What is the prescription regimen for Norethisterone (norethindrone) to delay the start of a menstrual cycle for travel?

Norethisterone Prescription Regimen for Menstrual Cycle Delay

For patients wishing to delay menstruation for travel, norethisterone should be taken at a dose of 5 mg three times daily, starting 3-4 days before expected menstruation and continued until the desired end date when menstruation can occur. 1

Dosing Protocol

• Begin norethisterone 5 mg three times daily (total 15 mg/day) 3-4 days before the expected onset of menstruation 2
• Continue taking the medication until the desired end date when menstruation can safely occur (e.g., after returning from travel) 1
• Withdrawal bleeding typically begins 2-3 days after stopping the medication 2

Efficacy and Expectations

• When started before cycle day 12, norethisterone is superior to combined oral contraceptives in preventing breakthrough bleeding (only 8% of women experience spotting with norethisterone compared to 43% with OCPs) 2
• Patient satisfaction is significantly higher with norethisterone for menstrual delay, with 80% of women willing to choose this method again 2
• Patients should be advised that withdrawal bleeding after stopping norethisterone may be heavier than their usual menstrual flow 2

Important Contraindications

• Pregnancy or suspected pregnancy 3
• History of thromboembolism or deep vein thrombosis 3, 1
• Undiagnosed vaginal bleeding 3, 1
• Active liver disease 3, 1
• Breast cancer or other hormone-sensitive cancers 3, 1
• Uncontrolled hypertension 3, 1
• Cerebrovascular disease or coronary artery disease 3

Potential Side Effects

• Weight gain (typically temporary and resolves after cessation of therapy) 2
• Heavier withdrawal bleeding compared to regular menstruation 2
• Other possible side effects: nausea, headache, breast tenderness 4

Additional Considerations

• Norethisterone does not provide contraception at this dosage; if contraception is also required, additional methods should be used 3
• Time to conception after norethisterone use is typically shorter compared to combined oral contraceptives, making it preferable for women who wish to maintain fertility 2
• For women with contraindications to estrogen-containing contraceptives, norethisterone is a particularly suitable option 4

Common Pitfalls to Avoid

• Starting the medication too late in the cycle (after bleeding has begun) will not effectively delay menstruation 2
• Discontinuing the medication abruptly may result in breakthrough bleeding; it should be continued until the desired end date 1
• Failure to warn patients about potentially heavier withdrawal bleeding may lead to dissatisfaction with the treatment 2