This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Levonorgestrel oral 30mcg


Oral formulations containing 30 micrograms of levonorgestrel.

Drugs List

  • levonorgestrel 30microgram tablets
  • NORGESTON tablets
  • Therapeutic Indications


    Oral contraception - progestogen only



    One tablet daily, starting on the first day of the menstrual cycle, at a time of day chosen by the patient. All subsequent tablets must then be taken at this time. The contraceptive effect is likely to be reduced if a tablet is delayed by more than three hours. Pack follows pack without interruption, and without regard to bleeding.

    Additional Dosage Information

    Changing from a combined oral contraceptive
    Start the first tablet of levonorgestrel 30mcg the day after the last active tablet of the previous contraceptive pack. In the case of an every day (twenty eight day) preparation, start the day after the last active tablet has been taken, discarding the inactive tablets. Additional contraceptive precautions are not required. Withdrawal bleeding should not be expected until the end of the first pack of the new preparation.

    Changing from a progestogen-only pill (POP), injection or implant
    The switch from one POP to an other can be made at any time. Additional contraceptive precautions are not required.

    Alternatively, the new preparation may be started before or when the next implant or injection is due.

    Post-partum use
    Oral contraception can be initiated up to twenty one days post-partum (no additional contraceptive is required). If started after twenty one days, an additional barrier method of contraception should be used for seven days. However, if intercourse has already occurred, pregnancy should be excluded before the actual start of levonorgestrel use or the woman has to wait for her first menstrual period.

    After abortion or miscarriage
    After a first trimester abortion or miscarriage, oral contraception may be started immediately in which case no additional contraceptive precautions are required. If started after this time, barrier methods of contraception are required for the first seven days of table taking.


    Abnormal liver function test
    Breast cancer
    Diabetes mellitus with vascular involvement
    Hepatic neoplasm
    Hereditary fructose intolerance
    History of breast cancer
    History of hepatic neoplasm
    History of hormone dependent neoplasm
    History of severe hepatic disorder
    History of thromboembolic disorder
    Severe hepatic impairment
    Thromboembolic disorder
    Undiagnosed gynaecological haemorrhage

    Precautions and Warnings

    Family history of venous thromboembolism
    Females over 35 years
    History of ectopic pregnancy
    Prolonged immobilisation
    Recent major surgery
    Tobacco smoking
    Diabetes mellitus
    Glucose-galactose malabsorption syndrome
    Hepatic impairment
    History of cholestatic jaundice during pregnancy
    History of pruritus during pregnancy
    History of venous thromboembolism
    Lactose intolerance
    Recurrent cholestatic jaundice

    Assess family medical history prior to commencing treatment
    Contains lactose
    Preparation contains sucrose
    Resume use only after 2wks full ambulation from surgery/immobilisation
    Do breast & pelvic exam. before & during treatment if clinically indicated
    Exclude pregnancy prior to initiation of treatment
    Monitor blood pressure pre-treatment and periodically thereafter
    If intra-abdominal haemorrhage consider liver tumour
    If upper abdominal complaints/liver enlargement consider liver tumour
    Monitor patients at risk for signs & symptoms of venous thromboembolism
    Monitor patients with existing or tendency towards diabetes mellitus
    Avoid immobilisation-treatment may cause increased risk of thromboembolism
    Increased risk of venous thromboembolism
    May induce or enhance hepatic tumour development
    May affect results of some laboratory tests
    Discontinue 6 weeks before major surgery or prolonged immobilisation
    Advise patient to seek advice at first indications of pregnancy
    Discontinue at first signs of jaundice, hepatitis or whole body itching
    Discontinue at first signs of thrombophlebitis or thromboembolism
    Discontinue if conditions likely to deteriorate in pregnancy worsen
    Discontinue if differential diagnosis indicates liver tumour
    Discontinue if sudden occurrence of visual/hearing/perceptual disorders
    Discontinue-first occurrence/worsening migraine/severe or frequent headache
    Advise patient concurrent St John's wort may reduce contraceptive effect
    All contraceptive pills slightly increase the risk of breast cancer
    Changes in menstrual bleeding patterns should be expected
    Treatment does not protect against risk of sexually transmitted disease
    Women with a history of chloasma should avoid exposure to sun/UV light

    Patients should be individually assessed before oral contraceptives and at regular intervals thereafter. Assessment should include personal and family history which should then guide physical examination. Parameters to be measured should include blood pressure, weight and body mass index (BMI) and if judged appropriate by the clinician, breast, abdominal examination, pelvic examination and cervical cytology. Specific attention should be given to conditions associated with increased risk of adverse events including migraine and cardiovascular risk factors such as obesity, smoking, hypertension, thrombophilia, hyperlipidaemia and previous venous thromboembolism.

    In the few epidemiological studies that have been carried out, there is little evidence to support an association between progestogen only pills and an increased risk of myocardial infarction or cerebral thromboembolism. In women with hypertension, progesterone-only pills may slightly increase the risk of stroke. There may be a small, but not statistically significant, increased risk of venous thromboembolism associated with the use of progesterone-only pills.

    There is a small risk of developing breast cancer in women treated with progestogen-only contraceptives. The most important risk factor appears to be the age at which the contraceptive is stopped rather than the duration of use. The risk disappears gradually in the 10 years after stopping and there is no excess risk after 10 years. A possible small increase in the risk of breast cancer should be weighed against the benefits. Women should be advised of this increased risk before oral contraception is started.

    If there is a history of ectopic pregnancy or one Fallopian tube is missing, the use of levonorgestrel should be decided only after carefully weighing the benefits against the risks.

    Levonorgestrel has been associated with the occurrence of persistent ovarian follicles, most of which are asymptomatic. Some may, however, be accompanied by pelvic pain or dyspareunia. Usually, the enlarged follicles disappear spontaneously within two to three months of observation.

    If no menstrual bleeding has occurred within 6 weeks after the last menstrual bleeding, pregnancy should be excluded before further tablets are taken. If pregnancy has been excluded and the amenorrhoea lasts longer than 3 months or recurs repeatedly, levonorgestrel should be withheld until normal menstrual bleeding has resumed.
    Irregular bleeding is not a medical reason to stop the tablets, as long as organic causes for bleeding and pregnancy can be ruled out, provided it is ensured that the patient is fully compliant. It is not recommended to attempt to influence cycle disturbances with the concomitant administration of an oestrogen. This is because the oestrogen will reverse the changes made to the cervical mucus brought about by levonorgestrel, and thus reduce the contraceptive effect.

    Pregnancy and Lactation


    Levonorgestrel is contraindicated during pregnancy.

    Pregnancy must be excluded before starting treatment and the preparation should be withdrawn immediately if pregnancy occurs while taking oral contraception.

    The low dose progesterone-only oral contraceptives are fairly well studied due to their frequent (accidental) use in pregnancies. They pose no substantial risk for genital or extra-genital malformations according to the current available knowledge (Schaefer, 2015).

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use levonorgestrel with caution during breastfeeding.

    Progestogen-only pills are considered the second contraceptive of choice, after non-hormonal methods. Progestogen-only pills can be used during breastfeeding as there is little evidence to suggest that progestogen-only pills have a negative effect on breast milk, infant growth or infant development.

    Schaefer (2015) suggests that gestagens, such as levonorgestrel, have minimal effect on the milk supply or the milk composition. LactMed indicates that progesterone-only pills may offer some protection against loss of bone mineral density during lactation, or at least they do not exacerbate it.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at


    Advise patients to take the tablets at the same time each day (preferably in the evening).

    Missed pills (within 3 hours of correct administration time)
    Take one tablet as soon as possible. Consequent tablets should be taken at the correct administration time.

    Missed pills (more than 3 hours after correct administration time)
    Take one tablet as soon as possible. Consequent tablets should be taken at the correct administration time. Additional methods of contraception should be used (barrier methods) for 7 days after the missed tablet was taken.

    During gastrointestinal upsets
    Vomiting or diarrhoea may reduce the effectiveness of the tablets by preventing them form being fully absorbed. If vomiting occurs within 2 hours of taking a tablet, another tablet should be taken as soon as possible. If this replacement pill is not taken within 3 hours of the normal time, additional barrier contraceptive methods should be used for 7 days. In patients experiencing persistent vomiting and/or severe diarrhoea, additional barrier contraceptive methods should be used during the illness and for 7 days after recovery.

    Advise patients that taking St Johns Wort may reduce contraceptive efficacy.

    Advise patient to seek advice at first signs of pregnancy.

    When additional contraceptive precautions are required, advise patients either not to have sex or to use a cap plus spermicide, or for her partner to use a condom. Rhythm methods are not advisable as the pill disrupts the usual cyclical changes associated with the natural menstrual cycle.

    Side Effects

    Allergic reaction
    Changes in libido
    Depressed mood
    Hepatic tumours
    Increased risk of breast cancer
    Irregular menstruation
    Ischaemic stroke
    Life-threatening intra-abdominal haemorrhage
    Menstrual disturbances
    Pelvic pain
    Thromboembolic disorders
    Transient ischaemic attack
    Weight changes

    Effects on Laboratory Tests

    Oral contraceptives may influence the results of certain laboratory tests including:
    Biochemical parameters of thyroid, hepatic, adrenal and renal function;
    Plasma levels of carrier proteins and lipid/lipoprotein fractions;
    Parameters of carbohydrate metabolism and parameters of coagulation and fibrinolysis.
    Changes generally remain within the normal laboratory range.

    Laboratory technicians should be made aware of patients who are receiving oral contraception, so that any effects on the above tests can be taken into consideration.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: May 2017

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Summary of Product Characteristics: Norgeston. Bayer plc. Revised August 2017.

    NICE Evidence Services Available at: Last accessed: 08 September 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Levonorgestrel. Last revised: 11 April 2017
    Last accessed: 18 April 2017

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.