Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study

Vercellini, Paolo; Bracco, Beatrice; Mosconi, Paola; Roberto, Anna; Alberico, Daniela; Dridi, Dhouha; Somigliana, Edgardo

doi:10.1016/j.fertnstert.2015.11.016

Cited by 97 publications

(120 citation statements)

References 55 publications

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“…It could also be argued that, in women who were intolerant to NETA, instead of suggesting OC, we could have suggested shifting to dienogest, which has been proven to be better tolerated than NETA [16]. However, many women assisted in our center cannot afford the cost of dienogest (€730 – $860 – £670 per year in Italy, not reimbursed by the Italian NHS) and prefer NETA (€18 – $21 – £17 per year in Italy, €4 per year when reimbursed by the Italian NHS) specifically for economic reasons.…”

Section: Discussionmentioning

confidence: 99%

“…NETA, a 19-nortestosterone derivative progestin, has been repeatedly evaluated in women with endometriosis [6, 9-11, 30-32], and has been routinely used in our referral center for several years [7, 14-16]. NETA is approved by the FDA and the Italian Ministry of Health for the treatment of endometriosis and is reimbursed by the Italian National Health System.…”

Section: Methodsmentioning

confidence: 99%

“…The above scales and questionnaires have been described previously in detail [7, 13-16]. The presence and severity of dysmenorrhea, deep dyspareunia, non-menstrual pelvic pain, and dyschezia were assessed using an 11-point NRS, with 0 indicating absence of pain and 10 presence of pain as bad as it could be.…”

Section: Methodsmentioning

confidence: 99%

“…Scores are then categorized, with 9–10 indicating that a drug is very well tolerated; 7–8, well tolerated; 5–6, moderately tolerated; 3–4, poorly tolerated; 0–2, not tolerated [16]. …”

Section: Methodsmentioning

confidence: 99%

“…Overall, about two thirds of patients appear to benefit from these therapies [5-16]. The main reason of treatment failure in the remaining third, in addition to inefficacy, is drug intolerance.…”

Section: Introductionmentioning

confidence: 99%

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Shifting from Oral Contraceptives to Norethisterone Acetate, or Vice Versa, because of Drug Intolerance: Does the Change Benefit Women with Endometriosis?

Vercellini

Ottolini

Frattaruolo

et al. 2018

Gynecol Obstet Invest

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Background/Aims: Oral contraceptives (OC) and norethisterone acetate (NETA) are among first-line medical therapies for symptomatic endometriosis, but their use is sometimes associated with intolerable side effects. We investigated whether shifting from low-dose OC to NETA (2.5 mg/day), or vice versa, improved tolerability. Methods: Sixty-seven women willing to discontinue their treatment because of intolerable side effects despite good pain relief, were enrolled in a self-controlled study, and shifted from OC to NETA (n = 35) or from NETA to OC (n = 32). The main study outcome was satisfaction with treatment 12 months after the change. Tolerability, pain symptoms, health-related quality of life, psychological status, and sexual functioning were also evaluated. Results: After treatment change, good tolerability was reported by 37% of participants who shifted to NETA, and by 52% of those who shifted to OC. At 12-month assessment, 51% of women intolerant to OC were satisfied with NETA, and 65% of those intolerant to NETA were satisfied with OC (intention-to-treat analysis). Other study variables did not vary substantially. Conclusions: In selected endometriosis patients, shifting from OC to NETA, or vice versa, because of side effects, improved tolerability. Better results were observed when substituting NETA with OC rather than the other way round.

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Section: Discussionmentioning

confidence: 99%