Can Norethindrone acetate stop postcoital bleeding?

Norethindrone Acetate for Postcoital Bleeding

Norethindrone acetate is effective for treating postcoital bleeding when the bleeding is due to hormonal imbalance in the absence of organic pathology. 1

Mechanism and Indication

• Norethindrone acetate is FDA-approved for treating abnormal uterine bleeding due to hormonal imbalance when organic pathology (such as submucous fibroids or uterine cancer) has been ruled out 1
• Postcoital bleeding is a common symptom that may be associated with cervical cancer or other conditions such as genital Chlamydia trachomatis infection 2
• The probability of cervical cancer in women with postcoital bleeding varies by age - approximately 1 in 2400 for women aged 45-54 and decreases to 1 in 44,000 for women aged 20-24 2

Evaluation Before Treatment

• Rule out malignancy - if a visible ulcerating or fungating lesion is present on examination, urgent referral for further investigation is required 2
• Test for Chlamydia and treat if appropriate 2
• Consider underlying gynecological problems such as:
  • Sexually transmitted infections
  • Pregnancy
  • Thyroid disorders
  • Pathologic uterine conditions (polyps or fibroids) 2

Treatment Approach

• If an underlying gynecologic problem is found, treat the specific condition or refer for care 2
• If no underlying pathology is identified and hormonal imbalance is suspected, norethindrone acetate can be used to treat the postcoital bleeding 1
• Dosage considerations:
  • For abnormal uterine bleeding, including postcoital bleeding, norethindrone acetate is typically used at doses of 5-15 mg daily 3
  • Treatment can be continuous to prevent breakthrough bleeding 3

Effectiveness and Considerations

• Studies show norethindrone acetate effectively reduces abnormal uterine bleeding, with median bleeding scores decreasing significantly during treatment 3
• Higher doses of norethindrone acetate (such as 0.5 mg when combined with estradiol) are associated with lower incidence of breakthrough bleeding compared to lower doses 4
• When used as a single agent at higher doses (5 mg daily), norethindrone acetate can effectively manage bleeding symptoms 3
• However, breakthrough bleeding can occur in up to 68% of patients on norethindrone acetate alone 5

Potential Side Effects

• Most patients (55.2%) do not report any side effects when taking norethindrone acetate 3
• The most common adverse effect is weight gain (16.1%), with a mean increase in BMI of 1.2 ± 1.6 kg/m² at 12 months 3
• Other potential side effects may include headache and breast pain 6

Alternative Approaches for Persistent Bleeding

• If bleeding persists despite norethindrone acetate treatment and the patient finds it unacceptable:
  • Consider NSAIDs for short-term treatment (5-7 days) 2
  • For heavy or prolonged bleeding, consider hormonal treatment with low-dose combined oral contraceptives if medically eligible 2
  • Counsel on alternative contraceptive methods if appropriate 2

Important Caveats

• Unscheduled smears are not recommended outside the regular screening program for evaluation of postcoital bleeding 2
• If malignancy is suspected based on examination findings, urgent referral is necessary rather than hormonal treatment 2
• Treatment effectiveness should be reassessed periodically, and if bleeding persists despite treatment, further investigation may be warranted 2