Does Ozempic affect levonorgestrel emergency contraception? This is an important question for people managing type 2 diabetes whilst needing emergency contraception. Currently, no official evidence suggests that Ozempic (semaglutide) directly interferes with levonorgestrel emergency contraception (Levonelle). These medications work through entirely different mechanisms, and no pharmacological interaction has been documented in clinical studies or MHRA guidance. However, Ozempic's effect on gastric emptying may theoretically affect absorption of oral medications. Understanding this relationship helps ensure both effective diabetes management and reliable emergency contraception when needed.

Does Ozempic Affect Levonorgestrel Emergency Contraception?

There is currently no official evidence to suggest that Ozempic (semaglutide) directly interferes with the effectiveness of levonorgestrel emergency contraception (known as Levonelle in the UK). These medications work through entirely different mechanisms in the body, and no pharmacological interaction has been documented in clinical studies or regulatory guidance from the MHRA or EMA.

Levonorgestrel emergency contraception works by preventing or delaying ovulation when taken shortly after unprotected intercourse. It is most effective when taken within 72 hours, though efficacy decreases with time. Ozempic, meanwhile, is a glucagon-like peptide-1 (GLP-1) receptor agonist used for managing type 2 diabetes. It does not affect hormone levels in ways that would compromise emergency contraception.

However, one theoretical concern relates to Ozempic's effect on gastric emptying. Semaglutide slows the rate at which the stomach empties its contents into the small intestine. This delayed gastric emptying could, in theory, affect the absorption of oral medications, including emergency contraception. If you experience severe nausea, vomiting, or gastrointestinal upset whilst taking Ozempic—particularly within a few hours of taking emergency contraception—there is a possibility that the tablet may not be fully absorbed.

If you vomit within three hours of taking levonorgestrel emergency contraception, you should contact your GP, pharmacist, or sexual health clinic immediately, as you may need to take another dose. This advice applies regardless of whether you are taking Ozempic, but the risk of gastrointestinal side effects may be higher in people using GLP-1 receptor agonists.

It's worth noting that ulipristal acetate (ellaOne) is an alternative form of emergency contraception that can be used up to 120 hours (5 days) after unprotected sex. The copper intrauterine device (IUD) is the most effective form of emergency contraception and can be fitted up to 5 days after unprotected intercourse.

Potential Interactions Between Ozempic and Contraceptives

Ozempic does not interact with hormonal contraceptives in a way that reduces their contraceptive efficacy. According to the Ozempic Summary of Product Characteristics, studies have shown that semaglutide does not significantly alter the pharmacokinetics of ethinylestradiol and levonorgestrel, the hormones commonly found in combined oral contraceptive pills. This means that regular contraceptive pills, patches, rings, and implants should continue to work effectively in people taking Ozempic for diabetes.

The primary concern with Ozempic and oral medications—including oral contraceptives—centres on its effect on gastric motility and absorption. Because semaglutide delays gastric emptying, there has been some discussion in clinical circles about whether this might theoretically reduce the absorption of oral contraceptives. However, current evidence does not support this concern in practice. The MHRA and manufacturer guidance do not list hormonal contraceptives as medications requiring dose adjustment or additional precautions when used alongside Ozempic.

That said, gastrointestinal side effects are common with Ozempic, particularly during the initial weeks of treatment or after dose escalation. These may include:

• Nausea and vomiting

• Diarrhoea

• Abdominal discomfort or bloating

• Reduced appetite

If you experience severe vomiting or diarrhoea whilst taking any form of oral contraception (including emergency contraception), the absorption of the contraceptive may be compromised. In such cases, you should follow the standard missed pill guidance and use additional barrier methods (such as condoms) according to the advice in the patient information leaflet.

For non-oral contraceptive methods—such as the contraceptive implant, intrauterine device (IUD), intrauterine system (IUS), vaginal ring, or injection—there is no concern regarding absorption, as these do not rely on gastrointestinal uptake.

What to Do If You're Taking Both Medications

If you are taking Ozempic and need to use emergency contraception, there is no need to delay or avoid taking it. The most important factor in emergency contraception effectiveness is timing—the sooner it is taken after unprotected intercourse, the more effective it is.

Follow these practical steps to maximise safety and efficacy:

• Take levonorgestrel emergency contraception as soon as possible after unprotected intercourse, ideally within 24 hours, but no later than 72 hours.

• Consider ulipristal acetate (ellaOne) which can be used up to 120 hours (5 days) after unprotected sex and may be more effective than levonorgestrel, particularly for women with higher BMI.

• Monitor for vomiting. If you vomit within three hours of taking the tablet, contact your pharmacist, GP, or sexual health clinic immediately, as you may need a replacement dose.

• Consider taking emergency contraception at a time of day when your Ozempic-related nausea is typically less severe, if applicable. Some people find nausea worse in the morning or shortly after injecting semaglutide.

• Use barrier contraception (condoms) according to the guidance provided with your emergency contraception. If you've taken ulipristal acetate, you should delay restarting hormonal contraception for 5 days and use condoms for the appropriate period thereafter.

If you have concerns about the reliability of oral emergency contraception due to ongoing nausea or vomiting, discuss alternative options with a healthcare professional. The copper intrauterine device (IUD) can be fitted up to five days after unprotected intercourse and is the most effective form of emergency contraception. It is unaffected by Ozempic or any gastrointestinal symptoms.

If your period is more than seven days late following use of emergency contraception, or if you experience unusual symptoms such as severe abdominal pain, shoulder tip pain, or dizziness, you should take a pregnancy test and consult your GP. It's advisable to take a pregnancy test 3 weeks after unprotected intercourse if you haven't had a normal period.

How Ozempic Works in Your Body

Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus. A higher dose formulation of semaglutide (Wegovy) is licensed for weight management. Understanding how it works helps clarify why it is unlikely to interfere directly with emergency contraception.

Semaglutide mimics the action of GLP-1, a naturally occurring hormone released by the intestines in response to food intake. Its primary mechanisms of action include:

• Enhancing insulin secretion from the pancreas in a glucose-dependent manner, which helps lower blood sugar levels (though the risk of hypoglycaemia increases when used with insulin or sulfonylureas).

• Suppressing glucagon release, reducing the liver's production of glucose.

• Slowing gastric emptying, which prolongs the feeling of fullness and reduces appetite.

• Acting on appetite centres in the brain, leading to reduced calorie intake.

Ozempic is administered as a once-weekly subcutaneous injection, typically into the abdomen, thigh, or upper arm. The dose is gradually increased over several weeks to minimise gastrointestinal side effects, which are the most commonly reported adverse reactions.

Common side effects include:

• Nausea (often transient)

• Vomiting

• Diarrhoea or constipation

• Abdominal pain

• Reduced appetite

Serious but rare adverse effects that require immediate medical attention include signs of pancreatitis (severe, persistent abdominal pain), thyroid problems (lump in the neck, hoarseness, difficulty swallowing or breathing), or severe allergic reactions.

Because Ozempic does not influence the hormonal pathways targeted by emergency contraception, there is no biological basis for a direct interaction with levonorgestrel emergency contraception. The only relevant consideration is the potential for reduced oral absorption due to delayed gastric emptying or vomiting, which is a general concern with any oral medication taken during Ozempic therapy.

If you experience any suspected side effects from Ozempic or any other medication, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.

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