Can Norethindrone Be Started on Day 2 of Menstruation?
Yes, norethindrone can absolutely be started on day 2 of her menstrual period, and this timing is actually ideal for contraceptive effectiveness.
Timing of Initiation
Norethindrone (progestin-only pill) can be started at any time during the menstrual cycle, including while actively menstruating. 1 The most recent CDC guidelines (2024) explicitly state that norethindrone or norgestrel POPs can be initiated "anytime" without requiring any examination or test before starting. 1
Back-Up Contraception Requirements
The need for additional contraception depends on when in the cycle she starts:
- If started within 5 days of menstrual bleeding beginning (days 1-5): No back-up contraception needed 1
- If started after day 5: She needs to abstain from intercourse or use barrier methods (condoms) for 2 days 1
Since she is on day 2 of her cycle, she falls well within the 5-day window and requires no additional contraceptive protection. 1
Key Differences from Combined Hormonal Contraceptives
Norethindrone POPs have a shorter back-up period (2 days) compared to combined hormonal contraceptives (7 days) when started late in the cycle. 1 This makes progestin-only pills particularly advantageous for mid-cycle starts, though this is not relevant to her day 2 scenario.
Administration Instructions
- One tablet must be taken every day at the same time without interruption 2
- Administration is continuous with no pill-free intervals 2
- If a pill is taken 3 or more hours late, she needs back-up contraception (condoms/spermicide) for the next 48 hours 2
Common Pitfall to Avoid
The most important counseling point is that norethindrone must be taken at the same time every day to maintain contraceptive effectiveness. 2 Unlike combined oral contraceptives that have a 12-hour window, progestin-only pills have a much narrower window (3 hours) before back-up contraception is required. 2
Expected Side Effects
She should be counseled about menstrual irregularities, which are the most common side effect of progestin-only pills. 2 This includes breakthrough bleeding, spotting, or amenorrhea, which does not indicate lack of efficacy. 2