Efficacy and Safety of Norethisterone vs. Combined Oral Contraceptive pills for the management of Puberty Menorrhagia
Puberty menorrhagia is defined as excessive bleeding in amount (>80ml)
or in duration
(>7days) between menarche and
19 years of
age.
The most common cause of puberty menorrhagia
is anovulatory cycles. Other causes include infection, bleeding disorders, and endocrine
disorders (eg, hypothyroidism, polycystic ovary syndrome).
Treatment is directed towards
stabilizing the endometrium and treating the hormonal alterations. Medical interventions
to reduce menstruation include combined oral Contraceptive (COC) pills,
gonadotrophin-releasing hormone (GnRH) analogues and oral progesterones.
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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.
First line treatment in mild cases
is tranexamic acid and non-steroidal anti-inflammatory agents during the
menstrual cycle.
Hormonal treatment is required
where the girl is anemic or where the problem is recurrent and restricts her
activity for 3-6 months.
This study demonstrated that norethisterone and COC pills are effective for the management of puberty menorrhagia. Norethisterone was more effective with better safety profile compared to COC.
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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.
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