2122 Sex Hormones and their Modulators Venous thromboembolism. For mention that levonorg- 250 micrograms of levonorgestrel orally for 10 to 12 Microvlar; Miranova; Neogynon; Nordette; Nordiol†; Norgestrel Minor; estrel-containing combined oral contraceptives appeared to be Norgestrel Plus; Ovral†; Plenifem†; Tridestan N; Trinordiol; Triquilar; Aus- days of a 28-day cycle. Levonorgestrel may also be tral.: Biphasil†; Levlen ED; Loette; Logynon ED; Microgynon; Microlevlen associated with a lower incidence of venous thromboembolism given via a combined transdermal patch, releasing ED; Monofeme; Nordette; Nordiol†; Sequilar ED; Trifeme; Triphasil; Triqui- than desogestrel- or gestodene-containing preparations, see lar; Austria: Climabelle†; Cyclacur; Donnina; FemSeven Combi; Loette; p.2063. See also Effects on the Blood, above. 10 micrograms per 24 hours, which is applied once Madonella; Microgynon; Neo-Stediril; Neogynon†; Ovranette; Perikursal; weekly for 2 weeks of a 4-week cycle. Alternatively, a Sequilar; Stediril D; Trigynon; Trinordiol; Belg.: Binordiol†; Cyclocur; Femi- nova Plus; Lowette; Microgynon; Neo-Stediril†; Neogynon†; Stediril 30; Interactions patch releasing 7 or 15 micrograms per 24 hours with Stediril D†; Trigynon; Trinordiol; Braz.: Anfertil; Ciclo; Ciclofemme; an oestrogen is applied once weekly for continuous Ciclon†; Cicloprimogyna; Concepnor; Evanor; Gestrelan; Level; Levordiol; As for progestogens in general (see Progesterone, Lindisc Duo†; Lovelle; Microvlar; Neovlar; Nociclin; Nordette; Normamor; p.2126). See also under Hormonal Contraceptives, HRT. The intra-uterine levonorgestrel device described Postoval†; Trinordiol; Triquilar; Canad.: Alesse; Min-Ovral; Ovral; Triphasil; above may be used for up to 4 years with oestrogen Triquilar; Chile: Alesse; Anovulatorio Micro-Dosis; Anulette; Fem 7 Combi; p.2067. Femitres; Innova Cd; Loette†; Microfemin†; Microgynon; Modutrol; Nor- replacement therapy. dette; Nordiol; Norvetal; Postoval†; Progyluton; Trinordiol; Triquilar; Trolit; Cz.: Anteovin†; Climara Duo†; Cyclo-Menorette†; CycloOstrogynal†; Pharmacokinetics Administration. IMPLANTS. Some references to the use of Gravistat; Klimonorm; Loette; Microgynon; Minisiston; Stediril†; Tri-Regol; Levonorgestrel is rapidly and almost completely ab- levonorgestrel by subcutaneous implant for hormonal contra- Trinordiol; Triquilar; Trisiston†; Denm.: Cyclo-Progynon; Fironetta†; Gyna- sorbed after an oral dose, and undergoes little first-pass ception.1-3 trol†; Malonetta; Microgyn; Neogentrol†; Neogynon; Nuvelle; Tetragynon†; 1. Coukell AJ, Balfour JA. Levonorgestrel subdermal implants: a Triminetta; Trinordiol; Triquilar; Fin.: Climara Duo†; Cyclabil; FemSeven hepatic metabolism. It is highly bound to plasma pro- Combi; Microgynon; Neo-Primovlar†; Trikvilar; Trinordiol†; Fr.: Adepal; review of contraceptive efficacy and acceptability. Drugs 1998; Daily; Ludeal; Minidril; Stediril; Tetragynon†; Trinordiol; Ger.: Cyclo-Meno- teins; 42 to 68% to sex hormone binding globulin and 55: 861–87. rette; Cyclo-Progynova; CycloOstrogynal; Fem 7 Combi; Femigoa; Femran- 30 to 56% to albumin. The proportion bound to sex 2. Sivin I. Risks and benefits, advantages and disadvantages of lev- ette mikro†; Gravistat; Klimonorm; Leios; Microgynon; Minisiston; Miranova; onorgestrel-releasing contraceptive implants. Drug Safety 2003; MonoStep; Neo-Stediril†; Neogynon†; NovaStep; Ostronara; Perikursal†; hormone binding globulin is higher when it is given 26: 303–35. Sequilar†; Stediril 30†; Stediril D†; Stediril†; Tetragynon†; Triette†; Trigoa; with an oestrogen. Levonorgestrel and norgestrel are 3. Power J, et al. Subdermal implantable contraceptives versus oth- Trinordiol†; Triquilar; Trisiston; TriStep†; Gr.: Cyclacur; Loette; Neogynon†; er forms of reversible contraceptives or other implants as effec- Nordette†; Nordiol†; Nuvelle†; Ovral†; Trinordiol†; Triquilar†; Hong metabolised in the liver to sulfate and glucuronide con- tive methods of preventing pregnancy. Available in The Co- Kong: Eugynon; Klimonorm†; Microgynon; Neogynon†; Nordette; Rigevi- jugates, which are excreted in the urine and to a lesser chrane Database of Systematic Reviews; Issue 3. Chichester: don; Tri-Regol; Trinordiol†; Triquilar†; Hung.: Anteovin; Cyclo-Menorette†; John Wiley; 2007 (accessed 27/06/08). FemSeven Combi; Klimonorm; Loette; Miranova†; Ovidon; Rigevidon; Tri- extent in the faeces. Levonorgestrel is distributed into Regol; Trinordiol; Triquilar; India: Duoluton-L; Ovilow†; Ovipauz-L†; Ovral; breast milk. INTRA-UTERINE DEVICES. Some references to the use of lev- Triquilar; Indon.: Cyclo-Progynova; Microdiol; Microgynon; Pil Keluarga Be- onorgestrel-releasing intra-uterine devices for rencana; Planak; Trinordiol; Triquilar; Irl.: Logynon; Microgynon 30†; Micro- ◊ References. contraception1-7 and menopausal HRT.8,9 lite; Nuvelle†; Ovran†; Ovranette; Prempak-C; Trinordiol; Israel: Logy- non†; Microgynon; Neogynon†; Nordette; Progyluton; Trinordiol†; Ital.: 1. Fotherby K. Levonorgestrel: clinical pharmacokinetics. Clin 1. Backman T, et al. Length of use and symptoms associated with Combiseven; Egogyn; Eugynon†; Evanor-D†; Femity; Loette; Microgynon; Pharmacokinet 1995; 28: 203–15. premature removal of the levonorgestrel intrauterine system: a Miranova; Novogyn; Nuvelle; Nuvelle TS†; Ovranet†; Trigynon; Trinordiol†; nation-wide study of 17,360 users. Br J Obstet Gynaecol 2000; Jpn: Ange; Malaysia: Klimonorm†; Loette; Microgynon 30; Nordette; Pro- Uses and Administration 107: 335–9. gyluton; Rigevidon; Tri-Regol†; Trinordiol; Triquilar†; Mex.: Alesse; Femex- 2. French RS, et al. Levonorgestrel-releasing (20 microgram/day) in; Letinnov; Microgynon; Neogynon; Nordet; Nordiol; Ovral; Progyluton; Norgestrel and its active (−)-isomer levonorgestrel are intrauterine systems (Mirena) compared with other methods of Trinordiol; Triquilar; Mon.: FemseptCombi; Neth.: Alesse; Cyclocur; Fem progestogens (see Progesterone, p.2126) derived from reversible contraceptives. Br J Obstet Gynaecol 2000; 107: 7 Sequi; Levlen†; Logynon; Lovette; Microgynon; Miranova; Neogynon; 1218–25. Prempak-C†; Rigevidon; Stediril; Trigynon; Trinordiol; Norw.: Cyclabil; Fol- nortestosterone. They are more potent inhibitors of 3. Backman T. Benefit-risk assessment of the levonorgestrel intra- limin†; Loette; Microgynon; Tetragynon†; Trinordiol; Trionetta; NZ: Levlen ovulation than norethisterone and have androgenic ac- uterine system in contraception. Drug Safety 2004; 27: ED; Loette; Microgynon; Monofeme; Nordette; Nordiol†; Nuvelle; Ovral†; 1185–1204. Prempak-C†; Trifeme; Triphasil; Triquilar; Philipp.: Femenal; Lady; Logynon; tivity. Levonorgestrel is more commonly used than 4. Guillebaud J. The levonorgestrel intrauterine system: a clinical Microgynon; Nordette; Nordiol; Rigevidon; Seif; Trinordiol; Trust Pill; Pol.: norgestrel and is twice as potent. For example, lev- perspective from the UK. Ann N Y Acad Sci 2003; 997: 185–93. Anteovin; Cyclo-Progynova; Fem 7 Combi; Gravistat; Klimonorm; Microgy- 5. Jensen JT. Contraceptive and therapeutic effects of the levonorg- non; Minisiston; Rigevidon; Stediril; Tri-Regol; Trinordiol; Triquilar; Trisiston; onorgestrel 37.5 micrograms is equivalent to norg- Port.: Climara Duo†; Femsete Combi; Femsete Evo; Microginon; Miranova; estrel intrauterine system: an overview. Obstet Gynecol Surv estrel 75 micrograms. Neomonovar†; Nuvelle; Progyluton; Tetragynon; Trinordiol; Triquilar; Rus.: 2005; 60: 604–12. Anteovin (Антеовин); Cyclo-Progynova (Цикло-прогинова); Klimonorm They are both used as hormonal contraceptives (see 6. Peled Y, et al. Levonorgestrel-releasing intrauterine system as an (Климонорм); Microgynon (Микрогинон); Minisiston (Минизистон); Ovi- adjunct to estrogen for the treatment of menopausal symptoms— don (Овидон); Rigevidon (Ригевидон); Tri-Regol (Три-Регол); Triquilar p.2069). The typical daily dose is the equivalent of: a review. Menopause 2007; 14: 550–4. (Триквилар); Trisiston (Тризистон); S.Afr.: Biphasil; E-Gen-C; Loette; Log- 7. Faculty of Sexual and Reproductive Healthcare Clinical Effec- ynon ED; Miranova; Nordette; Nordiol; Ovral; Postoval; Triphasil; Singa- • 30 or 37.5 micrograms of levonorgestrel as an oral tiveness Unit. FSRH guidance (November 2007): intrauterine pore: Loette; Microgynon; Nordette; Prempak-C; Progyluton; Trinordiol; progestogen-only contraceptive contraception. Available at: http://www.ffprhc.org.uk/admin/ Triquilar†; Spain: Auroclim; Loette; Microgynon; Neogynona; Nuvelle; uploads/CEUGuidanceIntrauterineContraceptionNov07.pdf (ac- Ovoplex; Progyluton; Triagynon; Triciclor; Swed.: Cyclabil; Follimin; Folli- • 150 micrograms of levonorgestrel in monophasic cessed 18/07/08) nett; Neovletta; Trinordiol; Trionetta; Triregol; Switz.: Binordiol†; Cyclacur; combined oral contraceptives (doses may range 8. Sitruk-Ware R. The levonorgestrel intrauterine system for use in Fem 7 Combi; Microgynon; Miranova; Neogynon†; Ologyn; Stediril 30; Ste- peri- and postmenopausal women. Contraception 2007; 75 (sup- diril D; Tetragynon; Trinordiol; Triquilar; Thai.: Anna†; Cyclo-Progynova; from a low dose of 100 micrograms of levonorg- pl): S155–S160. Eugynon 250†; FMP†; Jeny-FMP†; Klimonorm; Microgest; Microgynon; Mic- estrel in some preparations up to 250 micrograms in 9. Chrisman C, et al. The levonorgestrel-releasing intrauterine sys- rolenyn; Nordette; R-Den†; Riget; Rigevidon; Triquilar; Turk.: Cyclo-Progy- tem: an updated review of the contraceptive and noncontracep- nova; Lo-Ovral; Microgynon; Miranova; Preven; Triquilar;