What is a recommended regimen for continuous birth control with norethindrone (progestin)?

Continuous Norethindrone Birth Control Regimen

For continuous birth control with norethindrone, take one tablet daily at the same time every day without interruption between pill packs, as this is the FDA-approved regimen for progestin-only contraception. 1

Dosing Strategy

Progestin-only norethindrone must be taken continuously without any hormone-free intervals to maintain contraceptive effectiveness 1. The key principles include:

• Take one tablet every day at the exact same time - timing consistency is critical for progestin-only pills 1
• No breaks between pill packs - start a new pack immediately after finishing the previous one 1
• No placebo or hormone-free days - continuous administration is required 1

Combined Hormonal Options (If Considering Norethindrone with Estrogen)

If you're considering combined hormonal contraception containing norethindrone rather than progestin-only pills, extended or continuous regimens offer specific advantages:

Benefits of Extended/Continuous Regimens

Extended or continuous combined oral contraceptive cycles are particularly appropriate for managing conditions like severe dysmenorrhea, endometriosis, abnormal uterine bleeding, anemia, and bleeding disorders 2. Additional benefits include:

• Optimized ovarian suppression by eliminating hormone-free intervals, potentially increasing contraceptive effectiveness especially when pills are frequently missed 2
• Reduced menstrual-related symptoms including migraine without aura, epilepsy, irritable bowel syndrome, and cyclically-worsening psychiatric symptoms 2
• Decreased total bleeding days compared to standard 21-day regimens 3

Combined Norethindrone Regimens

For combined hormonal contraception with norethindrone:

• 24-day active hormone regimen (norethindrone acetate 1 mg/ethinyl estradiol 20 mcg) followed by 4 placebo days provides fewer intracyclic bleeding days and fewer total bleeding/spotting days compared to 21-day regimens 3
• Monophasic formulations are recommended as the starting point, with 30-35 mcg ethinyl estradiol combined with a progestin like norethindrone 2
• Extended cycles can be created by skipping placebo pills and starting a new pack immediately, though this is off-label use 2

Common Pitfalls and Management

Breakthrough Bleeding

The most common adverse effect of extended-cycle regimens is unscheduled bleeding 2. This is expected and typically:

• Decreases after cycle 2 and throughout continued treatment 4
• Occurs more frequently in new OCP users versus those switching from another pill 4
• Is more common in women aged 18-35 years compared to those 36 years or older 4

Missed Pill Management

For combined hormonal pills containing norethindrone:

• If <24 hours late: Take as soon as remembered and continue as usual 2
• If 24-48 hours late (one missed pill): Take the most recent missed pill immediately, continue remaining pills as usual 2
• If >48 hours late (two or more missed): Take the most recent missed pill, discard others, use backup contraception for 7 consecutive days 2

For progestin-only norethindrone, even minor delays can compromise efficacy - strict adherence to the same daily time is essential 1.

Cardiovascular Considerations

For women with cardiovascular risk factors, consider alternative progestins like micronized progesterone instead of synthetic progestins when using combined hormonal methods 5, 6. However, this applies primarily to hormone replacement therapy contexts rather than contraception.