Levest

What is Levest? – Levest is often called ‘the pill’ but is more specifically a combined contraceptive pill. The word ‘combined’ means that it contains synthetic versions of progesterone and estrogen, two sex hormones women naturally produce. The synthetic hormones are called ethinylestradiol and levonorgestrel.

Why do people choose Levest? – Levest is one of the easiest-to-use and most effective types of contraception there are currently. It’s taken by women for a few reasons:

• Contraception – the hormones stop an egg from being released (ovulation) each month. The pill also increases the thickness of the mucus of the womb, making it harder for sperm to reach an egg, and changes the quality of the womb lining, making it less likely that a fertilised egg can implant there. Overall, these actions make a pregnancy very unlikely
• Managing your period – Levest can be prescribed for symptoms of your period, like intense pain or abnormal bleeding. Once you take the pill, you generally only have mild withdrawal bleeds, which mean that the menstrual symptoms significantly reduce

Levest can:

• make your periods regular
• reduce heaviness and pain associated with periods
• help relieve premenstrual symptoms

You can order Levest from ZAVA – if you’ve already been started on a combined pill by a nurse or doctor face to face. It’s an easy process – you simply pick your pill, then fill in a quick 3-minute questionnaire on things like your health and medications you might be taking. Once your answers are submitted, they’ll be assessed by our doctor and they’ll check whether you can be prescribed the pill you’ve chosen.

How to start treatment – in the same way, it’s easy to start your treatment first with Levest through your GP or nurse. You should have a talk with them first about your needs and any personal health aspects they should know about. Together you can then make a safe and effective decision for you.

When should you not take Levest? – if there aren’t any medical reasons for you not to take the pill, and you don't smoke, then you can take the pill until menopause. On the other hand, your physician might not think it’s a good idea or safe if you:

• are or could be pregnant
• are in the first 6 months of breastfeeding
• are allergic to any of the ingredients of Levest (you can check the product information leaflet for these)
• have a history or risk factors for thrombosis – examples are pulmonary embolism or heart attack
• have diabetes
• have a history of specific migraines
• have/have had pancreatitis
• have/have had severe kidney disease
• have liver tumours or a history of them
• have diagnosed or suspected cancer
• have undiagnosed vaginal bleeding
• have had breast cancer, of have a strong family history of breast cancer

Your Levest will come with instructions – before you start taking the pill, you should make sure you read through the patient information leaflet that comes with the pill. Make sure you’re comfortable enough to ask your physician if you have any questions too, since they may want you follow some specific instructions instead of what’s in the leaflet.

When to take your first tablet – the easiest way to start Levest is to take your first pill on the first day of your period (the first day that you bleed) if you weren’t taking any hormonal contraceptive in the past month. This way you will be protected immediately.

How to keep track of doses – Levest comes in a packet of 21 pills, with the foil packaging labelled to show you what day each pill should be taken on. This is designed to help you effectively keep track of when you’ve had your doses. Something which could also help you remember to take your pill each day is setting reminds or alarms on your phone – this wouldn’t require you to actively think about whether you’ve had it or not and might be suitable if you happen to live a busy daily life.

You should do your best not to miss any of your pills – if you’ve only forgotten one pill and you’re less than 24 hours late in taking your pill, your protection from pregnancy won’t be reduced. Take your pill as soon as you remember within this period and carry on the next day as usual. On the other hand, your protection from pregnancy could be reduced if you’re more than 24 hours late taking your pill. Depending on how far into your pill packet you are, your physician will let you know what your next steps should be, which could involve skipping your week treatment break, for example.

You could get side effects – the active ingredients in Levest tablets are levonorgestrel and ethinylestradiol and, like all medicines, Levest can cause some side effects. These don’t affect everyone, but it’s a good idea to discuss them with your physician before starting your treatment so you know what to look out for. Knowing about these might also help you become generally more attentive, which could translate into a better experience with your treatment. Common side effects are listed in the ‘common Levest side effects’ section to the right.

Some rarer side effects include:

• high blood pressure
• blood clots
• liver tumors
• swelling of the skin (angioedema)
• occurrence or worsening of conditions like epilepsy or migraine

When to get medical help – if any of the side effects become serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist immediately. In cases of emergency, you should contact emergency services for immediate medical attention. Some of the cases in which you should see your physician immediately if you:

• become pregnant
• experience symptoms of an allergic reaction (rash and/or facial swelling) – this could be because of ingredients in the pill, such as lactose or sucrose
• experience signs of a blood clot (sudden, severe pain in the chest, left arm or one leg; difficulty breathing; slurred speech; sudden weakness; seizure; collapse; vision loss)

The difference between Pills like Levest and mini Pills – the major difference between Levest and the mini pill is the hormones in each. While Levest is a combined pill with two active ingredients (ethinylestradiol and levonorgestrel), the mini pill only contains progesterone. Since it has only one hormone, the mini pill ends up delivering a lower dose of hormone into your body. This means that the time slot at which these mini pills can be taken is narrower.

Levest gives you a break but mini pills don't – one of the other differences between the combined pill and mini pill is the treatment regimen itself. You normally take Levest for 21 days then have a 7-day break, but mini pills are taken for 28 days continuously without a break in between.

Non-pill forms of contraception are quite varied and include:

• Barrier methods – the diaphragm and cervical cap are examples of these and they work as a barrier, essentially blocking a woman’s egg from sperm (fertilisation). There are more reliable methods of contraception than these. They might need to be refitted after you give birth (since the size you might need may change)
• Condoms – these act as an external barrier method (stopping the man’s sperm from reaching the woman’s egg), which isn’t fitted in the woman. This method has a higher chance of pregnancy than hormonal contraceptive methods, but some women might prefer this since it means not taking hormones. It also protects against sexually transmitted infections
• Long acting reversible contraceptives (LARC) – these are contraceptive methods that last for months or years and allow you to go back to your periods and fertility after using them. They are offered at most GP surgeries or sexual health clinics. These methods include:
• Intrauterine devices (IUDs) – these are usually small devices/coils, which are placed in the woman’s uterus. ParaGard is a non-hormonal type that works by releasing copper into the womb. Copper affects mucus in the cervix, making it tough for sperm to fertilise an egg, and then for the egg to implant and survive. The IUD has also been shown to be safe and effective for up to 10 years. Mirena is an example of a hormonal IUD (or intrauterine system - IUS) that releases the hormone, levonorgestrel into the uterus. The hormone makes the mucus in the cervix thick to prevent sperm from entering your uterus and reaching the egg and thins the uterus lining. Mirena can prevent pregnancy for up to 5 years
• The implant - this is a small plastic rod that is inserted under your skin in your arm and releases a progesterone at low doses. The implant lasts three years, after which it can be replaced. It can also be removed before if needed
• The progesterone injection - the most commonly used contraceptive injection lasts 13 weeks. It is a very effective contraceptive method if used correctly