Is norethisterone a lifestyle drug?

Editor—The summer peak in norethisterone prescribing shown so graphically by Shakespeare et al will not surprise most general practitioners.¹ Although there is evidence that norethisterone is ineffective in reducing menstrual loss in menorrhagia,² the drug is licensed and is effective at delaying the onset of menstruation and regulating chaotic or short menstrual cycles.³

It is, in our opinion, insulting to women to imply that the use of norethisterone to postpone menstruation—which may account for a substantial proportion of current prescriptions of the drug—is inappropriate for the NHS.

Menstrual bleeding disorders are common and are often not associated with any recognised organic disease process: dysfunctional uterine bleeding is an acceptable diagnosis. Problem periods result in physical and psychological disease.

In Southern Derbyshire Health Authority, focus groups informed the development of our guidelines for menstrual bleeding problems.⁴ Women with problem periods perceived that their symptoms were often disregarded by health professionals. Positive outcomes desired from treatment were to have a regular cycle, without restrictions on their social functioning and sex lives.

In this era of patient centred care, once serious disease has been excluded many women choose to put up with their problem periods most of the time. However, for a few weeks of the year they may decide to take a holiday from periods.

Tranexamic acid used to treat menorrhagia for one year costs as much as £100 whereas norethisterone to delay a period may cost only £5.³ It could be argued that women who tolerate their symptoms for most of the year but who take a period holiday make efficient use of NHS resources.

Health is not merely the absence of disease, but a positive concept of wellbeing.⁵ Norethisterone used to delay a period is no more a “lifestyle treatment” than other activities of the NHS aimed at promoting health.