Will Norethindrone Stop Periods When Taken With Lo Loestrin Fe?
Adding norethindrone to Lo Loestrin Fe (which already contains norethindrone acetate) may increase the likelihood of amenorrhea (absence of periods), but this outcome is unpredictable and varies significantly between individuals.
Understanding the Medication Combination
Lo Loestrin Fe already contains norethindrone acetate (a form of norethindrone) combined with ethinyl estradiol 1. Adding additional norethindrone creates a higher total progestin dose, which can suppress menstrual bleeding through increased endometrial suppression 1.
Expected Bleeding Patterns
With Lo Loestrin Fe Alone
- Lo Loestrin Fe (norethindrone acetate 1 mg/ethinyl estradiol 20 mcg) is associated with approximately 10% amenorrhea rates in clinical trials 2
- This formulation causes irregular bleeding and spotting in 22-35% of users, particularly in early cycles 2, 3
- The low estrogen dose (20 mcg) contributes to less predictable bleeding patterns compared to higher-dose formulations 2
With Additional Norethindrone
- Higher progestin exposure increases the probability of amenorrhea 1
- Continuous progestin dosing (without hormone-free intervals) is more likely to cause amenorrhea than cyclic regimens 1
- However, breakthrough bleeding and spotting may paradoxically increase with progestin-only or progestin-dominant regimens 1
Clinical Considerations and Caveats
Unpredictable Individual Response
The bleeding response to combined hormonal contraceptives varies substantially between individuals 1. Some women will experience amenorrhea while others may have increased breakthrough bleeding with the same regimen 1.
Important Safety Monitoring
Before adding norethindrone, confirm:
- Pregnancy status must be ruled out (Category X contraindication) 1, 4
- Blood pressure should be measured at baseline and monitored ongoing 1, 5
- No contraindications exist including history of blood clots, breast cancer, liver disease, or undiagnosed vaginal bleeding 1, 4
Medication Confusion Risk
Critical warning: Norethindrone and norethindrone acetate are different medications with different potencies 6, 4. Norethindrone acetate (already in Lo Loestrin Fe) is more potent, so adding norethindrone tablets requires careful dose consideration to avoid excessive progestin exposure 6.
Alternative Approaches for Menstrual Suppression
If the goal is to stop periods, more predictable options include:
- Extended or continuous cycling of the current Lo Loestrin Fe (skipping placebo weeks) may be more effective than adding additional medication 1
- Switching to a higher-dose combined oral contraceptive used continuously provides more reliable amenorrhea 1
- Progestin-only methods like depot medroxyprogesterone acetate (DMPA) cause amenorrhea in the majority of users after one year of use 1
Bottom Line
While adding norethindrone to Lo Loestrin Fe increases progestin exposure and may stop periods, the outcome is unpredictable—some women will achieve amenorrhea while others may experience more irregular bleeding 1, 2. This approach lacks specific evidence-based dosing guidelines for menstrual suppression. If amenorrhea is the therapeutic goal, consider evidence-based alternatives like continuous cycling of the current contraceptive or switching to methods with higher documented amenorrhea rates 1.