How long should a patient take norethindrone (norethindrone) to delay menstruation?

Duration of Norethindrone for Menstrual Delay

Norethindrone should be continued until the desired end date when menstruation can occur, with no specific maximum duration limit for short-term menstrual delay. 1

Standard Treatment Duration

• Start norethindrone 5 mg orally 2-3 times daily beginning 3 days before the expected period and continue until menstruation is desired. 1
• The medication can be safely continued for the entire duration needed to avoid menstruation during a specific event or time period (e.g., vacation, athletic competition, religious observance). 1
• Once norethindrone is stopped, withdrawal bleeding typically occurs within 2-3 days. 2

Key Considerations for Duration

Short-Term Use (Days to Weeks)

• For single-event menstrual delay (such as a wedding or vacation), norethindrone can be used for the specific duration needed without concern. 1, 2
• Research demonstrates successful menstrual suppression when started on or before cycle day 12, with only 8% of patients experiencing breakthrough bleeding. 2
• Patient satisfaction is significantly higher with norethindrone (80% willing to use again) compared to combined oral contraceptives for short-term delay. 2

Extended Use Considerations

• For repeated or prolonged use beyond a single menstrual cycle, alternative hormonal management should be considered. 1
• While norethindrone can theoretically be used continuously, the American College of Obstetricians and Gynecologists recommends transitioning to standard contraceptive methods for ongoing menstrual suppression rather than repeated cycles of norethindrone for delay. 1
• Case reports document successful use for up to 4 years in specific medical conditions (such as ACUM), though this represents therapeutic suppression rather than menstrual delay. 3

Critical Safety Parameters

When to Stop

• Discontinue immediately if any thromboembolic symptoms develop (severe leg pain, chest pain, shortness of breath, severe headache with focal neurologic symptoms). 1
• Stop if undiagnosed vaginal bleeding occurs during treatment. 1
• Cease use if signs of liver dysfunction appear (jaundice, severe right upper quadrant pain). 4

Monitoring During Use

• No specific laboratory monitoring is required for short-term menstrual delay (less than one month). 1
• Blood pressure should be assessed at baseline before initiating therapy. 4

Common Pitfalls

• Do not reduce the dose below 5 mg 2-3 times daily, as lower doses may not reliably suppress menstruation and increase breakthrough bleeding risk. 1
• Counsel patients that norethindrone for menstrual delay is NOT contraceptive, and additional contraception is needed if sexually active during treatment. 1
• Patients may experience heavier withdrawal bleeding after stopping norethindrone compared to their typical menstrual flow, which is expected and resolves spontaneously. 2
• Weight gain of 2-3 pounds may occur during treatment but resolves after cessation. 2

Practical Implementation

• For a 7-day event: Start 3 days before expected period, continue through the event, stop on the last day or day after the event ends. 1
• For a 14-day event: Same approach—start 3 days before expected period, continue for the full 14 days, then discontinue. 1
• If breakthrough bleeding occurs despite correct dosing, the medication can still be continued, though efficacy for that cycle may be compromised. 2