those individuals with a body mass index of more than 26kg/m2 or who weigh more than 70kg: An individual who requests levonorgestrel with a body mass index of more than 26kg/m2 or who weighs more than 70kg can be offered a total of 3mg levonorgestrel (two 1500mcg tablets) as a single dose and within 96 hours of UPSI

This Patient Group Direction (PGD) includes off-label use in the following conditions (3)

• Use between 72 and 96 hours post UPSI
• Increased dose for individuals with BMI over 26kg/m2 or weight over 70kg and in individuals using liver enzyme inducing agent
• Severe hepatic impairment
• Individuals with previous salpingitis or ectopic pregnancy
• Lapp-lactase deficiency
• Hereditary problems of galactose intolerance
• Glucose-galactose malabsorption

Note - POEC can be safely used during lactation.

Reference

1. Clinical Guidance: Emergency Contraception. Faculty of Sexual and Reproductive Healthcare (March 2017 - updated July 2023
2. Curtis KM, Nguyen AT, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2024. MMWR Recomm Rep 2024;73(3):1-77.
3. Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Supply and/or administration of levonorgestrel 1500micrograms tablet(s) for emergency contraception