Norethindrone Acetate for Dysfunctional Uterine Bleeding in Morbidly Obese Women

Andrew M. Kaunitz, MD

Disclosures

May 11, 2004

Question

This is actually a comment for Dr. Kaunitz about the PCOS/morbid obesity question (see http://www.medscape.com/viewarticle/467101). I have seen some morbidly obese patients whose bleeding was controlled only with substantial doses of norethindrone acetate for a longer than usual time, eg, 5-7.5 mg once daily for 21 days monthly. Try to cut back and bleeding worsens again. These are patients who have failed the other treatments that you have suggested. Would you care to comment?

Judith Evans, MD

Response from Andrew M. Kaunitz, MD

High-dose oral progestin therapy (such as 5-mg tablets of norethindrone acetate [Aygestin], 1-3 tablets daily) is indeed useful in the treatment of women with heavy bleeding. This is an approach I use with selected patients in my practice. Continuous norethindrone acetate tablets can also be used for the treatment of menorrhagia as well as for endometriosis and endometrial hyperplasia.

Because high-dose progestin therapy reduces ovarian estradiol production, long-term use can be associated with loss of bone density. Fortunately, this is not likely to be a clinical concern in obese patients. In addition, such therapy can reduce HDL and increase LDL levels; lipid monitoring is therefore appropriate. Finally, high-dose progestin therapy may cause side effects, including bloating and irritability.

Comments

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