Norethisterone Dosing for Menstrual Postponement
For postponing menstruation, norethisterone should be taken at 5 mg three times daily (total 15 mg/day), starting 3 days before the expected period and continuing throughout the desired delay period. 1
Dosing Protocol
- Standard regimen: 5 mg norethisterone three times daily (total daily dose of 15 mg) 1
- Timing of initiation: Must start 3 days before expected menstruation 1
- Duration: Continue throughout the entire period you wish to delay menstruation 2
- Maximum recommended delay: Up to 2 weeks 1
Critical Timing Considerations
- Starting norethisterone after bleeding has already begun will NOT be effective 2
- Women with regular menstrual cycles achieve higher success rates (87% in clinical studies) compared to those with irregular cycles 1
- For optimal effectiveness, initiation should occur on or before cycle day 12 if possible 3
Expected Outcomes
- Menstruation typically occurs 2-3 days after stopping norethisterone 4
- Success rate of approximately 82% overall, increasing to 87% in women with regular cycles (cycle length varying by ≤2 days) 1, 4
- Norethisterone demonstrates superior efficacy compared to combined oral contraceptives for menstrual delay, with only 8% experiencing breakthrough bleeding versus 43% with OCPs 3
Absolute Contraindications
The following conditions preclude norethisterone use for menstrual delay 1, 2:
- Current or history of venous thromboembolism or deep vein thrombosis
- Active liver disease or hepatic tumors
- Undiagnosed vaginal bleeding
- Pregnancy
- Breast cancer or other hormone-sensitive malignancies
- Uncontrolled hypertension
Relative Cautions
Exercise caution in patients with 1:
- History of depression
- Cardiovascular risk factors
- Migraine with aura (particularly if over age 35)
Note that norethisterone carries lower thrombotic risk compared to combined contraceptives 1
Important Distinctions
This dosing regimen (15 mg/day) for menstrual delay is substantially higher than norethisterone dosing for other indications, such as hormone replacement therapy (5 mg daily for 12-14 days per month) or menorrhagia treatment (5 mg twice daily on days 19-26) 5, 6. Do not confuse these different therapeutic applications.