Combined oral contraceptives have a well-known side effect of causing a reaction similar to intrahepatic cholestasis of pregnancy. This has been thought to be largely due to the estrogen component of contraceptives. However, in this case report, we delineated the case of cholestasis in a middle-aged woman who has been receiving norethisterone, a progestogen only pill, for symptomatic fibroids. Within 2 months of starting norethisterone, this patient developed hepatomegaly and jaundice. Her labs showed abnormalities of liver function indicative of a cholestatic picture. Upon discontinuation of norethisterone and starting ursodeoxycholic acid, her liver functions began to trend down and returned to normal within a month. There have been similar case reports; however, the data is lacking with regards to establishing a correlation. Awareness of unanticipated side effects of a drug such as norethisterone is crucial in the prompt recognition and treatment of cholestasis should it arise. Moreover, knowledge is lacking with regards to the effect of progesterone on the liver in general and on developing cholestasis in particular.
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