Keywords
Contraceptives Oral
Menarche
Menorrhagia
Norethisterone
Quality of Life
How to Cite
Abstract
Objective: To compare the efficacy of norethisterone acetate (NETA) and combined oral contraceptive pills (COCs) in the management of heavy menstrual bleeding (menorrhagia) at the onset of menarche in adolescent girls.
Methods:
This Quasi-experimental comparative study was conducted from July 2025 to January 2026 at the Department of Obstetrics and Gynecology, Pakistan Ordnance Factories (POF) Hospital, Wah Cantt.
Methodology: A total of 120 adolescent girls aged 11–16 years presenting with heavy menstrual bleeding (HMB) at the onset of menarche were enrolled. Participants were assigned to two groups (n=60 each) using a non-random allocation approach. Group A received norethisterone acetate (5 mg twice daily) during the latter half of the menstrual cycle, whereas Group B received combined oral contraceptive pills prescribed in the conventional 21-day cyclic regimen. Efficacy was assessed as a clinically significant improvement in the Menorrhagia Impact Questionnaire (MIQ) score after treatment. Data were analyzed using SPSS version 25
Results: The mean age was 13.6±1.6 years in the norethisterone group and 13.4±1.8 years in the combined oral contraceptive group. Efficacy was observed in 85% of patients who received norethisterone acetate compared to 65% of patients who received combined oral contraceptive pills, showing a statistically significant difference (P = .011). A greater reduction in estimated blood loss and substantial improvement in MIQ scores were observed in the norethisterone group.
Conclusion: Under the specific cyclical treatment protocols used in this study, norethisterone acetate demonstrated greater short-term improvement in menstrual blood loss and MIQ scores than combined oral contraceptive pills in adolescent girls presenting with heavy menstrual bleeding (HMB) at the onset of menarche.
Keywords: Adolescent; Contraceptives, Oral; Menarche; Menorrhagia; Norethisterone; Quality of Life
References
Luiro K, Holopainen E. Heavy Menstrual bleeding in adolescents: normal or a sign of an underlying disease?. Semin Reprod Med. 2022 Jan;40(1-02):23-31. https://doi.org/10.1055/s-0041-1739309
Gomes H, Abreu B, Barros L, Veríssimo C. Abnormal uterine bleeding in adolescence: when menarche reveals other surprises. Rev Bras Ginecol Obstet. 2021 Oct;43(10):789-92. https://doi.org/10.1055/s-0041-1736143
Akpan IJ, Narang M, Zampaglione E, Marshall S, Stefanik D. Iron deficiency anemia in patients with heavy menstrual bleeding: the patients’ perspective from diagnosis to treatment. Womens Health (Lond). 2025 Jan-Dec;21:17455057251321221. https://doi.org/10.1177/17455057251321221
Zia A, Jain S, Kouides P, Zhang S, Gao A, Salas N, et al. Bleeding disorders in adolescents with heavy menstrual bleeding in a multicenter prospective US cohort. Haematologica. 2020 Jul;105(7):1969-76. https://doi.org/10.3324/haematol.2019.225656
Elmaoğulları S, Aycan Z. Abnormal uterine bleeding in adolescents. J Clin Res Pediatr Endocrinol. 2018 Sep 1;10(3):191-7. https://doi.org/10.4274/jcrpe.0014
Boruah AM, Banerjee D, Bhardwaj F, Mallya S, Singal R, Sharma S, et al. Effect of norethisterone dose and duration in the management of abnormal uterine bleeding: a narrative review and case report. Drugs Context. 2024 Jul 4;13:2024-4-1. https://doi.org/10.7573/dic.2024-4-1
Nagy B, Szekeres-Barthó J, Kovács GL, Sulyok E, Farkas B, Várnagy Á, et al. Key to life: physiological role and clinical implications of progesterone. Int J Mol Sci. 2021 Oct 7;22(20):11039. https://doi.org/10.3390/ijms222011039
Yaşa C, Güngör Uğurlucan F. Approach to abnormal uterine bleeding in adolescents. J Clin Res Pediatr Endocrinol. 2020 Feb 6;12(Suppl 1):1-6. https://doi.org/10.4274/jcrpe.galenos.2019.2019.S0200
Anthon C, Steinmann M, Vidal A, Dhakal C. Menstrual disorders in adolescence: diagnostic and therapeutic challenges. J Clin Med. 2024 Dec 11;13(24):7668. https://doi.org/10.3390/jcm13247668
Mason E, Black K. Update on long- and short-acting contraceptive methods. Aust Prescr. 2025 Jun;48(3):72-81. https://doi.org/10.18773/austprescr.2025.023
Shoupe D. The progestin revolution: progestins are arising as the dominant players in the tight interlink between contraceptives and bleeding control. Contracept Reprod Med. 2021 Jan 12;6(1):3. https://doi.org/10.1186/s40834-020-00142-5
Ulukapi HB, Simsek E. Comparison of combined oral contraceptives and a transdermal estrogen patch with oral progesterone: treatment of abnormal uterine bleeding in adolescents. Cureus. 2024 Oct;16(10):e72218. https://doi.org/10.7759/cureus.72218
Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019 Feb 11;2019(2):CD000154. https://doi.org/10.1002/14651858.CD000154.pub3
Todd N, Black A. Contraception for adolescents. J Clin Res Pediatr Endocrinol. 2020 Feb 6;12(Suppl 1):28-40. https://doi.org/10.4274/jcrpe.galenos.2019.2019.S0003
Patel NK, Patel S, Damor R, Pandya MR. Comparison of the efficacy and safety of norethisterone vs combined oral contraceptive pills for the management of puberty menorrhagia. Int J Basic Clin Pharmacol. 2013 Feb;2(1):47-51. https://doi.org/10.5455/2319-2003.ijbcp003512
Dean J, Kramer KJ, Akbary F, Wade S, Hüttemann M, Berman JM, et al. Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: a randomized trial. BMC Womens Health. 2019 Apr 26;19(1):70. https://doi.org/10.1186/s12905-019-0541-4
Sen S, Mandal TK, Dutta A, Mondal H, Khalua T. A comparative study of norethisterone and combined oral contraceptive pill in the treatment of dysfunctional uterine bleeding. CHRISMED J Health Res. 2019 Apr-Jun;6(2):87-92. https://doi.org/10.4103/cjhr.cjhr_92_18
Papapanagiotou IK, Charamanta M, Roidi S, Al-Achmar NS, Soldatou A, Michala L. The use of norethisterone for the treatment of severe uterine bleeding in adolescents: an audit of our experience. J Pediatr Adolesc Gynecol. 2019 Dec;32(6):596-9. https://doi.org/10.1016/j.jpag.2019.09.002
Boruah AM, Jaiswal P, Chinda M, Jaiswal A. Real-world safety and effectiveness analysis of norethisterone in the management of abnormal uterine bleeding. J South Asian Feder Obst Gynae. 2022 May-Jun;14(3):313-6. https://doi.org/10.5005/jp-journals-10006-2048
Gawande V, Kose V, Bhalerao A. Comparative efficacy of ormeloxifene versus norethisterone acetate in the management of abnormal uterine bleeding: a randomized controlled trial. Cureus. 2025 Nov 14;17(11):e96844. https://doi.org/10.7759/cureus.96844
Shaheen S, Shaheen R, Sobia. Efficacy of tranexamic acid in menorrhagia in comparison to norethisterone. Esculapio J Serv Inst Med Sci. 2012 Oct-Dec;8(4):186-90. http://esculapio.pk/journal/index.php/journal-files/article/view/766
Naqvi T, Rizvi F, Khan A, Afzal M. Patient satisfaction for levonorgestrel intrauterine system and norethisterone for treatment of dysfunctional uterine bleeding. J Ayub Med Coll Abbottabad. 2012 Jan-Mar;24(1):23-6. https://pubmed.ncbi.nlm.nih.gov/23855102/
Ashraf MN, Habib-ur-Rehman A, Shehzad Z, AlSharari SD, Murtaza G. Clinical efficacy of levonorgestrel and norethisterone for the treatment of chronic abnormal uterine bleeding. J Pak Med Assoc. 2017 Sep;67(9):1331-8. https://pubmed.ncbi.nlm.nih.gov/28924358/
Malik F, Sara S, Kasi R. Comparative trial of levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Pak J Med Health Sci. 2020 Oct-Dec;14(4):1184-6. https://pjmhsonline.com/2020/oct_dec/pdf/1184.pdf
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