Comment on “Norethindrone Acetate Versus Combined Oral Contraceptives in Patients With Acute Abnormal Uterine Bleeding”

Any uterine bleeding that is not part of a normal menstrual pattern is considered abnormal uterine bleeding (AUB), and it can encompass heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB), as well as other abnormal bleeding, such as bleeding after menopause. AUB is also classified as structural or nonstructural. The management of AUB varies in practice, though it is a relatively common condition. Treatment for AUB usually includes hormonal medications such as combined oral contraceptives (COC), though currently there are no studies that assess the efficacy of norethindrone acetate (NA) and COC in adolescents with acute AUB. This study was designed to show that NA can be equal in efficacy to COC without the same side effect profile.

This was a study conducted between January 2022 and March 2023. Inclusion criteria were age 10 to 21 and presentation to the adolescent medicine clinic with AUB, menorrhagia, HMB, or other irregular menses. Exclusion criteria were pregnancy, history of bleeding disorder, and contraindications to estrogen use. All included patients were sent a 19-question questionnaire.

A total of 15 patients completed the questionnaire, with 7 in the NA group and 8 in the COC group. The mean age for this cohort was 11.1 in the NA group and 14.3 in the COC group ( P =0.003). There were no significant differences in length of stay or time to bleeding cessation. Side effects were reported in 25% of COC patients and none of the NA patients ( P <0.05), though patient satisfaction was high with both treatments.

These results indicate that NA is as effective as COC for the treatment of AUB, with fewer side effects. AUB can have a significant impact on the quality of life, particularly in adolescents. Treatment goals for AUB include reducing blood loss, preventing future excessive blood loss, preventing iron deficiencies, regulating menses, and improving overall quality of life. COC has traditionally been the first-line therapy, with NA and other progesterone-only options offered when estrogen therapy is contraindicated. Several studies have assessed provider-specific management of AUB and have shown that COC, NA and medroxyprogesterone acetate are the most commonly used treatments for AUB.

Future studies should attempt to validate these findings in a larger sample as well as collect data between time from presentation at the ED to presentation at the clinic. In addition, future studies should attempt to diversify the study cohort to allow for more generalizable results.

(Summarized from Han T, Regard MM, Cardenas GA, Gray SA, Comkornruecha M. Norethindrone acetate versus combined oral contraceptives in patients with acute abnormal uterine bleeding. J Pediatr Adolesc Gynecol . 2026;39(2):242-245. doi:10.1016/j.jpag.2025.10.012).