Potentially effective therapy of heavy menstrual bleeding with an oestradiol-nomegestrol acetate oral contraceptive: a pilot study

Abstract

BackgroundHeavy menstrual bleeding (HMB) exceeding 80 mL per cycle leads to considerable adverse impact on a woman’s iron metabolism, incidence of iron deficiency and anaemia, as well as her functioning in society.The objective of the study is to determine the potential efficacy of a Monophasic oestradiol-17β-nomegestrol acetate (E2/Nomac) combined oral contraceptive pill on measured menstrual blood loss as a pilot study in 12 women with objectively demonstrated HMB (>80 mL per cycle). The pilot study aimed to recruit 20 women.MethodConsented women completed the HMB questionnaire. The blood was taken for haemoglobin, transferrin, iron saturation, TIBC, serum iron and ferritin. Women were given verbal and written detailed instructions for MBL collection for three control cycles and four treatment cycles.ResultsForty-three women were enrolled, but 31 were ineligible and withdrawn (mainly for failure to meet eligibility criteria). Twelve women entered the treatment phase and commenced the E2/nomegestrol acetate (NOMAC) 24/4 combined pill treatment on the first day of their fourth cycle. All women with complete MBL measurements had >50% reduction in MBL on treatment (exact 95% confidence interval for proportion with MBL reduction >50%: 69 to 100%). The mean percent reduction in MBL between pretreatment and during treatment was 76.9%, and the median was 79% with a range of 53.7 to 100%.ConclusionsThis pilot study indicates that the E2/NOMAC COC will provide a useful potential option for treating HMB in women with FIGO classification AUB-E (primary endometrial causes) but requires a larger placebo-controlled study for confirmation.

Hepcidin response to interval running exercise is not affected by oral contraceptive phase in endurance‐trained women

“…This may be related to the occurrence of menstrual bleeding during this phase. Despite menstrual losses being smaller in OC cycles than eumenorrheic cycles, 37 lower plasma iron concentrations are still observed during menses. In addition, the present results showed a trend for hepcidin concentrations to be higher at baseline than during the withdrawal phase, which along with menstrual bleeding may reduce the availability of iron in plasma during that phase.…”

Metformin Enhances Nomegestrol Acetate Suppressing Growth of Endometrial Cancer Cells and May Correlate to Downregulating mTOR Activity In Vitro and In Vivo

“…Its progesterone activity is higher than that of MPA [28]. The longer half-life and less adverse effects of NOMAC lead to it being successfully used in contraception and in the treatment of many hormone-dependent gynecological disorders, including menstrual disturbances, heavy menstrual bleeding, and premenstrual syndrome [28,29,30]. Preliminarily, we found that NOMAC inhibited the growth of RL95-2 EC cells and the inhibitory effect was stronger than that of MPA [31].…”

Effect of combined contraceptive pill on immune cell of ovarian endometriotic tissue

“…We hypothesize that COCs can modulate these immune cells in many ways. First, COCs could cause a reduction in menstrual bleeding [ 38 , 39 ] and consequently, menstrual reflux into the pelvic cavity. This reduction would then decrease inflammatory reactions and local estrogen production.…”