From the Guidelines
Norethisterone can be used by women with a high BMI of 30, but with careful consideration of the potential risks and close monitoring. For women with a BMI of 30 or higher, norethisterone remains a viable contraceptive or hormone therapy option, though progestin-only methods are generally preferred over combined hormonal contraceptives 1. The typical dose for menstrual disorders is 5-10mg daily for 5-10 days, while for contraception, the "mini-pill" contains 0.35mg taken daily without breaks.
Key Considerations
- Women with high BMI should take norethisterone at the same time each day to maintain effectiveness, especially for contraceptive purposes.
- Obesity can affect hormone metabolism and may slightly reduce contraceptive efficacy, though this is less concerning with progestin-only methods like norethisterone compared to combined hormonal contraceptives.
- Women with high BMI using norethisterone should be monitored for cardiovascular risk factors such as hypertension and diabetes, as obesity combined with hormonal treatments may increase these risks 1.
- Regular follow-up appointments are recommended to assess tolerance and effectiveness of the medication.
Monitoring and Follow-up
- Clinicians should consider the individual's clinical characteristics and the country-specific approved labeling of the available products when prescribing norethisterone to women with high BMI 1.
- The safety profile of norethisterone acetate in women with high BMI has been evaluated, and while it may have a worse profile in terms of blood pressure, renal function, and activation of the renin-angiotensin system, the relative contribution of progestogen and estrogen is difficult to discern 1.
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
3 Carbohydrate and Lipid Metabolism Some users may experience slight deterioration in glucose tolerance, with increases in plasma insulin but women with diabetes mellitus who use progestin-only oral contraceptives do not generally experience changes in their insulin requirements. Nonetheless, prediabetic and diabetic women in particular should be carefully monitored while taking POPs
The FDA drug label does not answer the question about Norethisterone and high BMI 30.
From the Research
Norethisterone and High BMI
- Norethisterone is a progestogen that is widely used for contraception, in postmenopausal hormone therapy, and in treatment of abnormal uterine bleeding and endometriosis 2
- The effects of norethisterone on the endometrium are pronounced, making it a good choice for treating abnormal uterine bleeding, endometriosis, and endometrial hyperplasia 2
- However, long-term use of norethisterone is associated with a slightly increased breast cancer risk, and the risk of venous thromboembolism is moderately increased 2
- This risk seems to be dose-dependent; contraceptive use carries no risk, but therapeutic doses might be associated with an increased risk 2
Interaction with High BMI
- There is no direct evidence in the provided studies that discusses the interaction between norethisterone and high BMI (30) specifically
- However, it is known that high BMI is a risk factor for venous thromboembolism, and the use of hormonal contraceptives, including those containing norethisterone, may further increase this risk 3, 4
- Older COCs with norethisterone or levonorgestrel have a lower risk for venous thromboembolism (VTE) than newer COCs with desogestrel, drospirenone, or gestodene 4
Physical Activity and Weight Management
- Regular physical activity is recommended for weight management and to reduce the risk of chronic diseases, including those associated with high BMI 5, 6
- The American College of Sports Medicine (ACSM) recommends at least 150 min·wk-1 of moderate-intensity physical activity for weight loss and prevention of weight gain 5
- Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level 5