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Option 2 (Levonorgestrel Tablet 1.5 mg) Emergency Contraceptive Review

Option-2 is an emergency birth control pill containing progestin (levonorgestrel) intended for use within 72 hours of unprotected sexual intercourse.


Indications for use

  • Emergency contraception (postcoital) after unprotected sexual intercourse;
  • Emergency contraception after unreliable or pre-ineffective protection during sexual intercourse.

This drug is intended exclusively for emergency contraception and does not replace regular contraception. Repeated use of Option-2 pill during one menstrual period is not recommended.

Mechanism of action

Getting into the body of a woman, levonorgestrel slows down ovulation and changes the inner shell of the uterus, thereby blocking the possibility of the already fertilized egg to attach to the uterine cavity. In addition, levonorgestrel increases the density and viscosity of mucus in the cervix, which in turn slows down and disrupts the movement of spermatozoa to the egg and prevents fertilization.

Dosage and mode of application

One Option-2 pill contains levonorgestrel 1.5 mg. The tablet should be taken as soon as possible, but no later than 72 hours after unprotected sexual intercourse.

If vomiting occurs within 3 hours after ingestion, the same dose of levonorgestrel should be taken again.

The medication can be taken at any time of the period. If you have an irregular period, you need to exclude pregnancy.

After taking a pill before the next period, additional non-hormonal methods of contraception should be used. The use of the medication with repeated unprotected intercourse during one period is not recommended because of the increased frequency of acyclic bleeding.

The effectiveness of Option-2 contraceptive decreases as the time elapsed between sexual intercourse and drug intake: the effectiveness of contraception is 95% if a pill is taken within the first 24 hours, 85% in the period between 24 and 48 hours, and 58% between 48 and 72 hours.


  • Symptoms: increased severity of side effects;
  • Treatment: symptomatic therapy, there is no antidote.


Option-2 is contraindicated in the following conditions:

  • allergy to levonorgestrel or to other constituents of the drug;
  • pregnancy;
  • breastfeeding period;
  • hepatic insufficiency and acute liver inflammation;
  • jaundice (both in the present and in the anamnesis).

With caution:

  • liver or bile duct disease,
  • jaundice (including in the anamnesis),
  • Crohn’s disease.

Side effects

Side effects of Option-2 occur in 5-15% of all cases. However, they are weakly expressed and do not bring any particular inconvenience to a woman. The most common adverse reactions include:

  • nausea;
  • aching in the abdomen;
  • menstrual disorders (for example, lean or abundant bleeding);
  • headache, including a migraine;
  • general weakness;
  • diarrhea;
  • tension in the mammary glands;
  • increased irritability;
  • spotting in the middle of the period;
  • skin rashes;
  • feet swelling.

The above mentioned negative reactions disappear after the drug is discontinued. In some cases, symptomatic treatment may be required.


Avoid mixing levonorgestrel emergency contraception with inducers of hepatic enzymes – such an interaction can increase metabolism and reduce plasma concentrations of unchanged levonorgestrel.

The effectiveness of the contraceptive may reduce when the drug is combined with barbiturates, carbamazepine, phenytoin, St. John’s Wort preparations, ritonavir, rifampicin, griseofulvin and rifabutin.

Taking Option-2 pill is not a contraindication to continuing oral contraceptives.

Option-2 and pregnancy

Emergency contraception is contraindicated for use in pregnancy. Based on the available data, there was no adverse effect of the drug on the fetus on the occurrence of pregnancy against the background of an Option-2 pill.

Levonorgestrel is excreted in breast milk. After taking the drug, breastfeeding should be discontinued for 24 hours.

Special instructions

The safety and effectiveness of Option-2 are established in women of reproductive age.

There are no indications for the use of emergency birth control pills before menarche.

The use of the drug is not intended for use by women in postmenopausal women.

Emergency contraceptives do not prevent conception in all cases. The probability of fertilization is great in cases when the time of sexual intercourse is not exactly known, and when more than 72 hours have elapsed since the unprotected sexual intercourse. In such cases, taking a pill with levonorgestrel after the second sexual intercourse will not bring the desired result. If the menstruation is delayed for more than 5 days, and if the menstrual period occurs in an unusual time, or if there is a suspicion of pregnancy for some other reason, a gynecological examination should be performed to exclude pregnancy.

Pregnancy following with the use of Option-2 tablets may appear to be ectopic, especially if a woman has:

  • pain in the lower abdomen,
  • an ectopic pregnancy in an anamnesis,
  • operations on the pelvic organs or their inflammation in an anamnesis.

With severe violations of liver function, the use of emergency birth control tablets is not recommended. If you have violations of absorption in the gastrointestinal tract (eg, Crohn’s disease), the effectiveness of the contraceptive may decrease.

The use of the drug, usually, does not violate the regularity and nature of menstruation. Sometimes, a woman may have a premature menstruation or delay in menstrual bleeding (about 2 days). After using the pill of Option-2, it is recommended to ensure regular contraception in the future. If the levonorgestrel drug is used because of an error in regular hormonal contraception and you have no menstruation within the next seven days, pregnancy should be excluded.

Avoid the repeated use of emergency contraceptives during the same menstrual period in order to avoid irregularities in the menstrual periods.

In comparison with regular birth control pills, Option-2 is less effective. Women who often resort to an emergency contraceptive should be offered a method of regular contraception.

The drug does not replace the need for protection from sexually transmitted diseases (HIV infection (AIDS) or other sexually transmitted infections).

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