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Levonorgestrel
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Main page Not to be confused with Norgestrel.

Contents Levonorgestrel is a hormonal medication which is used in a number of birth control
Current events Levonorgestrel
methods.[5] It is combined with an estrogen to make combination birth control pills.[6] As an
Random article
emergency birth control, sold under the brand name Plan B among others, it is useful within
About Wikipedia
Contact us 72 hours. This should not be confused with EllaOne which can be effective within 120 hours
Donate (5 days) of unprotected sex.[5] The more time that has passed since sex, the less effective
the medication becomes, and it does not work after pregnancy (implantation) has
Contribute
occurred.[5] It decreases the chances of pregnancy by 57 to 93%.[7] In an intrauterine
Help
device (IUD), such as Mirena among others, it is effective for the long-term prevention of
Learn to edit
pregnancy.[5] A levonorgestrel-releasing implant is also available in some countries.[8]
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Recent changes Common side effects include nausea, breast tenderness, headaches, and increased,
Upload file decreased, or irregular menstrual bleeding.[5] When used as an emergency contraceptive, if
pregnancy occurs, there is no evidence that its use harms the baby.[5] It is safe to use
Tools
during breastfeeding.[5] Birth control that contains levonorgestrel will not change the risk of
What links here
Related changes
sexually transmitted infections.[5] It is a progestin and has effects similar to those of the
Special pages hormone progesterone.[5] It works primarily by preventing ovulation and closing off the
Permanent link cervix to prevent the passage of sperm.[5]
Page information
Levonorgestrel was patented in 1960 and introduced for medical use together with
Cite this page
ethinylestradiol in 1970.[9][10] It is on the World Health Organization's List of Essential Clinical data
Wikidata item
Trade names Plan B, others
Medicines, the safest and most effective medicines needed in a health system.[11] It is
Other names LNG; d-Norgestrel; d(–)-
Print/export available as a generic medication.[12] In the United States, levonorgestrel-containing
Norgestrel; D-Norgestrel;
Download as PDF

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 Printable version emergency contraceptives are available over the counter (OTC) for all ages.[13] In 2016, it WY-5104; SH-90999; NSC-
744007; 18-
was the 223rd most commonly prescribed medication in the United States, with more than
In other projects Methylnorethisterone; 17α-
two million prescriptions.[14] Ethynyl-18-methyl-19-
Wikimedia Commons
nortestosterone; 17α-
Contents [hide]
Languages Ethynyl-18-methylestr-4-en-
1 Medical uses 17β-ol-3-one; 13β-Ethyl-
‫اﻟﻌﺮﺑﯿﺔ‬
1.1 Birth control 17α-hydroxy-18,19-
Deutsch
dinorpregn-4-en-20-yn-3-
Español 1.2 Emergency birth control
one
Français 1.3 Hormone therapy
한국어 1.4 Available forms
AHFS/Drugs.com Monograph
MedlinePlus
Italiano
a610021
2 Contraindications
Русский Pregnancy AU: B3[1]
3 Side effects category Contraindicated[1]
Tiếng Việt
中 4 Overdose Routes of By mouth, transdermal
5 Interactions administration patch, intrauterine device,
13 more subcutaneous implant
6 Pharmacology
Edit links 6.1 Pharmacodynamics Drug class Progestogen (medication);
6.2 Pharmacokinetics Progestin
ATC code G03AC03 (WHO )
7 Chemistry
G03AD01 (WHO )
8 History
Legal status
9 Society and culture
Legal status US: ℞-only / OTC
9.1 Generic names
In general: ℞ (Prescription
9.2 Brand names only)
9.3 Availability Pharmacokinetic data
9.4 Accessibility Bioavailability 95% (range 85–100%)[2][3]
10 Research Protein binding 98% (50% to albumin, 48%
11 References to SHBG)[2]
12 External links Metabolism Liver (reduction,
hydroxylation,
conjugation)[2][4]
Medical uses [ edit ] Metabolites • 5α-Dihydro-LNG[2]
Elimination 24–32 hours[2]

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 half-life
Birth control [ edit ] Excretion Urine: 20–67%
See also: Ethinylestradiol/levonorgestrel Feces: 21–34%[4]
Identifiers
At low doses, levonorgestrel is used in monophasic and triphasic formulations of combined
IUPAC name [show]
oral contraceptive pills, with available monophasic doses ranging from 100 to 250 µg, and
CAS Number 797-63-7
triphasic doses of 50 µg/75 µg/125 µg.[15] It is combined with the estrogen ethinylestradiol
PubChem CID 13109
in these formulations.[15]
IUPHAR/BPS 2881
At very low daily dose of 30 µg, levonorgestrel is used in some progestogen-only pill
DrugBank DB00367
formulations.[15]
ChemSpider 12560
Levonorgestrel is the active ingredient in a number of intrauterine devices including Mirena UNII 5W7SIA7YZW
and Skyla.[15][16] It is also the active ingredient in the birth control implants Norplant and KEGG D00950
Jadelle.[15][16] ChEBI CHEBI:6443
ChEMBL ChEMBL1389
One of the more common forms of contraception that contains only levonorgestral is an
CompTox DTXSID3036496
IUD. One IUD, the Mirena is a small hollow cylinder containing levonorgestral and
Dashboard (EPA)
polydimethylsiloxane and covered with a release rate controlling membrane.[17] ECHA InfoCard 100.011.227
Chemical and physical data
Emergency birth control [ edit ]
Formula C21H28O2
Levonorgestrel is used in emergency contraceptive pills (ECPs), both in a combined Yuzpe Molar mass 312.453 g·mol−1
regimen which includes estrogen, and as a levonorgestrel-only method. The levonorgestrel- 3D model Interactive image
(JSmol)
only method uses levonorgestrel 1.5 mg (as a single dose or as two 0.75 mg doses 12
Melting point 235 to 237 °C (455 to
hours apart) taken within 3 days of unprotected sex, with one study indicating that
459 °F)
beginning as late as 120 hours (5 days) after intercourse could be
SMILES [show]
effective.[medical citation needed]
InChI [show]
The primary mechanism of action of levonorgestrel as a progestogen-only emergency (verify)
contraceptive pill is, according to International Federation of Gynecology and Obstetrics
(FIGO), to prevent fertilization by inhibition of ovulation and thickening of cervical mucus.[18][19][20][21] FIGO has stated that: "review of the
evidence suggests that LNG [levonorgestreol] ECPs cannot prevent implantation of a fertilized egg. Language on implantation should not
be included in LNG ECP product labeling."[22][23] In November 2013, the European Medicines Agency (EMA) approved a change to the
label saying it cannot prevent implantation of a fertilized egg.[24]

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 Other studies still find the evidence to be unclear.[25] While it is unlikely that emergency contraception affects implantation it is impossible
to completely exclude the possibility of post-fertilization effect.[26]

In November 2013, the EMA also approved a change to the label for HRA Pharma's NorLevo saying: "In clinical trials, contraceptive
efficacy was reduced in women weighing 75 kg [165 pounds] or more, and levonorgestrel was not effective in women who weighed more
than 80 kg [176 pounds]."[24][27][28] In November 2013 and January 2014, the FDA and the EMA said they were reviewing whether
increased weight and body mass index (BMI) reduce the efficacy of emergency contraceptives.[24]

An analysis of four WHO randomised clinical trials, published in January 2017, showed pregnancy rates of 1.25% (68/5428) in women
with BMI under 25, 0.61% (7/1140) in women with BMI between 25 and 30, and 2.03% (6/295) in women with BMI over 30.[29] These
values yield an eight-fold reduction in efficacy for women with BMI over 30 compared to women with BMI under 25. However, emergency
contraceptives remain effective regardless of BMI.

Hormone therapy [ edit ]

Levonorgestrel is used in combination with an estrogen in menopausal hormone therapy.[15][30] It is used under the brand name
Klimonorm as a combined oral tablet with estradiol valerate and under the brand name Climara Pro as a combined transdermal patch
with estradiol.[15][30]

Available forms [ edit ]

As a type of emergency contraception, levonorgestrel is used after unprotected intercourse to reduce the risk of pregnancy.[31] However,
it can serve different hormonal purposes in its different methods of delivery. It is available for use in a variety of forms:

By mouth [ edit ]

Levonorgestrel can be taken by mouth as a form of emergency birth control. The typical dosage is either 1.5 mg taken once or 0.75 mg
taken 12–24 hours apart.[32] The effectiveness in both methods is similar.[32] The most widely used form of oral emergency contraception
is the progestin-only pill, which contains a 1.5 mg dosage of levonorgestrel.[31] Levonorgestrel-only emergency contraceptive pills are
reported to have an 89% effectiveness rate if taken within the recommended 72 hours after sex.[33] The efficacy of the drug decreases by
50% for each 12 hour delay in taking the dose after the emergency contraceptive regimen has been started.[33]

Skin patch [ edit ]

See also: Estradiol/levonorgestrel

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 Estradiol with levonorgestrel in the form of a skin patch is used under the brand name Climara Pro for hormone replacement therapy in
postmenstrual women, treating symptoms such as hot flashes or osteoporosis.[34] The simultaneous delivery of a progestogen such as
levonorgestrel is necessary for the protection of the endometrium.[35][36]

Intrauterine device [ edit ]

The levonorgestrel intrauterine system (LNG-IUS) is a type of long-term birth control that releases the progestin into the uterine
cavity.[37][17] Levonorgestrel is released at a constant, gradual rate of 0.02 mg per day by the polydimethylsiloxane membrane of the
device, which renders it effective for up to 5 years.[37] Because it is inserted directly into the uterus, levonorgestrel is present in the
endometrium in much higher concentrations that would result from a LNG-containing oral pill; the LNG-IUS delivers 391 ng of
levonorgestrel to the inner uterine region while a comparable oral contraceptive delivers only 1.35 ng.[37] This high level of levonorgestrel
impedes the function of the endometrium, making it hostile for sperm transport, fertilization, and implantation of an ovum.[37]

Implant [ edit ]

Subcutaneous implants of levonorgestrel have been marketed as birth control implants under the brand names Norplant and Jadelle and
are available for use in some countries.[38][15]

Contraindications [ edit ]

Known or suspected pregnancy is a contraindication of levonorgestrel as an emergency contraceptive.[39]

Side effects [ edit ]

See also: Progestin § Side effects

After an intake of 1.5 mg levonorgestrel in clinical trials, very common side effects (reported by 10% or more) included: hives, dizziness,
hair-loss, headache, nausea, abdominal pain, uterine pain, delayed menstruation, heavy menstruation, uterine bleeding, and fatigue;
common side effects (reported by 1% to 10%) included diarrhea, vomiting, and painful menstruation; these side effects usually
disappeared within 48 hours.[40][41] However, the long term side effects common with oral contraceptives such as arterial disease are
lower with levonorgestrel than in combination pills.[medical citation needed]

Levonorgestrel as a contraceptive intrauterine device is associated with a higher risk of breast cancer than with non-use.[42]

Overdose [ edit ]

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 Overdose of levonorgestrel as an emergency contraceptive has not been described.[39] Nausea and vomiting might be expected.[39]

Interactions [ edit ]

If taken together with drugs that induce the CYP3A4 cytochrome P450 liver enzyme, levonorgestrel may be metabolized faster and may
have lower effectiveness.[43] These include, but are not limited to barbiturates, bosentan, carbamazepine, felbamate, griseofulvin,
oxcarbazepine, phenytoin, rifampin, St. John's wort and topiramate.[medical citation needed]

Pharmacology [ edit ]

Levonorgestrel (LNG) is a progestin and has effects similar to those of the hormone progesterone.[5] It works primarily by preventing
ovulation and closing off the cervix to prevent the passage of sperm.[5]

Pharmacodynamics [ edit ]

Levonorgestrel is a progestogen; that is, an agonist of the progesterone receptor (PR), the main biological target of the progestogen sex
hormone progesterone.[2] It is also a weak agonist of the androgen receptor (AR), the main biological target of the androgen sex hormone
testosterone.[2] Levonorgestrel has no other important hormonal activity, including no estrogenic, glucocorticoid, or antimineralocorticoid
activity.[2] The lack of significant mineralocorticoid or antimineralocorticoid activity with levonorgestrel is in spite of a relatively high affinity
for the mineralocorticoid receptor of as much as 75% of that of aldosterone.[2] Due to its progestogenic activity, levonorgestrel has
antigonadotropic effects, and is able to suppress fertility and gonadal sex hormone production in both women and men.[2][44]

V·T·E Relative affinities (%) of levonorgestrel and metabolites [show]

Androgenic activity [ edit ]

Levonorgestrel is a weakly androgenic progestin and in women may cause androgenic side effects such as decreased sex hormone-
binding globulin (SHBG) levels, decreased HDL cholesterol levels, weight gain, and acne.[2][45] In combination with a potent estrogen like
ethinylestradiol however, all contraceptives containing androgenic progestins are negligibly androgenic in clinical practice and can in fact
be used to treat androgen-dependent conditions like acne and hirsutism in women.[45] This is because ethinylestradiol causes a marked
increase in SHBG levels and thereby decreases levels of free and hence bioactive testosterone, acting as a functional antiandrogen.[45]
Nonetheless, contraceptives containing progestins that are less androgenic increase SHBG levels to a greater relative extent and may be
more effective for such indications.[45] Levonorgestrel is currently the most androgenic progestin that remains used in contraceptives, and

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 contraceptives containing levonorgestrel may be less effective for androgen-dependent conditions relative to those containing other
progestins that are less androgenic.[46][47][48]

Other activity [ edit ]

Levonorgestrel stimulates the proliferation of MCF-7 breast cancer cells in vitro, an action that is independent of the classical PRs and is
instead mediated via the progesterone receptor membrane component-1 (PGRMC1).[49][50] Certain other progestins act similarly in this
assay, whereas progesterone acts neutrally.[49][50] It is unclear if these findings may explain the different risks of breast cancer observed
with progesterone and progestins in clinical studies.[51]

Antigonadotropic effects [ edit ]

In men, levonorgestrel causes marked suppression of circulating testosterone levels secondary to its antigonadotropic effects.[52]
Because of this, and due to its androgenic activity being only weak and hence insufficient for purposes of androgen replacement in males,
levonorgestrel has potent functional antiandrogenic effects in men, and is able to produce associated adverse effects like decreased
libido and erectile dysfunction among others.[52] In relation to this, levonorgestrel has been combined with an androgen like testosterone
or dihydrotestosterone when it has been studied as a hormonal contraceptive in men.[44][52]

Pharmacokinetics [ edit ]

The bioavailability of levonorgestrel is approximately 95% (range 85 to 100%).[2][3] The plasma protein binding of levonorgestrel is about
98%.[2] It is bound 50% to albumin and 48% to SHBG.[2] Levonorgestrel is metabolized in the liver, via reduction, hydroxylation, and
conjugation (specifically glucuronidation and sulfation).[2][4] Oxidation occurs primarily at the C2α and C16β positions, while reduction
occurs in the A ring.[4] 5α-Dihydrolevonorgestrel is produced as an active metabolite of levonorgestrel by 5α-reductase.[2] The elimination
half-life of levonorgestrel is 24 to 32 hours, although values as short as 8 hours and as great as 45 hours have been reported.[2][4] About
20 to 67% of a single oral dose of levonorgestrel is eliminated in urine and 21 to 34% in feces.[4]

Chemistry [ edit ]

See also: List of progestogens, List of androgens/anabolic steroids, and Norgestrel

Levonorgestrel, also known as 17α-ethynyl-18-methyl-19-nortestosterone or as 17α-ethynyl-18-methylestr-4-en-17β-ol-3-one, is a

synthetic estrane steroid and a derivative of testosterone.[53][54] It is the C13β or levorotatory stereoisomer and enantiopure form of
norgestrel, the C13α or dextrorotatory isomer being inactive.[55][56] Levonorgestrel is more specifically a derivative of norethisterone (17α-
ethynyl-19-nortestosterone) and is the parent compound of the gonane (18-methylestrane) subgroup of the 19-nortestosterone family of

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 progestins.[57] Levonorgestrel acetate and levonorgestrel butanoate are C17β esters of levonorgestrel.[58][59] It has a molecular weight of
312.45 g/mol and a partition coefficient (logP) of 3.8.[citation needed]

History [ edit ]

Norgestrel (rac-13-ethyl-17α-ethynyl-19-nortestosterone), the racemic mixture containing levonorgestrel and dextronorgestrel, was
discovered by Hughes and colleagues at Wyeth in 1963 via structural modification of norethisterone (17α-ethynyl-19-
nortestosterone).[60][61][62][63] It was the first progestogen to be manufactured via total chemical synthesis.[62][63] Norgestrel was
introduced for medical use as a combined birth control pill with ethinylestradiol under the brand name Eugynon in Germany in 1966 and
under the brand name Ovral in the United States 1968, and as a progestogen-only pill under the brand name Ovrette in the United States
in 1973.[63][64][65][66] Following its discovery, norgestrel had been licensed by Wyeth to Schering AG, which separated the racemic mixture
into its two optical isomers and identified levonorgestrel (13β-ethyl-17α-ethynyl-19-nortestosterone) as the active component of the
mixture.[10][62][63] Levonorgestrel was first studied in humans by 1970, and was introduced for medical use in Germany as a combined
birth control pill with ethinylestradiol under the brand name Neogynon in August 1970.[10][64][65][67][68][69] A more widely used formulation,
containing lower doses of ethinylestradiol and levonorgestrel, was introduced under the brand name Microgynon by 1973.[15][70][71] In
addition to combined formulations, levonorgestrel was introduced as a progestogen-only pill under the brand names Microlut by 1972 and
Microval by 1974.[72][73] Many other formulations and brand names of levonorgestrel-containing birth control pills have also been
marketed.[15]

Levonorgestrel, taken alone in a single high dose, was first evaluated as a form of emergency contraception in 1973.[74] It was the
second progestin to be evaluated for such purposes, following a study of quingestanol acetate in 1970.[74][75] In 1974, the Yuzpe regimen,
which consisted of high doses of a combined birth control pill containing ethinylestradiol and norgestrel, was described as a method of
emergency contraception by A. Albert Yuzpe and colleagues, and saw widespread interest.[76][77] Levonorgestrel-only emergency
contraception was introduced under the brand name Postinor by 1978.[78] Ho and Kwan published the first study comparing
levonorgestrel only and the Yuzpe regimen as methods of emergency contraception in 1993 and found that they had similar effectiveness
but that levonorgestrel alone was better-tolerated.[79][80] In relation to this, the Yuzpe regimen has largely been replaced as a method of
emergency contraception by levonorgrestrel-only preparations.[81] Levonorgestrel-only emergency contraception was approved in the
United States under the brand name Plan B in 1999, and has also been marketed widely elsewhere throughout the world under other
brand names such as Levonelle and NorLevo in addition to Postinor.[15][82] In 2013, the Food and Drug Administration approved Plan B
One-Step for sale over-the-counter in the United States without a prescription or age restriction.[83]

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 Levonorgestrel has also been introduced for use as a progestogen-only intrauterine device under the brand names Mirena and Skyla
among others, as a progestogen-only birth control implant under the brand names Norplant and Jadelle, as a combined oral tablet with
estradiol valerate for menopausal hormone therapy under the brand name Klimonorm, and as a combined transdermal patch with
estradiol for menopausal hormone therapy under the brand name Climara Pro.[15][16][30] Ester prodrugs of levonorgestrel such as
levonorgestrel acetate and levonorgestrel butanoate have been developed and studied as other forms of birth control such as long-acting
progestogen-only injectable contraceptives and contraceptive vaginal rings, but have not been marketed for medical use.[58][59]

Society and culture [ edit ]

Generic names [ edit ]

Levonorgestrel is the generic name of the drug and its INN, USAN, USP, BAN, DCIT, and JAN, while lévonorgestrel is its DCF.[15][53][54]
It is also known as d-norgestrel, d(–)-norgestrel, or D-norgestrel, as well as by its developmental code names WY-5104 (Wyeth) and SH-
90999 (Schering AG).[15][53][54][72]

Brand names [ edit ]

Levonorgestrel is marketed alone or in combination with an estrogen (specifically ethinylestradiol, estradiol, or estradiol valerate) under a
multitude of brand names throughout the world, including Alesse, Altavera, Alysena, Amethia, Amethyst, Ashlyna, Aviane, Camrese,
Chateal, Climara Pro, Cycle 21, Daysee, Emerres, Enpresse, Erlibelle, Escapelle, Falmina, Introvale, Isteranda, Jadelle, Jaydess,
Jolessa, Klimonorm, Kurvelo, Kyleena, Lessina, Levlen, Levodonna, Levonelle, Levonest, Levosert, Levora, Liletta, Loette, Logynon,
LoSeasonique, Lutera, Lybrel, Marlissa, Microgynon, Microlut, Microvlar, Min-Ovral, Miranova, Mirena, My Way, Myzilra, Next Choice,
Nordette, Norgeston, NorLevo, Norplant, One Pill, Option 2, Orsythia, Ovima, Ovranette, Plan B, Plan B One-Step, Portia, Postinor,
Postinor-2, Preventeza, Ramonna, Rigevidon, Quartette, Quasense, Seasonale, Seasonique, Skyla, Sronyx, Tri-Levlen, Trinordiol,
Triphasil, Triquilar, Tri-Regol, Trivora, and Upostelle, among many others.[15][54][84] These formulations are used as emergency
contraceptives, normal contraceptives, or in menopausal hormone therapy for the treatment of menopausal
symptoms.[medical citation needed]

As an emergency contraceptive, levonorgestrel is often referred to colloquially as the "morning-after pill".[85][86]

Availability [ edit ]
See also: List of progestogens available in the United States

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 Levonorgestrel is very widely marketed throughout the world and is available in almost every country.[15][54]

Accessibility [ edit ]

Levonorgestrel-containing emergency contraception is available over-the-counter in some countries, such as the United States.[83]

A policy update in 2015, required all Indian Health Services-run pharmacies, clinics, and emergency departments to have Plan B One-
Step in stock, to distribute it to any woman (or her representative) who asked for it without a prescription, age verification, registration or
any other requirement, to provide orientation training to all staff regarding the medication, to provide unbiased and medically accurate
information about emergency contraception, and to make someone available at all times to distribute the pill in case the primary staffer
objected to providing it on religious or moral grounds.[87]

Research [ edit ]

Levonorgestrel has been studied in combination with androgens such as testosterone and dihydrotestosterone as a hormonal
contraceptive for men.[44][52]

References [ edit ]

1. ^ a b c "Levonorgestrel Use During Pregnancy" . Drugs.com. 23 5. ^ a b c d e f g h i j k l "Progestins (Etonogestrel, Levonorgestrel,

March 2020. Retrieved 29 June 2020. Norethindrone)" . The American Society of Health-System
2. ^ abcdefghijklmnopq Kuhl H (August 2005). "Pharmacology Pharmacists. Archived from the original on 2015-09-07. Retrieved
of estrogens and progestogens: influence of different routes of Aug 21, 2015.
administration". Climacteric. 8 Suppl 1: 3–63. 6. ^ Postgraduate Gynecology . Jaypee Brothers Medical Pub. 2011.
doi:10.1080/13697130500148875 . PMID 16112947 . p. 159. ISBN 9789350250822. Archived from the original on
S2CID 24616324 . 2015-09-26.
3. ^ a b Fotherby K (August 1996). "Bioavailability of orally 7. ^ Gemzell-Danielsson, K (November 2010). "Mechanism of action
administered sex steroids used in oral contraception and hormone of emergency contraception". Contraception. 82 (5): 404–9.
replacement therapy". Contraception. 54 (2): 59–69. doi:10.1016/j.contraception.2010.05.004 . PMID 20933113 .
doi:10.1016/0010-7824(96)00136-9 . PMID 8842581 . 8. ^ "Chapter 1" . Research on reproductive health at WHO : biennial
4. ^ abcdef Shoupe D, Haseltine FP (6 December 2012). report 2000-2001. Geneva: World health organization. 2002.
Contraception . Springer Science & Business Media. pp. 22–. ISBN 9789241562089. Archived from the original on 2015-09-26.
ISBN 978-1-4612-2730-4. 9. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug
Discovery . John Wiley & Sons. p. 479. ISBN 9783527607495.

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 10. ^ a b c Roth K (2014). Chemische Leckerbissen . John Wiley & 17. ^ a b Bao Q, Gu B, Price CF, Zou Y, Wang Y, Kozak D, Choi S,
Sons. pp. 77–. ISBN 978-3-527-33739-2. "[Levonorgestrel (24): The Burgess DJ (October 2018). "Manufacturing and characterization of
product generated by Smith's norgestrel total synthesis was a long-acting levonorgestrel intrauterine systems" . International
racemate, so half of each consisted of the left- and the right-handed Journal of Pharmaceutics. 550 (1–2): 447–454.
enantiomer. Chemists at Schering discovered that only the doi:10.1016/j.ijpharm.2018.09.004 . PMC 6622171 .
levorotatory enantiomer was effective [49] and developed a PMID 30195080 .
biotechnological process for the preparation of the pure levorotatory
enantiomer. This was the active ingredient levonorgestrel born. With
the single-acting enantiomer, the dose and thus the liver burden
could be halved again. The resulting Neogynon® contained 0.25
mg levonorgestrel and 0.05 mg ethinylestradiol and was introduced
in 1970.]"
11. ^ World Health Organization (2019). World Health Organization
model list of essential medicines: 21st list 2019. Geneva: World
Health Organization. hdl:10665/325771 .
WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
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13. ^ "FDA approves Plan B One-Step emergency contraceptive for
use without a prescription for all women of child-bearing potential"
(Press release). June 20, 2013. Archived from the original on 14
January 2016. Retrieved 2 February 2016.
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11 April 2020.
15. ^ a b c d e f g h i j k l m n o p "Levonorgestrel" . Archived from the
original on 2017-08-03. Retrieved 2017-08-03.
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release systems over the past 50years in the area of
contraception". Journal of Controlled Release. 240: 235–241.
doi:10.1016/j.jconrel.2015.12.043 . PMID 26732558 .

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 18. ^ Trussell J, Schwarz EB (2011). "Emergency contraception". In Ulipristal acetate (UPA). One study has demonstrated
Hatcher RA, Trussell J, Nelson AL, Cates W Jr, Kowal D, Policar that UP can delay ovulation.81... Another study found
MS (eds.). Contraceptive technology (20th revised ed.). New York: that UPA altered the endometrium, but whether this
Ardent Media. pp. 113–145. ISBN 978-1-59708-004-0. ISSN 0091- change would inhibit implantation is unknown.82
9721 . OCLC 781956734 . p. 121: p. 122:
Progestin-only emergency contraceptive pills. Early
Mechanism of action treatment with ECPs containing only the progestin
Copper-releasing IUCs levonorgestrel has been show to impair the ovulatory
When used as a regular or emergency method of process and luteal function.83–87
contraception, copper-releasing IUCs act primarily to p. 123:
prevent fertilization. Emergency insertion of a copper Combined emergency contraceptive pills. Several
IUC is significantly more effective than the use of ECPs, clinical studies have shown that combined ECPs
reducing the risk of pregnancy following unprotected containing ethinyl estradiol and levonorgestrel can
intercourse by more than 99%.2,3 This very high level of inhibit or delay ovulation.107–110
effectiveness implies that emergency insertion of a
copper IUC must prevent some pregnancies after
fertilization.
Emergency contraceptive pills
To make an informed choice, women must know that
ECPs—like the birth control pill, patch, ring, shot, and
implant,76 and even like breastfeeding77—prevent
pregnancy primarily by delaying or inhibiting ovulation
and inhibiting fertilization, but may at times inhibit
implantation of a fertilized egg in the endometrium.
However, women should also be informed that the best
available evidence indicates that ECPs prevent
pregnancy by mechanisms that do not involve
interference with post-fertilization events.
ECPs do not cause abortion78 or harm an established
pregnancy. Pregnancy begins with implantation
according to medical authorities such as the US FDA,
the National Institutes of Health79 and the American
College of Obstetricians and Gynecologists (ACOG).80

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 19. ^ RCOG Faculty of Sexual; Reproductive Healthcare; Clinical
Effectiveness Unit (January 2012). "Clinical guidance: emergency
contraception" (PDF). Clinical Guidance. London: Royal College
of Obstetricians and Gynaecologists. ISSN 1755-103X . Archived
from the original (PDF) on 2012-05-26. Retrieved 2012-04-30.
p.3:
How does EC work?
In 2002, a judicial review ruled that pregnancy begins at
implantation, not fertilisation.8 The possible mechanisms
of action should be explained to the patient as some
methods may not be acceptable, depending on
individual beliefs about the onset of pregnancy and
abortion.
Copper-bearing intrauterine device (Cu-IUD). Copper is
toxic to the ovum and sperm and thus the copper-
bearing intrauterine device (Cu-IUD) is effective
immediately after insertion and works primarily by
inhibiting fertilisation.9–11 A systematic review on
mechanisms of action of IUDs showed that both pre-
and postfertilisation effects contribute to efficacy.11 If
fertilisation has already occurred, it is accepted that
there is an anti-implantation effect,12,13
Levonorgestrel (LNG). The precise mode of action of
levonorgestrel (LNG) is incompletely understood but it is
thought to work primarily by inhibition of ovulation.16,17
Ulipristal acetate (UPA). UPA’s primary mechanism of
action is thought to be inhibition or delay of ovulation.2
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20. ^ UNDP/UNFPA/WHO/World Bank Special Programme of
Research, Development and Research Training in Human
Reproduction (HRP) (March 25, 2010). "Fact sheet on the safety of
levonorgestrel-alone emergency contraceptive pills (LNG
ECPs)" (PDF). Geneva: World Health Organization. Archived
(PDF) from the original on March 16, 2012.
Can LNG ECPs cause an abortion?
LNG ECPs do not interrupt an established pregnancy or
harm a developing embryo.15 The evidence available to
date shows that LNG ECP use does not prevent a
fertilized egg from attaching to the uterine lining. The
primary mechanism of action is to stop or disrupt
ovulation; LNG ECP use may also prevent the sperm
and egg from meeting.16
21. ^ Speroff L, Darney PD (2011). "Special uses of oral contraception:
emergency contraception, the progestin-only minipill". A clinical
guide for contraception (5th ed.). Philadelphia: Lippincott Williams &
Wilkins. pp. 153–166. ISBN 978-1-60831-610-6. p. 155:
Emergency postcoital contraception
Levonorgestrel
Mechanism and efficacy
22. ^ Belluck P (June 6, 2012). "No abortion role seen for morning-after
pill" . The New York Times. p. A1. Archived from the original on
February 27, 2017.
Belluck, Pam (June 6, 2012). "Drug's nickname may have aided
politicization" . The New York Times. p. A14.
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 23. ^ International Federation of Gynecology and Obstetrics (FIGO)
and International Consortium for Emergency Contraception (ICEC)
(April 4, 2011). "Mechanism of action: How do levonorgestrel-only
emergency contraceptive pills (LNG ECPs) prevent pregnancy?"
(PDF). London: International Federation of Gynecology and
Obstetrics. Archived (PDF) from the original on December 29,
2014.
Levonorgestrel-only emergency contraceptive pills:
• Interfere with the process of ovulation;
• May possibly prevent the sperm and the egg from
meeting.
Implications of the research:
• Inhibition or delay of ovulation is LNG ECPs principal
and possibly only mechanism of action.
• Review of the evidence suggests that LNG-ECs cannot
prevent implantation of a fertilized egg. Language on
implantation should not be included in LNG ECP product
labeling.
• The fact that LNG-ECs have no demonstrated effect
on implantation explains why they are not 100%
effective in preventing pregnancy, and are less effective
the later they are taken. Women should be given a clear
message that LNG-ECs are more effective the sooner
they are taken.
• LNG ECPs do not interrupt a pregnancy (by any
definition of the beginning of pregnancy). However, LNG
ECPs can prevent abortions by reducing unwanted
pregnancies.
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24. ^ a b c Belluck, Pam (November 26, 2013). "New birth control label
counters lawsuit claim; European authorities found that a drug like
Plan B One-Step cannot prevent fertilized eggs from implanting in
the womb" . The New York Times. Archived from the original on
March 4, 2014. Retrieved March 5, 2014.
HRA Pharma (November 2013). "NorLevo 1.5 mg tablet Patient
Information Leaflet (PIL)" (PDF). Dublin: Irish Medicines Board.
Archived (PDF) from the original on March 5, 2014. Retrieved
March 5, 2014. "NorLevo works by stopping your ovaries from
releasing an egg. It cannot stop a fertilized egg from attaching to
the womb."
HRA Pharma (November 2013). "NorLevo 1.5 mg tablet Summary
of Product Characteristics (SPC)" . Dublin: Irish Pharmaceutical
Healthcare Association. Archived from the original on June 15,
2012. Retrieved March 5, 2014.
European Medicines Agency (January 24, 2014). "Review of
emergency contraceptives started" . London: European Medicines
Agency. Archived from the original on March 27, 2014. Retrieved
March 5, 2014.
25. ^ Mozzanega B, Cosmi E (June 2011). "How do levonorgestrel-only
emergency contraceptive pills prevent pregnancy? Some
considerations". Gynecological Endocrinology. 27 (6): 439–42.
doi:10.3109/09513590.2010.501885 . PMID 20670097 .
S2CID 6431709 .
26. ^ Leung VW, Levine M, Soon JA (February 2010). "Mechanisms of
action of hormonal emergency contraceptives". Pharmacotherapy.
30 (2): 158–68. doi:10.1592/phco.30.2.158 . PMID 20099990 .
S2CID 41337748 .
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 27. ^ Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, 33. ^ a b Shohel M, Rahman MM, Zaman A, Uddin MM, Al-Amin MM,
Gainer E, Ulmann A (October 2011). "Can we identify women at risk Reza HM (April 2014). "A systematic review of effectiveness and
of pregnancy despite using emergency contraception? Data from safety of different regimens of levonorgestrel oral tablets for
randomized trials of ulipristal acetate and levonorgestrel". emergency contraception" . BMC Women's Health. 14: 54.
Contraception. 84 (4): 363–7. doi:10.1186/1472-6874-14-54 . PMC 3977662 .
doi:10.1016/j.contraception.2011.02.009 . PMID 21920190 . PMID 24708837 .
28. ^ Trussell J, Raymond EG, Cleland K (February 2014). "Emergency 34. ^ "Estradiol And Levonorgestrel (Transdermal Route) Description
contraception: a last chance to prevent unintended pregnancy" and Brand Names - Mayo Clinic" . www.mayoclinic.org. Retrieved
(PDF). Princeton: Office of Population Research at Princeton 2019-06-01.
University, Association of Reproductive Health Professionals. 35. ^ "Climara Pro® (Estradiol/Levonorgestrel Transdermal
Archived from the original (PDF) on September 23, 2010. System)" (PDF). Food and Drug Administration.
Retrieved April 9, 2014. 36. ^ Mueck AO, Römer T (July 2018). "Choice of progestogen for
29. ^ Festin, Mario Philip R.; Peregoudov, Alexandre; Seuc, Armando; endometrial protection in combination with transdermal estradiol in
Kiarie, James; Temmerman, Marleen (2017-01-01). "Effect of BMI menopausal women". Hormone Molecular Biology and Clinical
and body weight on pregnancy rates with LNG as emergency Investigation. 37 (2). doi:10.1515/hmbci-2018-0033 .
contraception: analysis of four WHO HRP studies" . PMID 30063464 . S2CID 51886877 .
Contraception. 95 (1): 50–54. 37. ^ a b c d Jensen JT (September 2005). "Contraceptive and
doi:10.1016/j.contraception.2016.08.001 . ISSN 0010-7824 . therapeutic effects of the levonorgestrel intrauterine system: an
PMC 5357708 . PMID 27527670 . overview". Obstetrical & Gynecological Survey. 60 (9): 604–12.
30. ^ a b c Kubíková D (2014). "[Menopausal symptoms and hormone doi:10.1097/01.ogx.0000175805.90122.af . PMID 16121115 .
replacement therapy]" (PDF). Praktické Lékárenství. 10 (2): 68– S2CID 43177026 .
73. 38. ^ Benagiano, Giuseppe; Gabelnick, Henry; Farris, Manuela (2014).
31. ^ ab "Emergency Contraception - ACOG" . www.acog.org. "Contraceptive devices: subcutaneous delivery systems". Expert
Retrieved 2019-06-01. Review of Medical Devices. 5 (5): 623–637.
32. ^ ab Hansen LB, Saseen JJ, Teal SB (February 2007). doi:10.1586/17434440.5.5.623 . ISSN 1743-4440 .
"Levonorgestrel-only dosing strategies for emergency PMID 18803473 . S2CID 207201811 .
contraception". Pharmacotherapy. 27 (2): 278–84. 39. ^ a b c
doi:10.1592/phco.27.2.278 . PMID 17253917 . https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/02199
S2CID 24229915 . 8lbl.pdf
40. ^ HRA Pharma (November 2013). "NorLevo 1.5 mg tablet Summary
of Product Characteristics (SPC)" . Dublin: Irish Pharmaceutical
Healthcare Association. Archived from the original on June 15,
2012. Retrieved April 9, 2014.

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 41. ^ Chen X, Wu X, Zhu H (April 2014). "Acute urticaria as a side 49. ^ a b Neubauer H, Ma Q, Zhou J, Yu Q, Ruan X, Seeger H, Fehm T,
effect of the Mirena® (levonorgestrel-releasing intrauterine system): Mueck AO (October 2013). "Possible role of PGRMC1 in breast
a case report" . BMC Research Notes. 7: 209. doi:10.1186/1756- cancer development". Climacteric. 16 (5): 509–13.
0500-7-209 . PMC 3992142 . PMID 24708811 . doi:10.3109/13697137.2013.800038 . PMID 23758160 .
42. ^ Conz L, Mota BS, Bahamondes L, Teixeira Dória M, Françoise S2CID 29808177 .
Mauricette Derchain S, Rieira R, Sarian LO (January 2020). 50. ^ ab Ruan X, Neubauer H, Yang Y, Schneck H, Schultz S, Fehm T,
"Levonorgestrel-releasing intrauterine system and breast cancer Cahill MA, Seeger H, Mueck AO (October 2012). "Progestogens
risk: A systematic review and meta-analysis". Acta Obstet Gynecol and membrane-initiated effects on the proliferation of human breast
Scand. 99 (8): 970–982. doi:10.1111/aogs.13817 . cancer cells". Climacteric. 15 (5): 467–72.
PMID 31990981 . S2CID 210946832 . doi:10.3109/13697137.2011.648232 . PMID 22335423 .
43. ^ Medicines and Healthcare products Regulatory Agency (15 S2CID 11302554 .
September 2016). "Levonorgestrel-containing emergency hormonal 51. ^ Trabert B, Sherman ME, Kannan N, Stanczyk FZ (September
contraception: advice on interactions with hepatic enzyme inducers 2019). "Progesterone and breast cancer" . Endocr. Rev. 41 (2):
and contraceptive efficacy" . GOV.UK. Archived from the 320–344. doi:10.1210/endrev/bnz001 . PMC 7156851 .
original on 21 January 2017. Retrieved 6 June 2017. PMID 31512725 .
44. ^ a b c Nieschlag E (November 2010). "Clinical trials in male
hormonal contraception" (PDF). Contraception. 82 (5): 457–70.
doi:10.1016/j.contraception.2010.03.020 . PMID 20933120 .
45. ^ abcd Darney PD (January 1995). "The androgenicity of
progestins". The American Journal of Medicine. 98 (1A): 104S–
110S. doi:10.1016/s0002-9343(99)80067-9 . PMID 7825629 .
46. ^ Knaus JV, Isaacs JH (6 December 2012). Office Gynecology:
Advanced Management Concepts . Springer Science & Business
Media. pp. 151–. ISBN 978-1-4612-4340-3. Archived from the
original on 8 September 2017.
47. ^ Golan DE, Tashjian AH, Armstrong EJ (15 December 2011).
Principles of Pharmacology: The Pathophysiologic Basis of Drug
Therapy . Lippincott Williams & Wilkins. pp. 516–. ISBN 978-1-
60831-270-2. Archived from the original on 8 September 2017.
48. ^ Committee on the Relationship Between Oral Contraceptives and
BreastCancer (1 January 1991). Oral Contraceptives and Breast
Cancer . National Academies. pp. 147–. ISBN 9780309044936.
NAP:13774. Archived from the original on 8 September 2017.

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 52. ^ a b c d Meriggiola MC, Farley TM, Mbizvo MT (2003). "A review of
androgen-progestin regimens for male contraception" . Journal of
Andrology. 24 (4): 466–83. doi:10.1002/j.1939-
4640.2003.tb02695.x . PMID 12826683 . "Based on animal
studies and clinical studies in women, 19‐norderived progestins are
known to be potent in terms of gonadotropin suppression (Couzinet
et al, 1996). Among this class of steroidal compounds are
norethisterone (NET), norethynodrel, and its dextrorotatory isomer
LNG (ie, the biologically active form of this progestin). The
progestins of this class are known to be potent suppressors of
gonadotropin secretion, and when administered to men these
compounds induced a profound suppression of sperm production
(Frick, 1973). However, a decrease of libido and sexual potency
was also reported, presumably due to the suppression of T
production secondary to gonadotropin suppression (Kamischke et
al, 2000b). Therefore, like other progestins available thus far, nor‐
progestins should not be administered alone for male contraception
because their residual androgenic activity is not sufficient to
maintain androgen‐dependent physiological functions like libido or
sexual potency (Kamischke et al, 2000a)."
53. ^ a b c Elks J (14 November 2014). The Dictionary of Drugs:
Chemical Data: Chemical Data, Structures and Bibliographies
Springer. pp. 887–. ISBN 978-1-4757-2085-3. Archived from the
original on 8 September 2017.
54. ^ a b c d e Index Nominum 2000: International Drug Directory . form, levonorgestrel, provides the biological activity."
Taylor & Francis. 2000. pp. 605–. ISBN 978-3-88763-075-1.
Archived from the original on 2017-09-08.
55. ^ Alldredge BK, Corelli RL, Ernst ME (1 February 2012). Koda-
Kimble and Young's Applied Therapeutics: The Clinical Use of
Drugs . Lippincott Williams & Wilkins. pp. 1072–. ISBN 978-1-
60913-713-7. Archived from the original on 8 September 2017.
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56. ^ Lavery JP, Sanfilippo JS (6 December 2012). Pediatric and
Adolescent Obstetrics and Gynecology . Springer Science &
Business Media. pp. 248–. ISBN 978-1-4612-5064-7. Archived
from the original on 8 September 2017.
57. ^ Offermanns S, Rosenthal W (14 August 2008). Encyclopedia of
Molecular Pharmacology . Springer Science & Business Media.
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8 September 2017.
58. ^ a b Population Reports: Injectables and implants . Department of
Medical and Public Affairs, George Washington University. 1987.
"The Population Council also plans to test vaginal rings with two
other progestins, ST-1435 and levonorgestrel acetate, alone and
combined with ethinyl estradiol (168)."
59. ^ a b Crabbé P, Archer S, Benagiano G, Diczfalusy E, Djerassi C,
Fried J, Higuchi T (March 1983). "Long-acting contraceptive agents:
design of the WHO Chemical Synthesis Programme". Steroids. 41
(3): 243–53. doi:10.1016/0039-128X(83)90095-8 .
PMID 6658872 . S2CID 12896179 .
60. ^ Meikle AW (1 June 1999). Hormone Replacement Therapy .
Springer Science & Business Media. pp. 383–. ISBN 978-1-59259-
700-0. "The gonanes share the structural modifications found in the
. estranes and also possess [an ethyl] group at the position 13 and a
keto group at position 3. Norgestrel was synthesized in 1963 and is
a racemic mixture of dextro and levorotatory forms. The levorotatory
61. ^ Szejtli J, Szente L (6 December 2012). Proceedings of the Eighth
International Symposium on Cyclodextrins: Budapest, Hungary,
March 31–April 2, 1996 . Springer Science & Business Media.
pp. 317–. ISBN 978-94-011-5448-2. "[Norgestrel] was discovered
by Hughes et al. (1963)."
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 62. ^ a b c Filshie M, Guillebaud J (22 October 2013). Contraception:
Science and Practice . Elsevier Science. pp. 12–. ISBN 978-1-
4831-6366-6. "Norgestrel, developed by Wyeth and patented in
1964, was the first progestogen to be manufactured by total
chemical synthesis. It was subsequently licensed to Schering AG,
who separated the racemic mixture into an inactive structural
isomer l-norgestrel and the active d-norgestrel -- more usually
known as dextronorgestrel and levonorgestrel respectively, because
of the optical isomerism that each displays."
63. ^ abcd Marks L (2010). Sexual Chemistry: A History of the
Contraceptive Pill . Yale University Press. pp. 73, 76. ISBN 978-0-
300-16791-7. "In 1964 the pharmaceutical company Wyeth
developed norgestrel, the first progestogen to be made from a total
chemical synthesis. Subsequently licensed to Schering AG,
norgestrel was used to develop levonorgestrel, another active
progestogen later used for oral contraception."
64. ^ ab Pohl WG (2004). Die wissenschaftliche Welt von gestern: die
Preisträger des Ignaz L. Lieben-Preises 1865-1937 und des
Richard Lieben-Preises 1912-1928 : ein Kapitel österreichischer
Wissenschaftsgeschichte in Kurzbiografien . Böhlau Verlag Wien.
pp. 150–. ISBN 978-3-205-77303-0. "[The contraceptive EUGYNON
is launched in 1966. NEOGYNON follows in 1970.]"
65. ^ ab Ortiz-Gómez T, Santesmases MJ (22 April 2016). Gendered
Drugs and Medicine: Historical and Socio-Cultural Perspectives
Taylor & Francis. pp. 175–. ISBN 978-1-317-12981-3. "The 1966
marketing campaign for Schering's second contraceptive, Eugynon,
[...] (Schering AG Berline 1966, 11). [...] In 1970 [Schering] had
already conducted an opinion poll among doctors in the run up to
the marketing campaign for the newly introduced Neogynon. [...]"
66. ^ Tone A, Watkins ES (8 January 2007). Medicating Modern
America: Prescription Drugs in History . NYU Press. pp. 118 – substance". Contraception. 9 (1): 81–92. doi:10.1016/0010-
119. ISBN 978-0-8147-8300-9.
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67. ^ Albach H (1993). Culture and Technical Innovation: A Cross-
Cultural Analysis and Policy Recommendations . Walter de
Gruyter. p. 952. ISBN 978-3-11-013947-1. "[Since the safety of
ovulation inhibition by levonorgestrel was also proven in the clinical
studies, the cycle was extremely stable and the side effects were
low, the drug was on August 1, 1970 introduced as Neogynon 21
and Neogynon 28 in Germany on the market.] [...] After the OC
market had risen sharply in 1968 and 1969, the launch of Neogynon
/ Schering and Stediril-d / Wyeth in August 1970 gave the market a
fresh boost.]"
68. ^ Apelo R, Veloso I (1970). "Results of a controlled study employing
d-norgestrel and ethinyl estradiol". Contraception. 2 (6): 391–400.
doi:10.1016/S0010-7824(70)80002-6 . ISSN 0010-7824 . "The
results obtained in these series clinically confirmed the findings in
animal work on the potency of d-norgestrel, i.e., that the biological
activity of norgestrel resides largely in the d-enantlomer (5,6)."
69. ^ Brosens I, Van Assche A, Wijnants P (1971). "Comparative
clinical and morphological studies on 2 oral contraceptives which
contain DL-norgestrel and D-norgestrel respectively" .
Geburtshilfe und Frauenheilkunde. 31 (3): 251–257. "Comparison of
the effects of Eugynon and Neogynon (.05 mg ethinyl estradiol with
.5 mg norgestrel or with .25 mg d-norgestrel, respectively) in 272
women is reported. The 2 preparations were comparable as regards
. effectiveness (100%), cycle control, and endometrial and cervical
morphology. No clinical or biological complications occurred, and
the incidence of minor side effects was very small. The d-norgestrel
preparation (Neogynon) may be preferable for metabolic reasons
because of its lower steroid dose."
70. ^ Schneider W, Spona J, Matt K (1974). "Inhibition of ovulation by
means of a combined preparation with reduced amounts of active
7824(74)90096-1 . ISSN 0010-7824 .
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 71. ^ Brat T (1974). "Clinical trial with a new low oestrogen combined 79. ^ Artini PG, Genazzani AR, Petraglia F (11 December 2001).
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465–70. doi:10.1185/03007997409115244 . PMID 4614952 . ISBN 978-1-84214-071-0.
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73. ^ Lambotte R, Werbrouck-Navette J (March 1974). "[Minipill as the doi:10.1093/oxfordjournals.humrep.a138057 . PMID 8473453 .
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doi:10.1016/0010-7824(73)90139-X . ISSN 0010-7824 . 83. ^ a b "FDA approves over-the-counter sales of Plan B One-Step for
75. ^ Rubio B, Berman E, Larranaga A, Guiloff E (1970). "A new all ages" . Archived from the original on 2017-08-03. Retrieved
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doi:10.1016/0010-7824(70)90016-8 . ISSN 0010-7824 . 84. ^ Trussell J, Cleland K (2007-04-10). "Emergency Contraceptive
76. ^ Balaji (19 November 2009). Textbook of Oral and Maxillofacial Pills Worldwide" . Princeton University. Archived from the
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are two main methods involving oral emergency pills, commonly 85. ^ Oats JJ, Abraham S (17 November 2011). Llewellyn-Jones
misleadingly described as the 'morning-after pill'. The first older Fundamentals of Obstetrics and Gynaecology E-Book . Elsevier
method, developed in the mid-1970s, involves two high-dose Health Sciences. pp. 247–. ISBN 978-0-7234-3719-2.
combined pills containing oestrogen (50 ug ethinyloestradiol) and 86. ^ Carlson KJ, Eisenstat SA, Ziporyn TD (2004). The New Harvard
progesterone (0.25 mg levonorgestrel): the Yuzpe regime (Schering Guide to Women's Health . Harvard University Press. pp. 285 –.
PC4 or Ovran). The second involves progesterone only (0.75 mg ISBN 978-0-674-01282-0.
levonorgestrel), and therefore, has a lower incidence of side effects, 87. ^ Rankin, Kenrya (2015-10-22). "This Policy Gives Native Women
in particular vomiting (6%)." Equal Access to Emergency Contraception" . Colorlines.
77. ^ Yuzpe AA, Thurlow HJ, Ramzy I, Leyshon JI (August 1974). "Post Archived from the original on 2015-10-26. Retrieved 2015-10-24.
coital contraception--A pilot study". The Journal of Reproductive
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cluster=8190066278284376785

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