{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T19:13:21Z","timestamp":1783797201416,"version":"3.55.0"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute hepatic porphyria (AHP) flares have been associated with female hormones and the use of hormonal treatments. Women with AHP are traditionally advised to avoid exogenous oestrogen and progesterone, limiting options for contraception and management of menorrhagia, dysmenorrhoea and menopausal symptoms. Evidence on specific hormonal therapies is limited; a 2003 study found that 25% of women with acute intermittent porphyria (AIP) experienced attacks with contraceptives containing progesterone, oestrogen or both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To update the current understanding of the tolerability of hormonal treatments in women with AHP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An anonymous questionnaire was distributed to women with AHP (acute intermittent porphyria, hereditary coproporphyria and variegate porphyria) via hospital records and a national patient support group, capturing prior hormonal therapy use and associated flares.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty responses were analysed; 23 participants had used hormonal therapies. Flares were most frequent in hereditary coproporphyria (66%) and less common in variegate porphyria and acute intermittent porphyria (~20%). No flares were reported with hormone replacement therapy, the progesterone\u2010only pill or progesterone implants. Flares occurred with combined oral contraceptives (46.6%) and progesterone\u2010containing intrauterine devices (28.5%), particularly drospirenone\u2010containing pills. Levonorgestrel\u2010based therapies, including the Mirena IUD, were better tolerated and often improved symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although limited by sample size and retrospective design, this study provides clinically useful data on the tolerability of specific hormonal therapies in women with AHP, supporting personalised prescribing and patient counselling for contraception and symptom management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70532","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T18:30:41Z","timestamp":1783794641000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tolerability of hormonal treatments in acute hepatic porphyria patients"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8145-1086","authenticated-orcid":false,"given":"Andjela","family":"Arandjelovic","sequence":"first","affiliation":[{"name":"Porphyria Expert Centre The Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Ross","sequence":"additional","affiliation":[{"name":"Porphyria Expert Centre The Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5750-1920","authenticated-orcid":false,"given":"Gayle","family":"Ross","sequence":"additional","affiliation":[{"name":"Porphyria Expert Centre The Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1046\/j.1365-2796.2003.01172.x","article-title":"Acute intermittent porphyria in women: clinical expression, use and experience of exogenous sex hormones. A population\u2010based study in northern Sweden","volume":"254","author":"Andersson C","year":"2003","journal-title":"J Intern Med"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/0016-6480(74)90114-2","article-title":"The effect of progesterone on activities of delta\u2010aminolevulinic acid synthetase and delta\u2010aminolevulinic acid dehydratase in estrogen\u2010primed avian oviduct","volume":"22","author":"Miller LK","year":"1974","journal-title":"Gen Comp Endocrinol"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1136\/bmj.1.5959.663","article-title":"Porphyria variegata provoked by contraceptive pill","volume":"1","author":"Fowler CJ","year":"1975","journal-title":"Br Med J"},{"key":"e_1_2_7_5_1","first-page":"653","article-title":"Porphyria cutanea tarda: comparison of cases precipitated by alcohol and estrogens","volume":"113","author":"Haberman HF","year":"1975","journal-title":"Can Med Assoc J"},{"key":"e_1_2_7_6_1","unstructured":"Association. BP.Contraception and Pregnancy2023Available from URL:http:\/\/porphyria.org.uk\/contraception-and-pregnancy\/."},{"key":"e_1_2_7_7_1","unstructured":"Service. WMA.Drugs in Porphyria2023."},{"key":"e_1_2_7_8_1","volume-title":"StatPearls [Internet]","author":"Kothadia JP","year":"2025"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1159\/000440620","article-title":"The impact of gonadal hormones on the expression of human neurological disorders","volume":"103","author":"Schipper HM","year":"2015","journal-title":"Neuroendocrinology"},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1001\/archinte.1990.00390190115018","article-title":"A gonadotropin releasing hormone analogue prevents cyclical attacks of porphyria","volume":"150","author":"Anderson KE","year":"1990","journal-title":"Arch Intern Med"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.3109\/00016340903390729","article-title":"Evaluation of gonadotropin\u2010releasing hormone agonist treatment for prevention of menstrual\u2010related attacks in acute porphyria","volume":"89","author":"Innala E","year":"2010","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1111\/j.0306-5251.2007.02955.x","article-title":"Guide to drug porphyrogenicity prediction and drug prescription in the acute porphyrias","volume":"64","author":"Thunell S","year":"2007","journal-title":"Br J Clin Pharmacol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/S0021-9258(18)96783-9","article-title":"The induction in vitro of the synthesis of delta\u2010aminolevulinic acid synthetase in chemical porphyria: a response to certain drugs, sex hormones, and foreign chemicals","volume":"241","author":"Granick S","year":"1966","journal-title":"J Biol Chem"},{"key":"e_1_2_7_14_1","volume-title":"StatPearls (Internet)","author":"Harper\u2010Harrison G","year":"2025"},{"key":"e_1_2_7_15_1","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1111\/aogs.14200","article-title":"Treatment with assisted reproduction technologies in women with acute hepatic porphyria","volume":"100","author":"Vassiliou D","year":"2021","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/joim.13376","article-title":"Acute hepatic porphyria and maternal health: clinical and biochemical follow\u2010up of 44 pregnancies","volume":"291","author":"Vassiliou D","year":"2022","journal-title":"J Intern Med"},{"key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1182\/hematology.2024000664","article-title":"Porphyria cutanea tarda: a unique iron\u2010related disorder","volume":"2024","author":"Leaf RK","year":"2024","journal-title":"Hematology Am Soc Hematol Educ Program"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70532","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.70532","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70532","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T18:30:44Z","timestamp":1783794644000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,11]]},"references-count":16,"alternative-id":["10.1111\/imj.70532"],"URL":"https:\/\/doi.org\/10.1111\/imj.70532","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,11]]},"assertion":[{"value":"2026-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"imj.70532"}}