Endometriosis-ectopic implantation of endometrial-like tissue-affects 10% of female adolescents and adults. First-line treatment includes progesterone-only (such as norethindrone acetate, NET-A) or combined estrogen/progestin oral contraceptive pills. Estrogen-containing contraceptives confer increased risk of hepatic adenomas, while the association with NET-A is very rarely reported.
Three adolescents with Stage I-II endometriosis managed with NET-A (up to 15 mg/day for 28-78 months) were diagnosed with hepatic adenomas at ages 17-22 years. They previously received estrogen-containing medications, which were stopped > 24 months before diagnosis of hepatic adenoma.
SUMMARY AND CONCLUSION:
NET-A in a dose above 10 mg per day may be associated with increased risk for hepatic adenomas, likely due to peripheral conversion to ethinyl estradiol. Use of NET-A may not be advisable in patients with known hepatic adenomas.
Copyright © 2016. Published by Elsevier Inc.