Low-dose progestagens and ectopic pregnancy. (Letter)

This letter was written in response to a case report involving low-dose progestagens and ectopic pregnancy. The 24-year-old patient had been taking norethisterone (Micronor) .35 mg daily for 13 months. When her period was 1 week late she had vaginal bleeding and lower abdominal discomfort which continued intermittently for 6 weeks before their exacerbation precipitated her admission. The presence of a hemoperitoneum with an ectopic pregnancy in a grossly distended right follopian tube was confirmed by laparotomy. This case reemphasizes the importance of considering an ectopic pregnancy in any patient on progestagen-only contraception who develops abdominal discomfort irrespective of her previous menstrual pattern and particularly in the presence of apparent side effects of this therapy such as irregular bleeding or prolongation of the cycle.