{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:19:10Z","timestamp":1783487950112,"version":"3.55.0"},"reference-count":50,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Progestogens (progestins) are widely used for contraception, in postmenopausal hormone therapy, and in treatment of abnormal uterine bleeding and endometriosis. Norethisterone (NET) and its acetate (NETA) differ from other progestogens by their partial conversion to ethinylestradiol (EE). We review their special characteristics and focus on the clinically relevant risk factors associated with estrogen action, such as migraine with aura and risk of thrombosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Narrative review based on a medical literature (OvidMedline and PubMed) search.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>NET converts to significant amounts of EE; 10\u201320\u2009mg NET corresponds to 20\u201330\u2009\u00b5g EE. The effects of NET on the endometrium are pronounced, making it a good choice for treating abnormal uterine bleeding, endometriosis, and endometrial hyperplasia. NET also has beneficial effects on bone mineral density and positive or neutral effects on cardiovascular health. Conversely, long-term use of NET is associated with a slightly increased breast cancer risk, and the risk of venous thromboembolism is moderately increased. This risk seems to be dose-dependent; contraceptive use carries no risk, but therapeutic doses might be associated with an increased risk. Studies suggest an association between combinations of EE and progestogens and ischaemic stroke, which in particular concerns women with migraine. No studies have, however, assessed this risk related to the therapeutic use of NET.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NET is a potent progestogen, especially when considering the endometrium. Its partial conversion to EE, however, is important to remember. Clinical consideration is required with women at high risk for either breast cancer or thromboembolism, or experiencing migraine with aura.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjsrh-2020-200619","type":"journal-article","created":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T21:15:30Z","timestamp":1589318130000},"page":"102-109","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":47,"title":["Norethisterone and its acetate \u2013 what\u2019s so special about them?"],"prefix":"10.1136","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2788-1947","authenticated-orcid":false,"given":"Emilia","family":"Huvinen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3572-1337","authenticated-orcid":false,"given":"Elina","family":"Holopainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-130X","authenticated-orcid":false,"given":"Oskari","family":"Heikinheimo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,12]]},"reference":[{"key":"2021042121550914000_47.2.102.1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.maturitas.2003.09.014","article-title":"Classification and pharmacology of progestins","volume":"46","author":"Schindler","year":"2003","journal-title":"Maturitas"},{"key":"2021042121550914000_47.2.102.2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.91"},{"key":"2021042121550914000_47.2.102.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-7824(97)00174-1"},{"key":"2021042121550914000_47.2.102.4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-0044"},{"key":"2021042121550914000_47.2.102.5","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12060"},{"key":"2021042121550914000_47.2.102.6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3109\/00016348209155312","article-title":"Gregory Pincus and steroidal contraception revisited","volume":"61","author":"Diczfalusy","year":"1982","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2021042121550914000_47.2.102.7","doi-asserted-by":"crossref","unstructured":"Stegeman BH , de Bastos M , Rosendaal FR , et al . 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