Adding Norethindrone to Lo Loestrin Fe for Breakthrough Bleeding
Adding a supplemental norethindrone pill to Lo Loestrin Fe is a reasonable and evidence-based approach to stop breakthrough bleeding, with studies showing significant reduction in bleeding frequency within 2-6 weeks. 1
Evidence Supporting This Approach
Your provider's recommendation is supported by recent research demonstrating that adding 5 mg norethindrone acetate to progesterone-only pills significantly reduces breakthrough bleeding. 1 While this study specifically examined progesterone-only pills, the mechanism—supplementing with additional progestin—applies to your situation with Lo Loestrin Fe, which already contains a very low dose of norethindrone (1 mg) and minimal estrogen (10 mcg ethinyl estradiol). 1
Expected Timeline for Improvement
- Within 2 weeks: You should notice a decrease in bleeding frequency 1
- By 4-6 weeks: Most women experience significant improvement in both bleeding quantity and frequency 1
- The treatment does not increase side effects compared to continuing your current regimen alone 1
Why This Works
Lo Loestrin Fe contains one of the lowest estrogen doses available (10 mcg), which may contribute to breakthrough bleeding in some women. 2 Adding supplemental norethindrone provides additional endometrial stabilization without increasing estrogen exposure. 1 This approach is preferable to switching formulations entirely, as it maintains your current contraceptive method while addressing the bleeding issue. 3
Alternative Considerations
If the additional norethindrone pill doesn't resolve your breakthrough bleeding within 6 weeks, your provider should evaluate for: 3
- Medication interactions (particularly enzyme-inducing drugs that reduce contraceptive hormone levels) 3
- Underlying uterine pathology (polyps or fibroids) 3
- Pregnancy (though unlikely if taking pills correctly) 3
- Sexually transmitted infections 3
Important Caveats
NSAIDs (like ibuprofen or mefenamic acid) taken during bleeding days are actually the first-line treatment recommended by guidelines for breakthrough bleeding on combined hormonal contraceptives. 3 However, your provider has chosen the norethindrone supplementation approach, which is also evidence-based and may provide more sustained improvement. 1
The breakthrough bleeding you're experiencing is not harmful and does not indicate reduced contraceptive effectiveness—it's simply a side effect that can be managed. 3