Norethisterone

Indications & Dose:

Endometriosis

• BY MOUTH

Adult: 10–15 mg daily for 4–6 months or longer, to be started on day 5 of cycle; increased to 20–25 mg daily if required, dose only increased if spotting occurs and reduced once bleeding has stopped

Dysfunctional uterine bleeding (to arrest bleeding) | Menorrhagia (to arrest bleeding)

• BY MOUTH

Adult: 5 mg 3 times a day for 10 days

Dysfunctional uterine bleeding (to prevent bleeding) | Menorrhagia (to prevent bleeding)

• BY MOUTH

Adult: 5 mg twice daily, to be taken from day 19 to day 26 of cycle

Dysmenorrhoea 

• BY MOUTH

Adult: 5 mg 3 times a day for 3–4 cycles, to be taken from day 5–24 of cycle

Premenstrual syndrome (but not recommended)

• BY MOUTH

Adult: 5 mg 2–3 times a day for several cycles, to be taken from day 19–26 of cycle

Postponement of menstruation

• BY MOUTH

Females of childbearing potential: 5 mg 3 times a day, to be started 3 days before expected onset (menstruation occurs 2–3 days after stopping)

Breast cancer 

• BY MOUTH

Adult: 40 mg daily, increased if necessary to 60 mg daily

Short-term contraception 

• BY DEEP INTRAMUSCULAR INJECTION

Females of childbearing potential: 200 mg, to be administered within first 5 days of cycle or immediately after parturition (duration 8 weeks). To be injected into the gluteal muscle, then 200 mg after 8 weeks if required 

Contraception

• BY MOUTH

Females of childbearing potential: 350 micrograms daily, dose to be taken at same time each day, starting on day 1 of cycle then continuously, if administration delayed for 3 hours or more it should be regarded as a ‘missed pill’

Contraindications:

Avoid in patients with a history of liver tumours . breast cancer (unless progestogens are being used in the management of this condition) . genital cancer (unless progestogens are being used in the management of this condition) . history during pregnancy of idiopathic jaundice . history during pregnancy of pemphigoid gestationis (noncontraceptive indications) . history during pregnancy of severe pruritus (non-contraceptive indications) . when used as a contraceptive, history of breast cancer (can be used after 5 years if no evidence of disease and non-hormonal contraceptive methods unacceptable)

CONTRA-INDICATIONS

With oral use Acute porphyrias p. 930 . severe arterial disease . undiagnosed vaginal bleeding

Side Effects:

Cautions:

 Asthma . cardiac dysfunction . conditions that may worsen with fluid retention . diabetes (progestogens can decrease glucose tolerance—monitor patient closely) . epilepsy . history of depression . hypertension . migraine . susceptibility to thromboembolism (particular caution with high dose)

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