Original Report| Volume 32, ISSUE 6, P596-599, December 2019

The Use of Norethisterone for the Treatment of Severe Uterine Bleeding in Adolescents: An Audit of Our Experience

Published:September 11, 2019DOI:


      Study Objective

      The purpose of this prospective study was to assess the effectiveness of norethisterone (NET) in the management of abnormal uterine bleeding (AUB) in adolescents in a tertiary care center.


      This was a prospective audit focused on administering high doses of NET in female adolescents with complaints of AUB.


      We included female adolescents who presented to our Emergency Gynecological Department or Adolescent Gynecological Outpatient Department from October 2016 to January 2019.


      The study included 29 female adolescents aged 11-17 (mean, 13.14) years.


      Patients were administered a daily dose of 10-30 mg, depending on the severity of the condition, bleeding duration, and patient weight.

      Main Outcome Measures

      Cessation of vaginal bleeding.


      Mean age at menarche of our patient sample was 11.4 years (range, 10.7-14 years). AUB presented at a mean time of 24.6 months after menarche (range, 0-79 months). Blood transfusion was deemed necessary in 9 patients. Bleeding stopped at a mean of 46.1 (range, 8-120) hours after onset of treatment with NET. No serious adverse events were reported with NET administration, with only 3 cases of minor side effects.


      The use of NET is an effective and reliable treatment option among adolescents for whom control of AUB is desired in the acute setting.

      Key Words

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        • Wilkinson J.P.
        • Kadir R.A.
        Management of abnormal uterine bleeding in adolescents.
        J Pediatr Adolesc Gynecol. 2010; 23: S22
        • Benjamins L.
        Practice guideline: evaluation and management of abnormal vaginal bleeding in adolescents.
        J Pediatr Health Care. 2009; 23: 189
        • Moon M.L.
        • Perez-Milicua G.
        • Dietrich E.J.
        Evaluation and management of heavy menstrual bleeding in adolescents.
        Curr Opin Obstet Gynecol. 2017; 29: 328
        • Nur Azurah A.G.
        • Sanci L.
        • Moore E.
        • et al.
        The quality of life in adolescents with menstrual problems.
        J Pediatr Adolesc Gynecol. 2013; 26: 102
        • Huguelet P.S.
        • Buyers E.M.
        • Lange-Liss J.H.
        • et al.
        Treatment of acute abnormal uterine bleeding in adolescents: what are providers doing in various specialties?.
        J Pediatr Adolesc Gynecol. 2016; 29: 286
        • Agarwal A.
        • Venkat A.
        Questionnaire study on menstrual disorders in adolescent girls in Singapore.
        J Pediatr Adolesc Gynecol. 2009; 22: 365
        • Friberg B.
        • Orno A.K.
        • Lindgren A.
        • et al.
        Bleeding disorders among young women: a population-based prevalence study.
        Acta Obstet Gynecol Scand. 2006; 85: 200
        • Irvine G.A.
        • Campbell-Brown M.B.
        • Lumsden M.A.
        • et al.
        Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia.
        Br J Obstet Gynaecol. 1998; 105: 592
        • Munro M.G.
        • Critchley H.O.
        • Broder M.S.
        • et al.
        FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.
        Int J Gynaecol Obstet. 2011; 113: 3
        • American Academy of Pediatrics Committee on Adolescence
        American College of Obstetrics Gynecologists Committee on Adolescent Health Care: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
        Pediatrics. 2006; 118: 2245
        • Warner P.E.
        • Critchley H.O.
        • Lumsden M.A.
        • et al.
        Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data.
        Am J Obstet Gynecol. 2004; 190: 1216
        • Kowalczyk Mullins T.L.
        • Miller R.J.
        • Mullins E.S.
        Evaluation and management of adolescents with abnormal uterine bleeding.
        Pediatr Ann. 2015; 44: 218
        • Curtis K.M.
        • Tepper N.K.
        • Jatlaoui T.C.
        • et al.
        U.S. medical eligibility criteria for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1
      1. ACOG Practice Bulletin No. 206: Use of hormonal contraception in women with coexisting medical conditions.
        Obstet Gynecol. 2019; 133: e128
        • Sokkary N.
        • Dietrich J.E.
        Management of heavy menstrual bleeding in adolescents.
        Curr Opin Obstet Gynecol. 2012; 24: 275
        • Frishman G.N.
        Evaluation and treatment of menorrhagia in an adolescent population.
        J Min Invasive Gynecol. 2008; 15: 682
        • Santos M.
        • Hendry D.
        • Sangi-Haghpeykar H.
        • et al.
        Retrospective review of norethindrone use in adolescents.
        J Pediatr Adolesc Gynecol. 2014; 27: 41
        • Munro M.G.
        • Mainor N.
        • Basu R.
        • et al.
        Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial.
        Obstet Gynecol. 2006; 108: 924
        • Aksu F.
        • Madazli R.
        • Budak E.
        • et al.
        High-dose medroxyprogesterone acetate for the treatment of dysfunctional uterine bleeding in 24 adolescents.
        Aust N Z J Obstet Gynecol. 1997; 37: 228
      2. Bayer New Zealand Limited: New Zealand Data Sheet.

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