Norethisterone and its acetate - what's so special about them?

Introduction Progestogens (progestins) are widely used for contraception, in postmenopausal hormone therapy, and in treatment of abnormal uterine bleeding and endometriosis. Norethisterone (NET) and its acetate (NETA) differ from other progestogens by their partial conversion to ethinylestradiol (EE). We review their special characteristics and focus on the clinically relevant risk factors associated with estrogen action, such as migraine with aura and risk of thrombosis. Methods Narrative review based on a medical literature (OvidMedline and PubMed) search. Results NET converts to significant amounts of EE; 10-20 mg NET corresponds to 20-30 mu g EE. The effects of NET on the endometrium are pronounced, making it a good choice for treating abnormal uterine bleeding, endometriosis, and endometrial hyperplasia. NET also has beneficial effects on bone mineral density and positive or neutral effects on cardiovascular health. Conversely, long-term use of NET is associated with a slightly increased breast cancer risk, and the risk of venous thromboembolism is moderately increased. This risk seems to be dose-dependent; contraceptive use carries no risk, but therapeutic doses might be associated with an increased risk. Studies suggest an association between combinations of EE and progestogens and ischaemic stroke, which in particular concerns women with migraine. No studies have, however, assessed this risk related to the therapeutic use of NET. Conclusions NET is a potent progestogen, especially when considering the endometrium. Its partial conversion to EE, however, is important to remember. Clinical consideration is required with women at high risk for either breast cancer or thromboembolism, or experiencing migraine with aura.

Automated summary

Progestogens like norethisterone (NET) are commonly used for contraception, hormone therapy, and treatment of various gynecological conditions. NET can partially convert to ethinylestradiol (EE), with positive effects on the endometrium, bone density, and cardiovascular health. However, long-term use of NET may slightly increase the risk of breast cancer and venous thromboembolism, especially in women with migraine with aura.