What medication can be used to delay menstrual bleeding by 2 or 3 days?

Medication for Delaying Menstruation by 2-3 Days

Norethisterone (norethindrone acetate) 5 mg three times daily is the superior choice for short-term menstrual delay, particularly when started late in the cycle and when even minimal breakthrough bleeding cannot be tolerated. 1

Primary Recommendation: Norethisterone

Norethisterone 5 mg three times daily should be started as soon as possible before the expected period and continued through the event you wish to avoid menstruation. 1 This regimen demonstrates:

• Only 8% breakthrough bleeding rate compared to 43% with combined oral contraceptives when started late in the cycle 1
• Significantly higher patient satisfaction (80% willing to use again) 1
• Effective when started on or before cycle day 12, making it ideal for women presenting late who need menstrual delay 1

Important Considerations with Norethisterone

• Expect temporary weight gain during treatment, which resolves after stopping the medication 1
• Withdrawal bleeding will be heavier than usual after discontinuation 1
• Stop the medication when you want menstruation to occur; bleeding typically begins 2-3 days after cessation 1

Alternative Option: Combined Oral Contraceptives

If norethisterone is unavailable, combined oral contraceptives containing 30-35 μg ethinyl estradiol can be used continuously (skipping placebo pills) to delay menstruation. 2, 3 However, this approach has significant limitations:

• 43% breakthrough bleeding rate when started late in cycle 1
• Less effective for short-term delay compared to norethisterone 1
• Requires starting earlier in the cycle for optimal effectiveness (within first 5 days of menstrual bleeding) 2

Contraindications to Screen For

Before prescribing either option, rule out: 4, 3

• Cardiovascular risk factors: smoking, hypertension, history of thromboembolism 4
• Positive antiphospholipid antibodies (absolute contraindication to estrogen-containing methods) 4
• Current pregnancy 3
• Active venous thromboembolism (VTE risk increases 3-4 fold with combined hormonal contraceptives) 4, 3

Practical Algorithm

For women requesting 2-3 day menstrual delay:

1. Determine timing: How many days until expected period?

   • If ≤12 days before expected period: Norethisterone 5 mg three times daily 1
   • If >12 days before expected period: Either norethisterone or continuous combined oral contraceptives acceptable 1

2. Screen for contraindications to hormonal therapy (thromboembolism history, cardiovascular risk factors, pregnancy) 4, 3

3. Counsel on expected effects:

   • Temporary weight gain with norethisterone 1
   • Heavier withdrawal bleed after stopping 1
   • Small risk of breakthrough bleeding (8% with norethisterone, 43% with COCs) 1

4. Instruct to stop medication when menstruation is desired; expect bleeding 2-3 days later 1

Common Pitfall to Avoid

Do not prescribe combined oral contraceptives for last-minute menstrual delay (started >5 days after cycle began), as they have a 43% breakthrough bleeding rate in this scenario compared to only 8% with norethisterone. 1 The research clearly demonstrates norethisterone's superiority when women present late in their cycle needing menstrual manipulation. 1