Central venous sinus thrombosis in a young woman taking norethindrone acetate for dysfunctional uterine bleeding: case report and review of literature.
BACKGROUND
The association between the progestin-only pill used for treatment of menstrual disorders and central venous sinus thrombosis (CVST) has rarely been reported in the literature. This report describes a case of central venous sinus thrombosis following intake of norethindrone acetate for dysfunctional uterine bleeding secondary to polycystic ovary syndrome in a young woman with undiagnosed underlying hyperhomocysteinemia.


METHODS
A 23-year-old woman presented with severe headache, followed by hemiparesis, seizures, and altered sensorium. She had been prescribed norethindrone acetate for the management of dysfunctional uterine bleeding secondary to polycystic ovary syndrome. Investigations revealed acquired hyperhomocysteinemia, presumably due to nutritional deficiencies, and evidence of CVST on MRI and magnetic resonance venography. Investigations showed no evidence of inherited thrombophilia. The patient was treated with low molecular weight heparin, followed by warfarin, vitamin B12, vitamin B6, and folic acid, and recovered successfully.


CONCLUSIONS
Although venous thrombosis is usually linked to the ingestion of estrogen, rather than progestogen, this case illustrates that patients who are prescribed progestogen-only pills for gynaecological disorders may develop thrombosis, especially if they have predisposing metabolic disorders.
Rajput
Rajesh
R
Department of Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
Dhuan
Joginder
J
Department of Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
Agarwal
Shalini
S
Department of Radiodiagnosis, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
Gahlaut
P S
PS
Department of Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
D003280:Contraceptives, Oral, Synthetic / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D020138:Hyperhomocysteinemia / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008595:Menorrhagia / Q000188:drug therapy* / Q000209:etiology; D009640:Norethindrone / Q000009:adverse effects* / Q000627:therapeutic use; D009748:Nutrition Disorders / Q000150:complications; D011085:Polycystic Ovary Syndrome / Q000150:complications; D012851:Sinus Thrombosis, Intracranial / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
D003280:Contraceptives, Oral, Synthetic; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D009640:Norethindrone