Comparison of the efficacy and safety of norethisterone vs. combined oral contraceptive pills for the management of puberty menorrhagia

Nita K. Patel, Shalin Patel, Rohit Damor, Manish R. Pandya


Background: The most common cause of puberty menorrhagia is immaturity of the hypothalamic pituitary ovarian axis. Treatment is directed towards stabilizing the endometrium and treating the hormonal alterations. The objective of this study was to compare the efficacy and safety of norethisterone and combined oral contraceptive (COC) pills for the management of puberty menorrhagia.

Methods: A total of 60 young girls from age of menarche to 19 years with menorrhagia were randomized to receive either norethisterone or COC pills. The end points included change from baseline in health-related quality-of-life parameters, estimation of blood loss and effect on hemoglobin level. Health-related quality-of-life question scores at baseline and after treatment were calculated as mean for norethisterone group and COC pills group.

Results: Norethisterone and COC pills treatment groups showed mean improvement in Menorrhagia Impact Questionnaire (MIQ) scores compared to baseline. However, the total mean score was higher in norethisterone group compared to COC pills group after three treatment cycles (21 Vs 17). The treatment failure was less in norethisterone group compared to COC pills group.

Conclusions: Use of norethisterone was more effective and better tolerated compared to combined oral contraceptive pills for the management of puberty menorrhagia.


Adolescent, Puberty, Menorrhagia, Progesterone, Heavy menstrual bleeding, Combined Oral Contraceptive (COC)

Full Text:



Caufriez A. Menstrual disorders in adolescence: pathophysiology and treatment. Horm Res 1991;36:156-9.

Hallberg L, Hogdahl AM, Nilsson L, Rybo G. Menstrual blood loss- a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynecol Scand 1966;45:320-51.

Lemarchand-Beraud T, Zufferey MM, Reymond M, Rey I. Maturation of the hypothalamo-pituitary-ovarian axis in adolescent girls. J Clin Endocrinol Metab 1982;54:241-6.

Claessens EA, Cowell CA. Acute adolescent menorrhagia. Am J Obstet Gynecol 1981;139:277-80.

Falcone T, Desjardins C, Bourque J, Granger L, Hemmings R, Quiros E. Dysfunctional uterine bleeding in adolescents. J Reprod Med 1994;39:761-4.

O'Connell BJ. The pediatrician and the sexually active adolescent. Treatment of common menstrual disorders. Pediatr Clin North Am 1997;44:1391-404.

Kadir RA, Economides DL, Sabin CA, Owens D, Lee CA. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet 1998;351:485-9.

Revel-Vilk S, Paltiel O, Lipschuetz M, et al. Underdiagnosed menorrhagia in adolescents is associated with underdiagnosed anemia. J Pediatr 2012;160:468-72.

Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA 1993;269:1823-8.

Patel NK, Pandya MR. A comparative study of tranexamic acid and ethamsylate in menorrhagia. Int J Basic Clin Pharmacol 2012;1:85-90.

Lukes AS, Moore KA, Muse KN. Tranexamic acid treatment for heavy menstrual bleeding: A randomized controlled trial. Obstet Gynecol 2010;116:865-75.

Abu Hashim H, Alsherbini W, Bazeed M. Contraceptive vaginal ring treatment of heavy menstrual bleeding: a randomized controlled trial with norethisterone. Contraception 2012;85:246-52.

Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkilä A, Walker JJ, Cameron IT. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol 1998;105:592-8.

Preston JT, Cameron IT, Adams EJ, Smith SK. Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia. Br J Obstet Gynaecol 1995;102:401-6.

Bonduelle M, Walker JJ, Calder AA. A comparative study of danazol and norethisterone in dysfunctional uterine bleeding presenting as menorrhagia. Postgrad Med J 1991;67:833-6.