What can a woman take to delay her menstrual period?

Methods to Delay Menstrual Period

Combined oral contraceptive pills (COCPs) are the most effective option for delaying menstruation, with norethindrone (5 mg three times daily) being superior when started late in the cycle to prevent breakthrough bleeding. 1

First-Line Options

Combined Oral Contraceptive Pills (COCPs)

• How to use: Take active hormonal pills continuously by skipping the placebo/hormone-free interval
• When to start: Ideally within the first 5 days of menstrual cycle 2
• Effectiveness: Highly effective when taken correctly
• Backup contraception needed: If started >5 days after menstrual bleeding began, use backup contraception for 7 days 2

Norethindrone (Progestin-Only)

• Dosage: 5 mg three times daily
• When to start: Most effective when begun on or before cycle day 12 1
• Advantages:
  • Only 8% of women experience breakthrough bleeding (compared to 43% with COCPs) 1
  • Superior for women who cannot tolerate any breakthrough bleeding
  • Better for women who present late in their cycle
• Side effects: Temporary weight gain, heavier withdrawal bleeding after stopping 1
• Note: Fertility returns more quickly after stopping norethindrone compared to COCPs 1

Practical Implementation

For COCPs:

1. If already on COCPs: Skip the placebo pills and start a new pack immediately
2. If not on hormonal contraception: Start taking COCPs within first 5 days of cycle
3. Continue taking active pills until you want your period to begin
4. Stop taking pills to allow withdrawal bleeding to occur

For Norethindrone:

1. Begin taking 5 mg three times daily (15 mg total daily)
2. Start on or before cycle day 12 for best results
3. Continue until you want your period to begin
4. Stop taking medication to allow withdrawal bleeding to occur

Important Considerations

• Timing is crucial: Starting either method early in the cycle reduces risk of breakthrough bleeding 2, 1
• Duration: These methods can safely delay menstruation for special events, holidays, or sports competitions 3
• Common reasons for menstrual manipulation: Special events/holidays (75%), convenience (54%), and sports competition (54%) 3
• Effectiveness: 74% of oral contraceptive users report having deliberately manipulated menstruation at least once during the previous year 3

Potential Side Effects and Management

• Breakthrough bleeding: More common with COCPs (43%) than norethindrone (8%) 1
• If breakthrough bleeding occurs with COCPs: Can temporarily stop pills for 3-4 days to allow for a brief withdrawal bleed, then restart 2
• Other side effects: Nausea (more common with COCPs), breast tenderness, headaches 2, 4

Special Situations

• If vomiting occurs within 24 hours of taking a pill: Continue taking pills as scheduled; no additional contraceptive protection needed 2
• If vomiting continues for 24-48 hours: Use backup contraception until pills have been taken for 7 consecutive days after vomiting resolves 2

Remember that while these methods are effective for delaying menstruation, they should be used under appropriate medical guidance, especially for women with contraindications to hormonal contraceptives.