How can I delay menstruation short term?

Short-Term Menstruation Delay Options

Combined hormonal contraceptives (CHCs) or norethindrone can effectively delay menstruation short-term, with norethindrone being superior for preventing breakthrough bleeding when started before cycle day 12. 1

First-Line Option: Norethindrone (Progestin-Only)

• Dosing: 5 mg three times daily (15 mg total daily dose)
• Timing: Start on or before cycle day 12 for optimal effectiveness 1
• Duration: Continue until desired end date, then stop to allow withdrawal bleeding
• Effectiveness: Only 8% of women experience breakthrough bleeding (compared to 43% with CHCs) 1
• Advantages:
  • Superior prevention of breakthrough bleeding
  • Faster return to fertility after discontinuation
  • Higher patient satisfaction (80% would choose again)
  • Safe for women with contraindications to estrogen

Second-Line Option: Combined Hormonal Contraceptives

• Method: Skip the hormone-free week (placebo pills) and continue with active pills 2
• Timing: Works best if started at the beginning of a pack
• Effectiveness: Higher rates of breakthrough bleeding compared to norethindrone 1
• Considerations:
  • If breakthrough bleeding occurs, a 3-4 day hormone-free interval can be taken (but not during the first 21 days of extended use) 2
  • Not recommended for women with contraindications to estrogen (smokers >35, history of thrombosis, cardiovascular risk factors) 3

Important Considerations

• Breakthrough bleeding management:

  • If using CHCs and breakthrough bleeding occurs, a 3-4 day hormone-free interval may help, but this should not be done more than once per month as it may reduce contraceptive effectiveness 2
  • For persistent unacceptable bleeding, consider switching methods 2

• Contraindications:

  • Combined hormonal methods should be avoided in women with:
    • History of thrombosis
    • Cardiovascular risk factors (smoking, hypertension, migraines with aura)
    • Age >35 years who smoke 3
  • Norethindrone is safer for women with these contraindications

• Side effects:

  • Norethindrone may cause temporary weight gain that resolves after stopping therapy 1
  • Withdrawal bleeding may be heavier after norethindrone use 1

Follow-up Considerations

• If menstrual period is missed after stopping hormonal method and the patient has been adherent to the prescribed regimen, pregnancy should be ruled out before continuing use 4
• For women who experience persistent abnormal bleeding, diagnostic measures should be taken to rule out pregnancy or malignancy 4

Clinical Pearl

When even minimal breakthrough bleeding cannot be tolerated (such as for special events or travel), norethindrone is the preferred option as it has significantly lower rates of breakthrough bleeding compared to combined hormonal contraceptives 1.