What medication is used to temporarily stop menses?

Medications to Temporarily Stop Menses

For short-term menstrual suppression, norethindrone (norethisterone) 5 mg three times daily is the most effective option when started on or before cycle day 12, demonstrating superior efficacy in preventing breakthrough bleeding compared to combined oral contraceptives. 1

First-Line Options by Clinical Scenario

Acute/Short-Term Menstrual Delay (Days to Weeks)

• Norethindrone acetate 5 mg three times daily is superior to combined oral contraceptives when started late in the cycle (on or before cycle day 12), with only 8% experiencing spotting versus 43% with OCPs 1
• This approach is ideal when even minute amounts of breakthrough bleeding cannot be tolerated 1
• Patients should be counseled about expected weight gain during therapy (which resolves after cessation) and heavier withdrawal bleeding 1

Long-Term Menstrual Suppression (Months)

• Depot medroxyprogesterone acetate (DMPA) 150 mg intramuscularly or 104 mg subcutaneously every 13 weeks provides effective long-term suppression, with menstrual irregularities initially that typically improve over time, often resulting in amenorrhea 2
• Levonorgestrel-releasing intrauterine device (LNG-IUS) is the single most effective option for long-term menstrual suppression, achieving 71-95% reduction in menstrual blood loss with 22% of users experiencing complete amenorrhea 3
• The LNG-IUS is particularly useful for adolescents with medical conditions requiring long-term menstrual suppression where estrogen is contraindicated 2

Alternative Hormonal Options

• Combined oral contraceptives can be used continuously (skipping hormone-free intervals) to suppress menses, though they are less effective than norethindrone for short-term delay when started late in the cycle 2, 1
• Cyclic oral progestins reduce bleeding by 87% and typically result in eventual reduction to light bleeding only 3

Clinical Algorithm for Selection

Step 1: Determine timeframe needed

• For events within 2 weeks: Use norethindrone 5 mg three times daily starting on or before cycle day 12 1
• For ongoing suppression (3+ months): Consider DMPA or LNG-IUS 2, 3

Step 2: Assess contraindications

• Rule out pregnancy before initiating any hormonal therapy 2
• In women with spontaneous coronary artery dissection, hormonal therapy including progesterone is relatively contraindicated 3
• Hormone replacement therapy should not be used for secondary prevention in women with established coronary artery disease 3

Step 3: Counsel on expected effects

• Enhanced counseling about expected bleeding patterns reduces discontinuation rates 3
• With norethindrone: expect weight gain during use, heavier withdrawal bleed, but high patient satisfaction (80% willing to repeat) 1
• With DMPA: nearly all patients experience menstrual irregularities initially, which improve over time 2
• With LNG-IUS: irregular bleeding is common initially but 22% achieve complete amenorrhea 3

Critical Pitfalls to Avoid

• Do not start norethindrone after cycle day 12 if breakthrough bleeding must be avoided, as efficacy decreases significantly 1
• Do not assume DMPA-related weight gain occurs in all patients—weight status at 6 months is a strong predictor of future excessive weight gain, but not universal 2
• Do not remove LNG-IUS for pelvic inflammatory disease—treatment can be provided with device in place if patient improves with therapy 2
• Do not forget backup contraception: norethindrone for menstrual delay does not provide reliable contraception during the suppression period 1