Medication to Delay Menstruation for 5 Days
Norethindrone acetate 5 mg three times daily is the most effective medication to delay menstruation by 5 days, particularly when started late in the menstrual cycle (on or before cycle day 12), as it provides superior prevention of breakthrough bleeding compared to combined oral contraceptives.
Optimal Medication Choice
Norethindrone acetate is the preferred agent for menstrual delay when:
- Starting late in the cycle (after cycle day 5) 1
- Even minimal breakthrough bleeding cannot be tolerated 1
- The delay period is relatively short (5-7 days) 1
Dosing Protocol
- Norethindrone acetate 5 mg three times daily starting on or before cycle day 12 1
- Continue until the desired delay period has passed 1
- Only 8% of women experience breakthrough bleeding with this regimen, compared to 43% with combined oral contraceptives 1
Alternative Option: Combined Oral Contraceptives
If norethindrone is unavailable or contraindicated, combined oral contraceptives can be used by:
- Starting immediately if reasonably certain the woman is not pregnant 2
- Continuing active pills without a hormone-free interval to delay menstruation 2
- This approach has higher breakthrough bleeding rates (43%) compared to norethindrone 1
Important Timing Consideration
When starting combined hormonal contraceptives >5 days after menstrual bleeding began, backup contraception is needed for 7 days 2
Critical Caveats and Practical Considerations
Expected Side Effects with Norethindrone
- Temporary weight gain that resolves after cessation 1
- Heavier withdrawal bleeding when menstruation eventually occurs 1
- Despite these effects, 80% of women report willingness to use this method again 1
Contraindications to Consider
Before prescribing, rule out:
- Current pregnancy 3, 4
- Underlying gynecological pathology (fibroids, polyps) 3
- Sexually transmitted infections 4
- Medication interactions, particularly with enzyme-inducing drugs 4
When Combined Hormonal Contraceptives Are Preferred
Use combined oral contraceptives instead of norethindrone if:
- The woman has contraindications to progestin-only methods 3
- Starting earlier in the cycle (before day 5) when breakthrough bleeding risk is lower 2
- Longer-term cycle manipulation is desired 2
Common Pitfall to Avoid
Do not use progestin-only pills (0.35 mg norethindrone) for menstrual delay, as this low dose is designed for contraception and provides inadequate ovulation suppression for reliable menstrual postponement 2, 5. The therapeutic dose for menstrual delay is substantially higher at 5 mg three times daily 1.