Assessing Practice Patterns Regarding Use of Norethindrone Acetate in Adolescents

Background: Norethindrone acetate (NETA) is commonly used in adolescent patients for management of heavy menstrual bleeding, menstrual suppression, and endometriosis. Clinical guidelines do not address specific dosing strategies, clinical indications, contraindications, or monitoring. We sought to survey current prescribers of NETA to assess practice patterns of use among adolescent patients. Methods: An anonymous cross-sectional survey was sent via email list-serv to members of the North American Society for Pediatric and Adolescent Gynecology Providers (NASPAG). Participants were asked about their own demographics, patterns of use and monitoring of NETA. Results: Seventy-one providers participated in the survey including 46 gynecologists and 22 adolescent medicine trained clinicians. The most common indications for use were menstrual suppression and treatment of endometriosis. Most providers (n = 51) used NETA in patients with estrogen contraindications, with over half limiting the maximum dose used (n = 24). While 14%(n = 9) of providers surveyed had concerns about effects on bone mineral density with prolonged NETA use, only 1 participant routinely obtained dual-energy X-ray absorptiometry (DEXA) scans. 43% of participants using NETA felt there were no absolute contraindications (n = 27); others cited liver disease (n = 15), active or prior venous thromboembolism (n = 7), and inherited thrombophilia or increased clotting risk (n = 3) as strict contraindications. Conclusions: NETA is commonly prescribed for adolescents by study participants. Despite widespread use, practice patterns vary regarding eligibility, monitoring, and perceived risks. This likely reflects limited data and highlights the need for further investigations of NETA use. Our study was limited by low response rate that may not be reflective of general clinical practice.