Norethisterone induced cerebral venous sinus thrombosis (CVST): a rare case report and review of literature

Abstract

The association between the progestin only pill used for treatment of menstrual disorders and cerebral venous sinus thrombosis (CVST) has rarely been reported in the literature. This report describes a case of cerebral venous thrombosis following intake of norethisterone for menorrhagia secondary to polycystic ovary syndrome in a young woman with undiagnosed underlying hyperhomocysteinemia. A 24 year old married woman presented with acute onset of headache, vomiting and right focal seizures. MRI Cerebral venogram and CT Brain revealed thrombosed anterosuperior segment of superior sagittal sinus and haemorrhagic infarct in right frontoparietal region. The risk factors were acquired hyperhomocysteinemia, polycystic ovary syndrome and norethisterone for menorrhagia. The patient was treated with low molecular weight heparin, followed by warfarin, vitamin B 12 , vitamin B 6 and folic acid. She made a total recovery. Although venous thrombosis is usually linked to the ingestion of estrogen, rather than progestogen, this case illustrates that patients who are prescribed progestogen only pills for gynaecological disorders may develop thrombosis, especially if they have predisposing metabolic disorders.

Intestinal obstruction induced by portal vein thrombosis in a female undergoing oral contraceptive therapy: a case report with comprehensive review

“…Despite a slight increase in thromboembolic risk, the overall benefits outweigh this concern, particularly compared to the risks associated with pregnancy or the postpartum period 20 . Additionally, first-generation progestogens like norethisterone pose a lower risk of venous thrombosis compared to third-generation progestogens, although the risk is slightly higher than second-generation progestogens 9 . In the presented case, the patient was under norethisterone 30 mg per day for six months for heavy menstrual bleeding due to uterine fibroids without a coagulation defect history.…”

“…Diagnosing PVT-induced intestinal obstruction in the context of prolonged oral contraceptive use is challenging due to nonspecific symptoms, atypical presentations, and limitations in imaging modalities like ultrasonography. The condition’s rarity and the potential for overlap with other abdominal issues further contribute to delays in diagnosis, emphasizing the importance of heightened clinical awareness and a comprehensive diagnostic approach 8 , 9 .…”

“…Variceal eradication before anticoagulation is considered. Thrombolytic therapy and surgical interventions are considered in select cases when anticoagulation fails 1 , 2 , 9 .…”