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EndometriosisPhase 2NCT04948489

IUD and Norethindrone Acetate for Treatment of Endometriosis

A Phase 2 study testing norethindrone acetate (NETA) in people with Endometriosis, run by Boston Children's Hospital at 1 site in United States.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

Endometriosis is the most common reproductive disease afflicting young women, often leading to debilitating chronic pelvic pain and impaired quality of life. Safe, effective, and convenient long-term treatments are lacking for adolescents and young adults. Read more about this study

Who is it for?
Ages 13 to 24 years, women only
Conditions the study is for
Endometriosis
What is being tested?
norethindrone acetate (NETA)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
0 participants
Where
1 siteUnited States
Study dates
1 Jan 2026to 1 Sep 2029
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 13 to 24 years
  • Women only
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Female with surgically confirmed endometriosis
  • Clinical decision to begin use of the LNG-IUD
  • Age 13 to 24 years
  • Current pelvic pain (score ≥ 3 on Visual Analog Scale) that has been present for at least 2 months prior to enrollment
  • Willingness to comply with visit schedule and study protocol

Who cannot join

  • Pre-menarche or post-menopause
  • Previous gonadotropin-releasing agonist use
  • Contraindications to an IUD (e.g., cavity-distorting uterine anomaly, acute pelvic inflammatory disease, <3 months from postpartum endometritis or septic abortion, local neoplasm, uterine bleeding of unknown etiology, breast cancer, untreated cervicitis or vaginitis or other lower genital tract infections)
  • Active or historical venous thromboembolism, active or recent arterial thromboembolic disease
  • Impaired liver function or liver disease
  • Systemic lupus erythematosus
Show all 11Show fewer
  • Uncontrolled diabetes or uncontrolled hypertension (BPs >140s/90s)
  • Hypersensitivity to any component of the NETA or LNG-IUS
  • Concurrent use of moderate or strong CYP34a inducers or inhibitors (such as erythromycin, ketoconazole, phenobarbital, rifampin)
  • Significant mental or chronic systemic illnesses that may impact pain assessment
  • Breast feeding, giving birth within the last 6 months, pregnancy, or planning to become pregnant in the next 12 month

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Boston Children's Hospital

    Boston, Massachusetts, 02115

Other trials in United States

About this study

Official title: Efficacy of the Levonorgestrel Intrauterine Device With Norethindrone Acetate for Treatment of Endometriosis in Adolescents and Young Adults

Endometriosis is the most common reproductive disease afflicting young women, often leading to debilitating chronic pelvic pain and impaired quality of life. Safe, effective, and convenient long-term treatments are lacking for adolescents and young adults. The levonorgestrel-containing IUD (LNG-IUD) represents an attractive long-term drug delivery system for the treatment of endometriosis during adolescence and young adulthood. However, while the LNG-IUD has an acceptable safety profile, it is not associated with a favorable bleeding profile and may not fully suppress endometriosis pain when used as monotherapy. Investigators hypothesize that the addition of NETA will improve bleeding patterns, maximize pain control, and improve continuation rates of the IUD when the two medications are used in combination. This proposed prospective trial provides the ideal context in which to investigate these clinical questions and advance research on the best treatments for endometriosis.

Read the detailed description

Endometriosis is a major source of morbidity for U.S. females, affecting ~49% of adolescents with chronic pelvic pain and 10% of all women of reproductive age. This percentage translates into approximately 176 million women worldwide who may suffer from endometriosis. Annual health care costs are estimated to be over $22 billion in the US alone. Over 50% of adults with endometriosis report onset of severe pelvic pain during their adolescence. Symptoms result in decreased quality of life, negative socioeconomic consequences, impaired reproductive potential, and diminished mental health. Endometriosis is a chronic disease that progresses over time in more than half of patients. Endometriosis has no cure. For adolescents in particular, this means that the impact of endometriosis and its symptoms can last for decades. Appropriate management involves not only prompt initiation of therapy, but also the maintenance of therapy for a protracted length of time.

Medical therapy for endometriosis typically includes oral progestins or contraceptive pills. Though often effective, these options are associated with systemic side-effects which may further affect compliance and preclude long-term use. Furthermore, the need for repeated or regular administration compromises compliance and therefore efficacy. The levonorgestrel-releasing intrauterine system (LNG-IUD) has been evaluated as a promising treatment for endometriosis in adult women. The LNG-IUD 52 mg (Mirena) delivers levonorgestrel (LNG) to the uterine cavity at a steady rate of 20 µg/day over 5 to 6 years. The LNG causes atrophy and pseudo decidualization of the uterine lining, along with apoptosis of endometrial glands and stroma. As the LNG-IUD requires no further patient action following insertion, patient compliance is excellent. While continuation of the device is generally very good in adults, unfavorable uterine bleeding patterns are the most frequent reason for early device removal, particularly within the first 6 months. Anecdotal clinical experience suggests that combining use of the LNG-IUD with low-dose oral progestin therapy may maximize effectiveness and continuation of the LNG-IUD device in adolescents.

The investigators will recruit 80 adolescents for participation in a double-blind, randomized trial of NETA (n=40) vs. placebo (control group, n=40) for adjunct treatment to the levonorgestrel-containing IUD for pelvic pain due to endometriosis. It is believed that a combination of the locally-acting LNG-IUD plus systemic NETA may be the optimal combination to effectively treat endometriosis pain, minimize side effects, provide contraception, and control bleeding for adolescents with endometriosis.

Conditions
Endometriosis
Being tested
norethindrone acetate (NETA), Placebo
Medical subject headings
Endometriosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • norethindrone acetate (NETA)Drug

    Also called Aygestin

    5mg of the NETA capsule by mouth daily for 12 months

  • PlaceboDrug

    Also called gelatin capsules- filled with lactose monohydrate (0.2 gram)

    Placebo capsule everyday for 12 months

Study groups in NCT04948489
Study groupRoleWhat they receive
LNG IUD+ Norethindrone AcetateExperimentalAll eligible participants will have the LNG-IUD. Experimental participants will also receive norethindrone acetate 5 mg by mouth daily for 12 months.
Receives: Drug: norethindrone acetate (NETA)
LNG IUD+PlaceboPlacebo comparatorAll eligible participants will have the LNG-IUD. Participants in the placebo comparator group will also receive a placebo tablet, 1 tablet by mouth daily for 12 months.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Pain-Physical functioning assessed by the BPI

    A 7-item self-report measure. The items in this scale can be grouped into those that assess physical functioning (general activity; walking ability; normal work, including both work outside the home and housework), those that assess emotional functioning (mood; relations with people; enjoyment of life), and a single item that assesses the extent to which pain interferes with sleep. Either the item asking about the "worst pain" or the arithmetic mean of the four severity items can be used as measures of pain severity; the arithmetic mean of the seven interference items can be used as a measure of pain interference. The BPI is anchored between a scale of zero (no pain/interference) to ten (maximum pain/interference). The magnitude of treatment-associated change in BPI Interference Scale scores in open-label and randomized clinical trials ranges from 1 to 3 points, depending on the specific pain conditions and treatments studied.

    Measured: Baseline, 3 Months, 6 Months, 9 Months, 12 Months

  2. Change in pain severity measured by Visual Analog Scale (VAS)

    VAS: A measurement of pain intensity, assessed by a 0 to 10 numerical rating scale, to rate maximum and average pain intensity over the preceding 7 days. Higher scores indicate more severe pain intensity.

    Measured: Baseline, 3 Months, 6 Months, 9 Months, 12 Months

  3. Change in pain measured by Biberoglu and Behrman patient ratings scale (B&B pain scale)

    Biberoglu and Behrman patient ratings scale (B\&B pain scale): Survey that assesses dyspareunia, dysmenorrhea, and noncyclic pelvic pain. Each is graded on a scale from 0 to 3, with higher numbers indicating more severe symptoms.

    Measured: Baseline, 3 Months, 6 Months, 9 Months, 12 Months

  4. Change in Emotional functioning, assessed by the Beck Depression Inventory-II (BDI)

    Beck Depression Inventory-II (BDI)130, a 21-item self-report instrument that provides a rapid assessment of depressive symptoms.Total scores on the BDI range from 0 to 63. Scores below 10 should be considered to reflect "minimal or no" depression, with score ranges of 10 to 18, 19 to 29, and 30 to 63 reflect "mild to moderate," "moderate to severe," and "severe" depression, respectively.

    Measured: Baseline, 3 Months, 6 Months, 9 Months, 12 Months

  5. Change in Participant ratings of overall improvement, assessed by the Patient Global Impression of Change scale (PGIC)

    This single-item self-assessed rating uses a 7-point rating scale with the options "very much improved," "much improved," "minimally improved," "no change," "minimally worse," "much worse," and "very much worse."

    Measured: Baseline, 3 Months, 6 Months, 9 Months, 12 Months

Secondary outcomes (12)
  1. Change in high sensitivity C-reactive protein

    investigators will measure changes in high sensitivity C-reactive protein (mg/L) over time to determine whether norethindrone acetate impacts inflammatory markers.

    Measured: Baseline, 6 months, 12 months

  2. Change in interleukin-8

    Investigators will measure changes in interleukin-8 (pg/mL) over time to determine whether norethindrone acetate impacts inflammatory markers.

    Measured: Baseline, 6 months, 12 months

  3. Change in tumor necrosis factor alpha

    Investigators will measure tumor necrosis factor alpha (pg/mL) to determine whether norethindrone acetate impacts inflammatory markers.

    Measured: Baseline, 6 months, 12 months

  4. Change in Tissue factor pathway inhibitor (TFPI)

    Investigators will measure changes in TFPI to determine whether norethindrone acetate impacts prothrombotic markers.

    Measured: Baseline, 6 months, 12 months

  5. Change in von Willebrand factor antigen

    Investigators will measure changes in von Willebrand factor antigen to determine whether norethindrone acetate impacts prothrombotic markers (VWFpp) to VWF antigen (VWF:Ag).

    Measured: Baseline, 6 months, 12 months

  6. Change in Factor VIII activity

    Investigators will measure changes in Factor VIII activity (1 U/mL) to determine whether norethindrone acetate impacts prothrombotic markers.

    Measured: Baseline, 6 months, 12 months

  7. Change in soluble P-selectin

    Investigators will measure changes in soluble P- selectin (unit) over time to determine whether norethindrone acetate impacts prothrombotic markers.

    Measured: Baseline, 6 months, 12 months

  8. Change in interleukin-6 (IL-6)

    Investigators will measure changes in interleukin-6 (pg/mL) over time to determine whether norethindrone acetate impacts prothrombotic markers.

    Measured: Baseline, 6 months, 12 months

  9. Change in lipoprotein[a]

    Investigators will measure changes in lipoprotein[a] (mg/dL) over time to determine whether norethindrone acetate impacts prothrombotic markers.

    Measured: Baseline, 6 months, 12 months

  10. Change in Measure of arterial stiffness by pulse wave velocity

    Pulse wave velocity is an ultrasound measurement of the rate at which pressure waves move down a blood vessel. It is collected by using two pressure monitors placed a known distance from one another, the "Pulse Wave Distance". Pulse wave velocity is a validated surrogate measure of arterial stiffness that is a novel biomarker for cardiovascular risk/dysfunction.

    Measured: Baseline, 12 months

  11. Change in Bone mineral density Z-scores by dual energy Xray absorptiometry (DXA)

    DXA has been the most widely used tool for the assessment of bone mass in clinical practice. DXA measures bone in two dimensions, and allows for the calculation of aBMD. Although these measures do not capture the internal architecture of bone, they are highly correlated with bone strength. A DXA scan of the total body (less head), lumbar spine, and total hip will be obtained. Age-, race-, and gender-specific Z-scores will be calculated using appropriate reference software.

    Measured: Baseline, 6 months, 12 months

  12. Change in measures of central hypersensitization measured by quantitative sensory testing.

    The Quantitative sensory testing (QST) is a standard method through which sensory nerve function is quantitatively measured, based on responses of the participant. It will be measured at the abdomen, as well as the arm, which serves as an internal control.

    Measured: Baseline, 6 months, 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Jul 2021
  2. Study start1 Jan 2026 (estimated)
  3. Primary completion1 Sep 2028 (estimated)
  4. Study completion1 Sep 2029 (estimated)

Why it stopped: No funding

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Investigators will recruit 80 adolescents for participation in a double-blind, randomized trial of NETA (n=40) vs. placebo (control group, n=40) for adjunct treatment to the levonorgestrel-containing IUD for pelvic pain due to endometriosis.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04948489
Sponsor's protocol ID
IRB-P00037934
Status last verified
Mar 2025
First submitted
7 Jun 2021
Last updated
21 Mar 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing norethindrone acetate (NETA) in people with Endometriosis, run by Boston Children's Hospital at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 21 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Pain-Physical functioning assessed by the BPI (time frame: Baseline, 3 Months, 6 Months, 9 Months, 12 Months). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Mar 2025.

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