Norethindrone Acetate Versus Combined Oral Contraceptives in Patients With Acute Abnormal Uterine Bleeding

To compare norethindrone acetate (NA) and combined oral contraceptives (COC) in managing adolescents with acute abnormal uterine bleeding (AUB).

We recruited adolescents and young adults (AYA) aged 10-21 years, with a diagnosis of AUB or other specified irregular menses from January 2022 to March 2023, who were first treated at our emergency department (ED) and then enrolled at our adolescent medicine clinic. We distributed questionnaires, focusing on days until bleeding cessation with treatment, hospitalizations related to bleeding, patient satisfaction, and side effects. Data were grouped as NA or COC and compared. A P < .05 was considered statistically significant.

Of fifteen patients, seven were treated with NA and eight patients were treated with COC. The average length of stay (LOS) in the hospital was 2.3 days (SD = 0.6) in the NA group and 2.4 days (SD = 0.9) in COC group. The time to bleeding cessation was 2.6 days in both groups. Most patients who took NA (86%) experienced no side effects compared to the COC group (25%) (P = .041).

In our small sample, NA appeared to be as efficacious as COC. We found no difference in the time to bleeding cessation and length of hospital stay. Those treated with NA had fewer side effects than those treated with COC. We hope this pilot study will promote further inquiries as to whether NA may be the better choice for acute AUB in young women.