Managing Abnormal Uterine Bleeding With Norethisterone Acetate: An Evidence-Based Review and Expert Insights

Abnormal uterine bleeding (AUB) is a commonly presented gynaecological disorder that significantly affects the physical, emotional, and social well-being of a woman. Norethisterone acetate (NETA), a synthetic progestin, is widely utilized for managing AUB in view of its proven efficacy and favourable safety profile. Despite its extensive use, optimal dosing, duration, and patient-specific considerations in Indian women remain undefined. This expert opinion employed a two-pronged approach to assess the role of NETA in managing AUB in India. A comprehensive literature review was conducted to assess the evidence on efficacy, safety, pharmacokinetics, and formulation benefits, followed by four expert advisory board meetings held across India involving nearly 50 practicing experts. During expert advisory meetings, the current literature was discussed, and expert opinions were developed. The findings suggest that NETA is an effective option for stabilizing abnormal uterine bleeding, particularly during perimenopause, offering rapid symptom control, and well-tolerated and high patient satisfaction across multiple indications, including heavy menstrual bleeding, endometrial hyperplasia, and adenomyosis. Controlled-release formulations of NETA demonstrated pharmacokinetic equivalence to immediate-release regimens and comparable efficacy with the added advantage of improved adherence. Experts highlighted the importance of individualized dosing based on patient characteristics, such as body mass index, bleeding severity, and comorbidities.