How can I switch from Alesse (levonorgestrel) to norethindrone 0.35?

Switching from Alesse to Norethindrone 0.35 mg

When switching from Alesse (levonorgestrel/ethinyl estradiol) to norethindrone 0.35 mg (progestin-only pill), you should start the norethindrone pill immediately and use a backup method of contraception for 2 days after starting the new pill.

Timing of Switch

• Start the norethindrone 0.35 mg pill immediately after finishing your last active Alesse pill (don't wait for withdrawal bleeding) 1
• If switching in the middle of an Alesse pack, you can start norethindrone immediately without completing the pack 1
• Norethindrone 0.35 mg can be started at any time if there is reasonable certainty that you are not pregnant 1

Backup Contraception Requirements

• Use a backup method of contraception (such as condoms) for 2 days after starting norethindrone 0.35 mg 1
• This is shorter than the 7-day backup period required when switching to combined hormonal methods 1
• Barrier methods, abstinence, or continued use of your current method can be used during this backup period 1

Differences Between Methods

• Alesse is a combined hormonal contraceptive containing both estrogen (ethinyl estradiol) and progestin (levonorgestrel) 2
• Norethindrone 0.35 mg is a progestin-only pill (POP) with no estrogen component 1
• POPs like norethindrone work primarily by thickening cervical mucus and may not consistently inhibit ovulation 1

Expected Changes After Switching

• Bleeding patterns may change when switching from Alesse to norethindrone 0.35 mg 3, 4
• You may experience more irregular bleeding with norethindrone compared to Alesse 2, 4
• The absence of estrogen in norethindrone may reduce estrogen-related side effects 5

Important Considerations

• Take norethindrone 0.35 mg at the same time every day - timing is more critical than with combined pills 1
• A delay of more than 3 hours in taking norethindrone may reduce contraceptive effectiveness 1
• If you miss a pill, take it as soon as you remember and use backup contraception for 2 days 1

Special Situations

• If you're switching due to concerns about estrogen-related side effects, norethindrone 0.35 mg is an appropriate option 5
• If you have risk factors for venous thromboembolism, norethindrone 0.35 mg may be safer than combined hormonal contraceptives 1, 5
• If you're breastfeeding, be aware that progestin-only pills like norethindrone may be associated with increased diabetes risk in Latino breastfeeding women 1

Common Pitfalls to Avoid

• Don't wait for your next period to start norethindrone - this creates an unnecessary gap in contraceptive coverage 1
• Don't forget that timing is more critical with progestin-only pills - set a daily alarm to take it at the same time 1
• Don't skip the 2-day backup period, as immediate contraceptive effectiveness is not guaranteed when switching 1