Norethisterone Dosing Guidelines for Menstrual Cycle Delay
For delaying a menstrual cycle, norethisterone should be taken at a dose of 5 mg three times daily (15 mg total daily), starting at least 3-4 days before expected menstruation and continuing until bleeding is desired to begin. 1
Recommended Dosing Protocol
- Norethisterone 5 mg three times daily is the most effective dose for delaying menstruation 1
- Start treatment at least 3-4 days before expected menstruation (ideally by day 12 of the cycle for maximum effectiveness) 1
- Continue until the desired end date when menstruation can occur 2
- Menstruation typically begins 2-3 days after discontinuing norethisterone 3
Efficacy and Advantages
- Norethisterone at 5 mg three times daily is superior to combined oral contraceptives for delaying menstruation 1
- Only 8% of women using norethisterone reported breakthrough bleeding compared to 43% using combined oral contraceptives 1
- Higher patient satisfaction reported with norethisterone (80% willing to choose this method again) 1
- Norethisterone 3 mg daily is insufficient to reliably prevent ovulation, which is why higher doses are needed for menstrual delay 4
Important Considerations and Side Effects
- Withdrawal bleeding after discontinuation may be heavier than usual menstruation 1
- Temporary weight gain may occur during treatment but typically resolves after discontinuation 1
- Fertility returns quickly after discontinuation, with shorter time to conception compared to combined oral contraceptives 1
Contraindications
- Pregnancy 2
- History of thromboembolism or deep vein thrombosis 2
- Undiagnosed vaginal bleeding 2
- Active liver disease 2
- Breast cancer or other hormone-sensitive cancers 2
- Uncontrolled hypertension 2
Clinical Pearls
- For maximum effectiveness in preventing breakthrough bleeding, start treatment earlier in the cycle (by day 12) rather than waiting until just before expected menstruation 1
- If contraception is also desired, be aware that norethisterone at this dose is not a reliable contraceptive and additional contraceptive measures should be used 4
- When used for menstrual delay, norethisterone should be discontinued once menstruation is desired to begin 3