Can norethindrone (Non-Steroidal Progestin) be used to stop a period?

Norethindrone for Menstrual Suppression

Norethindrone is highly effective for stopping periods and is superior to combined oral contraceptives when started before cycle day 12, with only 8% of women experiencing breakthrough bleeding compared to 43% with combined OCPs. 1

Mechanism and Efficacy

Norethindrone is a first-generation progestin that can be used for menstrual suppression. As a progestin-only medication, it works by:

• Thinning the endometrial lining
• Thickening cervical mucus
• Suppressing ovulation at higher doses
• Providing menstrual control without estrogen exposure

The efficacy of norethindrone for menstrual suppression depends on timing and dosage:

• When started before cycle day 12, it has superior efficacy in preventing breakthrough bleeding compared to combined OCPs 1
• For acute heavy menstrual bleeding, a norethindrone taper can achieve complete cessation of bleeding in approximately 79% of adolescents within 7 days 2

Dosing Recommendations

For menstrual suppression:

• Standard dose: 5 mg three times daily (15 mg total daily dose) 1
• Lower doses (0.35 mg daily) may be used for contraception but are less effective for complete menstrual suppression 2
• For acute heavy bleeding, a tapering regimen may be used 2

Advantages Over Combined OCPs

Norethindrone offers several advantages over combined OCPs for menstrual suppression:

1. Significantly less breakthrough bleeding (8% vs 43%) 1
2. Higher patient satisfaction rates, with 80% willing to choose this method again 1
3. Can be used in patients with contraindications to estrogen, including:
   • Women over 35 who smoke
   • History of venous thromboembolism (VTE)
   • Cardiovascular disease
   • Stroke risk factors 3
4. No increased risk of venous thromboembolism (RR 0.90,95% CI 0.57-1.45) 3

Side Effects and Considerations

Common side effects include:

• Weight gain (temporary, resolves after cessation) 1
• Heavier withdrawal bleeding when stopped 1
• Irregular bleeding (most common reason for discontinuation, seen in about 54.5% of users) 2
• Headache, fatigue, tension, and depression 4

Important considerations:

• Fertility returns quickly after discontinuation, with significantly shorter time to conception compared to combined OCPs 1
• No negative effects on long-term fertility 3
• May be particularly useful for adolescents with medical conditions where estrogen is contraindicated 2

Clinical Applications

Norethindrone is particularly useful in these scenarios:

1. When complete menstrual suppression is needed for an upcoming event (e.g., wedding, travel, athletic competition) 1
2. For patients with contraindications to estrogen 3
3. For acute management of heavy menstrual bleeding 2
4. For adolescents with disabilities requiring menstrual management 3
5. As part of combination therapy for uterine fibroids 5

Pitfalls and Caveats

• Must be taken consistently at the same time each day for optimal effect
• Breakthrough bleeding is the most common reason for discontinuation 2
• Depression may occur in some patients and should be monitored 4
• Set realistic expectations with patients that complete amenorrhea may be difficult to achieve in all cases 3
• Consider iron supplementation if breakthrough bleeding is heavy to prevent anemia 3

For optimal results when using norethindrone to stop a period, start the medication before cycle day 12 and use the higher dose regimen (5 mg three times daily) rather than the lower contraceptive dose.