Suppression of an accessory and cavitated uterine mass with norethindrone: a case report

Objective: To describe conservative management for accessory and cavitated uterine mass (ACUM) with norethindrone acetate. The patient gave signed written, informed consent authorizing publication. Design: We present a case report of a patient with ACUM who desired delay in surgical management. Subjects: The patient initially presented as a 16-year-old. She reported menses starting at the age of 11 years with increasing chronic pain and severe dysmenorrhea over the past 5 years. She was started on norethindrone acetate (5 mg orally once a day). Her periods were completely suppressed on this initial dose, and her pain resolved. After 4 years of conservative management, the patient requested definitive surgical management at the age of 20 years. Main Outcome Measures: Abdominal surgery was performed 4 years after initial diagnosis after delay with norethindrone acetate. Results: Pathology from the procedure confirmed the diagnosis of ACUM. Conclusion: On the basis of this case report, for patients with severe pain and dysmenorrhea secondary to ACUM, norethindrone acetate suppression may be a viable option. Because the patient was asymptomatic with norethindrone acetate (5 mg orally once a day), there was no need to titrate the dose higher. However, if patients continue to have pain with the starting regimen, it is reasonable to titrate the dose up to the maximum dose of norethindrone acetate (15 mg orally once daily). Although the intention for this patient was to delay surgery, for patients who are poor surgical candidates or do not desire surgical management, norethindrone acetate may be a viable, long-term option. (F S Rep (R) 2025;6:90-4. (c) 2025 by American Society for Reproductive Medicine.)