What medication is used to postpone menstruation?

Medication for Postponing Menstruation

Norethindrone acetate (a progestin-only medication) is the preferred medication to postpone menstruation, particularly when started on or before cycle day 12, as it provides superior control with minimal breakthrough bleeding compared to combined oral contraceptives. 1

Primary Medication Options

Norethindrone Acetate (First-Line)

• Dosing: 5 mg three times daily (15 mg total per day) when started late in the cycle 1
• Timing: Most effective when begun on or before cycle day 12 of the menstrual cycle 1
• Efficacy: Only 8% of women experience breakthrough spotting compared to 43% with combined oral contraceptives 1
• Patient satisfaction: 80% of women would choose this method again 1
• FDA-approved indication: Norethindrone acetate is approved for treatment of secondary amenorrhea and abnormal uterine bleeding 2

Key advantage: This approach is ideal for patients presenting late in their cycle who desire delaying menses, and in circumstances when even minute amounts of breakthrough bleeding cannot be tolerated 1

Combined Hormonal Contraceptives (Alternative)

• Method: Skip the placebo pills and immediately start a new pack of active hormonal pills to avoid the hormone-free interval and prevent withdrawal bleeding 3
• Extended regimens: Can be used continuously for 84 days followed by 7 hormone-free days, or even longer periods 4
• Limitation: Associated with significantly more breakthrough bleeding (43% vs 8%) compared to norethindrone when used for menstrual postponement 1
• CDC guidance: Deliberately omitting the hormone-free interval by finishing hormonal pills in the current pack and starting a new pack immediately is a recommended approach 5, 3

Clinical Implementation

When Using Norethindrone Acetate

• Start therapy as early as possible in the cycle (ideally by cycle day 12) for best results 1
• Continue daily dosing until the desired time period has passed 2
• Expected withdrawal bleeding: Occurs within 3-7 days after discontinuing therapy 2
• Side effects to counsel about: Temporary weight gain (which resolves after cessation) and heavier withdrawal bleeding compared to normal menses 1

When Using Combined Hormonal Contraceptives

• Must be taking active hormonal pills for at least 21 days before attempting to skip the hormone-free interval 3
• Simply continue with active pills from a new pack instead of taking the placebo pills 5, 3
• Can skip 3-4 consecutive days of pills to temporarily induce bleeding if needed, though not more often than monthly 5

Important Contraindications

Do not use norethindrone acetate if the patient has: 2

• Known or suspected pregnancy
• History of blood clots (legs, lungs, eyes, brain)
• Liver impairment or disease
• Known or suspected breast cancer
• Undiagnosed vaginal bleeding

Clinical Pearls

• Breakthrough bleeding management: If breakthrough bleeding occurs with combined hormonal contraceptives during extended use, this is expected and generally not harmful 3, 6
• Fertility considerations: Time to conceive after norethindrone use is actually shorter compared to combined oral contraceptives 1
• Counseling importance: Enhanced counseling about expected bleeding patterns and reassurance reduces method discontinuation 3, 6
• No harm from amenorrhea: Amenorrhea during hormonal contraceptive use is generally not harmful and does not require medical treatment 3