Levest

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Levest on Prescriptsy

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Levest is a combined oral contraceptive (COC) pill containing levonorgestrel 150 micrograms and ethinylestradiol 30 micrograms.

It is a generic equivalent of Microgynon 30 and is among the most widely prescribed contraceptive pills in the United Kingdom.

Levest prevents pregnancy through three mechanisms: suppression of ovulation, thickening of cervical mucus to block sperm penetration, and thinning of the endometrium to reduce the likelihood of implantation.

It is taken as one pill daily for 21 days followed by a 7-day pill-free interval, though extended and continuous regimens are also supported by current clinical guidance.

Levest is a prescription-only medicine.

Contraception is a fundamental aspect of reproductive healthcare in the UK.

The Faculty of Sexual and Reproductive Healthcare (FSRH) estimates that approximately 3.1 million women in England use hormonal contraception, with the combined oral contraceptive pill being the most popular hormonal method.

The choice of contraceptive depends on individual factors including age, medical history, lifestyle, reproductive plans, and personal preference.

This page provides a comprehensive clinical overview of Levest for UK patients and prescribers, covering how it works, its effectiveness, dosage guidance, side effects, important safety information, and how to obtain it.

Important safety information about Levest

Before reading further, note these essential safety points about Levest.

• Levest is a prescription-only medicine and requires a medical assessment before use.
• All combined hormonal contraceptives carry a small increased risk of venous thromboembolism (blood clots). Levonorgestrel-containing pills like Levest have the lowest VTE risk in this class.
• Do not take Levest if you have migraine with aura, a history of blood clots, active breast cancer, or severe hypertension.
• Smoking while taking the combined pill significantly increases the risk of heart attack and stroke, especially over the age of 35.
• Certain medicines, including some anticonvulsants and St John's wort, reduce the effectiveness of the pill.
• Seek immediate medical advice if you experience sudden severe leg pain, chest pain, breathlessness, sudden severe headache, or visual disturbance.

Understanding combined oral contraception

Combined oral contraceptives contain two hormones: an oestrogen (ethinylestradiol in most pills, including Levest) and a progestogen (levonorgestrel in Levest).

These synthetic hormones mimic the action of naturally produced oestrogen and progesterone to suppress the hormonal cycle that leads to ovulation.

The oestrogen component inhibits follicle-stimulating hormone (FSH), preventing the development of a dominant follicle.

The progestogen component inhibits the luteinising hormone (LH) surge that triggers ovulation, thickens cervical mucus (making it hostile to sperm), and thins the endometrium.

The combined effect of these three mechanisms makes the COC one of the most reliable reversible contraceptive methods available.

COCs are classified by the type of progestogen they contain. Second-generation progestogens (levonorgestrel and norethisterone) are associated with the lowest risk of VTE among combined pills.

Third-generation progestogens (desogestrel, gestodene) and anti-androgenic progestogens (drospirenone, cyproterone acetate) may carry a slightly higher VTE risk.

This is why the FSRH recommends levonorgestrel-containing COCs as the first-choice combined pill. Levest, as a levonorgestrel-containing COC, benefits from this recommendation.

How Levest works: mechanism of action

Levonorgestrel, the progestogen in Levest, binds to progesterone receptors in the hypothalamus, pituitary, endometrium, and cervix.

By providing a continuous exogenous progestogenic signal, it suppresses the pulsatile release of gonadotrophin-releasing hormone (GnRH) from the hypothalamus and, consequently, the secretion of LH and FSH from the anterior pituitary.

Without the mid-cycle LH surge, ovulation does not occur.

Levonorgestrel also acts locally on the cervix, increasing the viscosity of cervical mucus to create a physical barrier to sperm, and on the endometrium, rendering it less receptive to implantation.

Ethinylestradiol, the oestrogen component, primarily inhibits FSH secretion, preventing follicular recruitment and development.

It also stabilises the endometrium (preventing breakthrough bleeding during the active pill phase), potentiates the action of the progestogen, and contributes to cycle control.

The 30 microgram dose of ethinylestradiol in Levest provides reliable ovulation suppression with good cycle control while keeping the oestrogen dose as low as practically effective.

When taken correctly, the combined pill prevents ovulation in virtually every cycle. The 7-day pill-free interval allows a withdrawal bleed (not a true period) as hormone levels drop.

This interval was originally included to mimic the natural menstrual cycle for psychological acceptability but is not medically necessary.

The FSRH now supports extended and continuous regimens that reduce or eliminate the pill-free interval.

Effectiveness of Levest

With perfect use (taking the pill at the same time every day without missing any pills), the combined pill is more than 99% effective, meaning fewer than 1 in 100 women would become pregnant in a year.

With typical use (accounting for occasional missed pills, late starts, and human error), the effectiveness is approximately 91%, meaning about 9 in 100 women would become pregnant in a year.

The most common reasons for contraceptive failure with the pill are missed pills (particularly at the beginning or end of the pack, which extends the pill-free interval), drug interactions that reduce absorption or increase metabolism, and vomiting or severe diarrhoea that impairs absorption.

To maximise effectiveness, take Levest at the same time every day. Setting a daily reminder on your phone is a practical strategy. Follow the missed-pill guidance carefully.

Be aware of interactions with other medicines and report any new prescriptions to your contraception provider.

Clinical guidance and UK prescribing context

The FSRH Clinical Guideline on Combined Hormonal Contraception provides the primary evidence-based framework for prescribing COCs in the UK.

It recommends that a first-line COC should contain levonorgestrel or norethisterone combined with ethinylestradiol 30 micrograms, as this combination carries the lowest VTE risk.

Levest meets these criteria as a levonorgestrel/ethinylestradiol 30 microgram product.

Before prescribing, the clinician should take a thorough medical history, check blood pressure, and assess risk factors using the UKMEC framework.

UKMEC classifies conditions into four categories: UKMEC 1 (no restriction), UKMEC 2 (advantages generally outweigh risks), UKMEC 3 (risks generally outweigh advantages), and UKMEC 4 (unacceptable health risk, contraindicated).

For example, migraine with aura is UKMEC 4 for combined hormonal contraception, meaning it is an absolute contraindication.

NICE guideline NG136 on contraception recommends that women should be offered a choice of contraceptive methods with full information about effectiveness, risks, benefits, and alternatives.

Long-acting reversible contraceptives (LARCs) such as the intrauterine device, intrauterine system, and contraceptive implant are more effective than user-dependent methods like the pill and should be discussed as options.

Dosage and administration

The standard regimen is one tablet daily for 21 days followed by a 7-day pill-free interval. Start day 1 of your period for immediate protection.

If starting later (up to day 5), use condoms for 7 days. Swallow the tablet whole with water. Take it at the same time each day.

Extended and continuous regimens, supported by the FSRH, involve taking active pills for longer than 21 days (or continuously without a break) to reduce hormone-withdrawal symptoms and the frequency of withdrawal bleeds.

A common approach is the 63/7 regimen (three packs continuously, then a 7-day break) or flexible extended use (continuous pills until breakthrough bleeding occurs, then a 4-day hormone-free interval).

Discuss these options with your prescriber.

Side effects of Levest

Common side effects

Headache, nausea, breast tenderness, mood changes, and breakthrough bleeding are the most commonly reported effects, particularly during the first 2 to 3 cycles.

These usually settle with continued use. Changes in libido, mild fluid retention, and skin changes (acne may improve or worsen) also occur.

Serious risks

Venous thromboembolism (DVT and PE) is the most significant rare risk.

The absolute risk with levonorgestrel-containing COCs is approximately 5 to 7 per 10,000 women per year, compared with 2 per 10,000 in non-users.

The risk is highest in the first year of use and is increased by obesity, smoking, immobility, and inherited thrombophilia.

Arterial events (stroke and myocardial infarction) are very rare in young women but are increased by smoking (especially over age 35), hypertension, migraine with aura, and diabetes with complications.

A small increase in breast cancer risk has been observed during COC use, but this declines after stopping and returns to baseline within 10 years.

When to seek urgent medical advice

Use the ACHES mnemonic: Abdominal pain (severe), Chest pain or breathlessness, Headache (sudden, severe, unusual), Eye disturbance (sudden visual loss or blurring), and Severe leg pain or swelling.

These may indicate a blood clot and require immediate assessment. Call 999 or attend A&E. Report any suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Levest must not be used in women with VTE history, arterial thromboembolism history, migraine with aura, active or history of breast cancer, severe liver disease, undiagnosed vaginal bleeding, severe hypertension, diabetes with vascular complications, or known thrombogenic mutations.

Risk factor assessment

Smoking over age 35, BMI above 35, strong family history of VTE, and multiple cardiovascular risk factors each require careful evaluation.

Blood pressure should be checked before starting and at each annual review. The UKMEC framework guides prescribing decisions based on individual risk.

Drug interactions

Enzyme-inducing drugs (carbamazepine, phenytoin, phenobarbital, rifampicin, rifabutin, some antiretrovirals, St John's wort) reduce pill efficacy.

Use additional contraception during treatment and for 28 days after stopping the interacting drug. If long-term enzyme-inducing medication is needed, consider switching to a non-oral contraceptive method.

Broad-spectrum antibiotics (other than rifampicin and rifabutin) do not reduce COC efficacy.

How to get Levest in the UK

Levest is a prescription-only medicine available free on NHS prescription for contraception.

It can be prescribed by your GP, a sexual health or contraception clinic, or an authorised online prescriber registered with the GPhC.

A clinical assessment including medical history and blood pressure is required.

The NHS prescription charge in England is currently 9.90 pounds per item, but contraception is exempt from prescription charges when prescribed for contraceptive purposes.

Contraception is also available free from sexual health clinics and many community pharmacies.

Other contraceptive options

If the combined pill is not suitable, alternatives include the progestogen-only pill (mini-pill), the contraceptive implant (Nexplanon), the hormonal intrauterine system (Mirena, Levosert, Kyleena, Benilexa), the copper intrauterine device, the contraceptive injection (Depo-Provera, Sayana Press), the vaginal ring (NuvaRing), and the contraceptive patch (Evra).

Long-acting methods (implant, IUS, IUD) are the most effective and do not require daily user action.

Discuss your options with a healthcare professional to find the method that best suits your circumstances.

Sources

• Levest, Summary of Product Characteristics (EMC)
• Ethinylestradiol with levonorgestrel, British National Formulary (BNF)
• FSRH Clinical Guideline: Combined Hormonal Contraception
• NICE NG136: Contraception
• Combined pill, NHS
• MHRA Yellow Card Scheme