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Pathway Description
Levonorgestrel Action Pathway
Homo sapiens
Drug Action Pathway
Levonorgestrel (LNG) is a progestin (synthetic progestogen) found in contraceptives (birth control) that are taken orally, in subdermal implants or in intrauterine devices (IUD). Oral contraceptives and IUDs have a low dose, while emergency contraceptives (Plan B) are administered at high doses. This drug's contraceptive function delays or inhibits ovulation and thickens cervical mucus to prevent pregnancy before fertilization and implantation. This drug can also be used for hormone therapy in menopausal women. Levonorgestrel acts on the hypothalamic–pituitary-gonadal axis (HPG axis) where it binds to the progesterone and the androgen receptors. This binding inhibits the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. GnRH secretion is required to activate a luteinizing hormone (LH) surge that leads to ovulation. By its inhibition, the absence of LH results in no release of a viable egg from the ovaries. The thickening of the mucus interferes with sperm migration into the uterus for fertilization. An overdose of levonorgestrel may cause nausea and withdrawal bleeding.
References
Levonorgestrel Pathway References
Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M: DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2018 Jan 4;46(D1):D1074-D1082. doi: 10.1093/nar/gkx1037.
Pubmed: 29126136
Brinton LA, Felix AS: Menopausal hormone therapy and risk of endometrial cancer. J Steroid Biochem Mol Biol. 2014 Jul;142:83-9. doi: 10.1016/j.jsbmb.2013.05.001. Epub 2013 May 13.
Pubmed: 23680641
Sitruk-Ware R: New progestagens for contraceptive use. Hum Reprod Update. 2006 Mar-Apr;12(2):169-78. doi: 10.1093/humupd/dmi046. Epub 2005 Nov 16.
Pubmed: 16291771
Kahlenborn C, Peck R, Severs WB: Mechanism of action of levonorgestrel emergency contraception. Linacre Q. 2015 Feb;82(1):18-33. doi: 10.1179/2050854914Y.0000000026.
Pubmed: 25698840
Kook K, Gabelnick H, Duncan G: Pharmacokinetics of levonorgestrel 0.75 mg tablets. Contraception. 2002 Jul;66(1):73-6. doi: 10.1016/s0010-7824(02)00321-9.
Pubmed: 12169384
Shohel M, Rahman MM, Zaman A, Uddin MM, Al-Amin MM, Reza HM: A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception. BMC Womens Health. 2014 Apr 4;14:54. doi: 10.1186/1472-6874-14-54.
Pubmed: 24708837
Beatty MN, Blumenthal PD: The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009 Jun;5(3):561-74. doi: 10.2147/tcrm.s5624. Epub 2009 Aug 3.
Pubmed: 19707273
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