Medications for Period Delay
Norethindrone (5 mg three times daily) is the most effective medication for period delay when started before cycle day 12, with significantly less breakthrough bleeding (8%) compared to combined oral contraceptives (43%). 1
First-Line Option: Norethindrone
- Norethindrone is superior to combined oral contraceptives for delaying menstruation when started late in the cycle 1
- The recommended dose is 5 mg three times daily (15 mg total daily) 1
- Norethindrone should be started on or before cycle day 12 for optimal effectiveness in preventing breakthrough bleeding 1
- Patient satisfaction is significantly higher with norethindrone, with 80% of women willing to choose this method again 1
Mechanism and Effectiveness
- Norethindrone is approximately 8 times more potent than medroxyprogesterone acetate for endometrial effects 2
- Only 8% of women using norethindrone experience breakthrough spotting compared to 43% using combined oral contraceptives 1
- Norethindrone is particularly ideal in circumstances when even minimal breakthrough bleeding cannot be tolerated 1
Side Effects and Considerations
- Temporary weight gain may occur with norethindrone but typically resolves after cessation of therapy 1
- Withdrawal bleeding after stopping norethindrone may be heavier than normal 1
- No serious adverse events have been reported with short-term norethindrone use for period delay 3
Alternative Options: Combined Hormonal Contraceptives
- Combined oral contraceptives can be used in extended or continuous regimens to delay menstruation 4
- Extended regimens typically involve taking active pills continuously for 84 days followed by 7 days of placebo or low-dose estrogen 4
- Continuous regimens involve taking active pills without a hormone-free interval 4
- Breakthrough bleeding is more common with combined hormonal contraceptives than with norethindrone 1, 4
Management of Breakthrough Bleeding
- If breakthrough bleeding occurs with combined hormonal contraceptives, NSAIDs can be used for 5-7 days 5, 6
- For extended regimens, a 3-4 day hormone-free interval may help control breakthrough bleeding, but should not be taken during the first 21 days of use and not more than once per month 5, 7
Important Considerations for Fertility
- Time to conceive is significantly shorter after norethindrone use compared to combined oral contraceptives 1
- This makes norethindrone particularly suitable for women who wish to maintain near-term fertility 1
Practical Application
- For women who need to delay menstruation for a specific event (wedding, vacation, etc.), start norethindrone 5 mg three times daily at least 7-10 days before the event 1
- Continue norethindrone until the event has passed, then discontinue to allow withdrawal bleeding to occur 1
- Be prepared for potentially heavier withdrawal bleeding after discontinuation 1