From the FDA Drug Label
Therapy may be held at this level for six to nine months or until annoying breakthrough bleeding demands temporary termination. Initial daily dosage of 5 mg norethindrone acetate tablets for two weeks. Dosage should be increased by 2. 5 mg per day every two weeks until 15 mg per day of norethindrone acetate tablets is reached.
The answer to whether hormonal suppression will help prevent endometriosis recurrence after a hysterectomy in a 39-year-old patient is not directly addressed in the provided drug labels. Hysterectomy is not mentioned in the context of endometriosis treatment or hormonal suppression. Therefore, no conclusion can be drawn from the given information 1, 1.
From the Research
Hormonal suppression may help prevent endometriosis recurrence after hysterectomy in a 39-year-old patient, particularly if the ovaries were preserved, as supported by the most recent study 2 from 2023. The decision to use hormonal suppression should be individualized based on the extent of disease excision during surgery, presence of extragenital endometriosis, and symptom severity.
- For patients with retained ovaries, medications like continuous combined hormonal contraceptives (e.g., ethinyl estradiol 20-35 mcg with levonorgestrel or norethindrone daily), progestins (e.g., norethindrone acetate 5-15 mg daily or medroxyprogesterone acetate 30-100 mg daily), or GnRH agonists with add-back therapy (e.g., leuprolide 3.75 mg monthly with norethindrone 5 mg daily) can be effective, as shown in studies 3, 4, 5, 6.
- Treatment duration depends on symptom control and side effects, often continuing until natural menopause.
- If both ovaries were removed during hysterectomy, hormonal suppression is generally unnecessary as the primary source of estrogen stimulating endometriosis growth is eliminated. Hormonal suppression works by reducing estrogen levels or counteracting estrogen's effects, thereby inhibiting the growth and activity of remaining endometriosis lesions that may have been present outside the removed uterus, such as on the peritoneum, bowel, or other pelvic structures. Key considerations include the potential benefits of ovarian conservation during hysterectomy for endometriosis, as highlighted in the 2023 study 2, which found that patients who underwent a hysterectomy with bilateral salpingo-oophorectomy had a lower reoperation rate than those who underwent a hysterectomy with conservation of one or both ovaries.