Not just period delay: using norethisterone for menorrhagia
Most people who menstruate will probably, at some point in their lives, have Googled ‘how to stop my period’, or something similar. We are lucky, in a sense, that something exists which can delay menstruation, and it is available on prescription should we wish. If you’ve looked to delay your period before, chances are your doctor, or your searching, will have led you to norethisterone.
Norethisterone is a progestin, a type of synthetic progestogen, which has similar effects to the hormone progesterone. It is used as a hormonal contraceptive in some combined and mini oral contraceptive pills, as well as being used alone to delay periods. When used for the latter purpose, it works by artificially maintaining your levels of progesterone, thus stopping your womb lining from shedding, which only occurs when progesterone levels drop. Many women use it for this purpose without issue, although side effects can occur.1
Norethisterone is also used in some women to treat certain conditions, including endometriosis and menorrhagia. With endometriosis, norethisterone, taken three out of every four weeks, works by stopping the lining of the womb from growing, thus eliminating periods (elevated levels of progesterone are present in pregnancy, so in effect taking it constantly mimics the effect of pregnancy on the womb lining). Nonetheless, the NHS lists side effects that include bloating, mood changes, and irregular bleeding, and isn’t the first in line treatment.2
Norethisterone for menorrhagia
Menorrhagia is described as ‘excessive (heavy) menstrual blood loss which occurs regularly and interferes with a woman’s physical, emotional, social, and material quality of life’.3 In fact, menorrhagia is one of the most common reasons why someone may be referred to a gynaecologist, yet in 50% of cases no underlying cause is found.4 While the levonorgestrel hormonal coil (Mirena) is the first in line treatment, norethisterone is recommended as a treatment if that, or none of the other options such as NSAIDs or tranexamic acid, are suitable.
In one study, patients taking norethisterone were more likely to find the treatment unacceptable due to side effects, with 78% refusing to continue therapy after three months.
It is recommended that norethisterone is prescribed daily from days 5 to 26 of the menstrual cycle, although this is not a licensed use for the drug and requires “informed consent”.5 Used in this manner, the norethisterone will have the same effect as it does in people with endometriosis, ie. thinning the womb lining to stop periods. In one study, though, patients taking norethisterone were more likely to find the treatment unacceptable due to side effects, with 78% refusing to continue therapy after three months.6 But can it be beneficial in some people?
Does norethisterone stop bleeding when taken for menorrhagia?
Gail Rogan, 44, first went to see her GP about heavy periods in February 2018. Her periods were getting progressively longer and heavier, and she decided enough was enough. “Night-time pads became saturated within 1-2 hours and I had to call in sick to work for a week as I was unable to do anything,” she says, adding that she slept most of the time and only woke to change and drink water.
Originally her GP prescribed her mefenamic acid, an anti-inflammatory drug used to treat pain, and blood tests found she was low in iron. Things continued and each month her period got longer. Her GP changed her prescription to a mini-pill, but this had little effect, and eventually she was put on the waiting list to see a gynaecologist. “By the end of August my period was lasting 25 days,” she says. “I was physically and emotionally drained and just completely broke down in my GPs office. She recommended that I take some time off work and I’ve been out for two months now.”
She saw a gynaecologist who recommended she take norethisterone for three weeks each month with one week off, taking tranexamic acid on the week off. “I started this at the end of September,” she says. “The gynaecologist was confident that I would not bleed at all during the three weeks on the norethisterone.” Gail decided to go ahead with norethisterone because is only a temporary solution until she gets a Mirena coil fitted when she has a hysteroscopy.
“In my situation where I’m waiting on a procedure that could be several months away, norethisterone might help me with reducing the blood loss which could help me get back to some normality.”
While it is early days, norethisterone seems to be helping, although it hasn’t all been plain sailing. “At the beginning of October I woke up at 4.30am with very painful cramps,” she says. “I’ve never had cramps that bad before, and I started bleeding. But by lunchtime that day it had stopped and I was hopeful it was working.” For the next four days she felt like she was having her period “in every respect” except without the blood loss.
She actually threw up a couple of times, which was not normal for her, and she started bleeding again around 10 days after she started taking norethisterone, and was still bleeding over two weeks later. Nonetheless, she notices she now has less blood loss. “I have only had two days of flooding and clots where it has been five to seven days previous months,” she says.
The reduced, albeit still constant, blood loss is an improvement. “In my situation where I’m waiting on a procedure that could be several months away, norethisterone might help me with reducing the blood loss which could help me get back to some normality,” she says.
Bad experiences with norethisterone
Mollie Davies , 21, was prescribed norethisterone for menorrhagia when she was about 14. She was already on mefenamic acid and various other pills, but was in so much pain she said she “would have taken everything”. Her doctor described it as a magical tablet that would stop her periods when she was on holiday or swimming, so while she didn’t take it continuously, she used it whenever she wasn’t in a position to be able to cope with her extremely heavy periods.
When she was 17 she took it over several days for a holiday. “I did everything as I was told and woke up one morning in excruciating pain. I was screaming, on all fours. I panicked and thought something was seriously wrong.” After an hour or so of short pains on and off, suddenly these sped up and lasted a couple of minutes. “Then a palm sized ball of flesh covered in blood dropped to the floor,” she says. “I instantly felt better, but bled for the next few days. It pretty much ruined my holiday.”
“I did everything as I was told and woke up one morning in excruciating pain. I was screaming, on all fours. I panicked and thought something was seriously wrong.”
When she showed her doctor pictures, no one knew what had happened. Mollie thought she may have had a miscarriage but there was no way she could have been pregnant, and doctors said her pains were contractions and her body had been trying to release what had built up in her uterus, which basically sent her into a sort of labour. She used norethisterone once since, and the same thing happened again, only less extreme. “I won’t use it again,” she says.
Clearly, then, while norethisterone can and does work in many women when used for a short amount of time, for those with severe menorrhagia, it can have mixed effects, which is presumably why it isn’t the first in line treatment for the condition. Regarding Gail’s situation, when she returned to her doctor a few days ago, they were surprised that it hadn’t stopped her bleeding. She was advised to stay on her current dose for a few more weeks and return to her gynaecologist if that doesn’t work.
While Mollie’s story is probably an extreme example of a bad experience, it pays to be aware of the pros and cons when you are considering norethisterone. Follow your doctor’s advice, and make yourself aware of the numerous other treatment options there are out there for menorrhagia.
- NHS, ‘How can I delay my period?’, [website], 2016, https://www.nhs.uk/common-health-questions/travel-health/how-can-i-delay-my-period/, (accessed 1 November 2018).
- NHS, ‘Endometriosis’, Health A-Z, [website], 2015, https://www.nhs.uk/conditions/endometriosis/treatment/, (accessed 1 November 2018).
- NICE, ‘Menorrhagia’, Clinical Knowledge Summaries, [website], 2017, https://cks.nice.org.uk/menorrhagia, (accessed 1 November 2018).
- RCOG, ‘Norethisterone for menorrhagia (query bank)’, Guidelines, [website], 2016, https://www.rcog.org.uk/en/guidelines-research-services/guidelines/norethisterone-for-menorrhagia-query-bank/, (accessed 1 November 2018).