Abstract
Sir, Combination oral contraceptive steroids are (rarely) associated with cholestasis that resembles intrahepatic cholestasis of pregnancy. The incidence of cholestasis due to oral contraceptive steroids is approximately 1:10 000 women exposed in Western Europe, but as high as 1:4000 women exposed in Chile and Scandinavia.1 The oestrogenic component of the combined oral contraceptive pill is believed to be responsible. However, we report two cases of cholestasis induced by norethisterone, a progestogen contraceptive, which resolved after withdrawal of these pills. An 18-year-old schoolgirl developed jaundice, pruritus, fatigue and anorexia 2 weeks after starting norethisterone. She had taken 5 mg norethisterone three times daily for 10 days to delay menstruation during a skiing holiday. She was on no other medication and did not drink alcohol. Examination revealed icterus with a palpable liver edge. Blood tests showed alanine transaminase was 540 U/l, alkaline phosphatase was …
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