Can Norethidone (a progestin) be used to delay menstruation in a female patient of reproductive age with no significant medical history?

Norethindrone for Menstrual Delay

Norethindrone (norethindrone acetate) can effectively delay menstruation in healthy reproductive-age women, with optimal efficacy when started on or before cycle day 12 at a dose of 5 mg three times daily. 1

Dosing and Timing

For menstrual delay, norethindrone should be initiated:

• Starting dose: 5 mg three times daily (15 mg total daily) 1
• Optimal timing: On or before cycle day 12 for best results 1
• Late cycle initiation: Can still be effective when started later in the cycle, though breakthrough bleeding risk increases 1
• Duration: Continue until menstruation is no longer needed to be delayed; withdrawal bleeding typically occurs 2-4 days after discontinuation 2, 3

Efficacy Data

Norethindrone demonstrates superior performance compared to combined oral contraceptives for menstrual delay:

• Only 8% of norethindrone users experienced breakthrough bleeding versus 43% with combined oral contraceptives (p < 0.01) 1
• 82% of patients overall achieved planned menstruation timing 2-3 days after discontinuation 4
• 87% success rate in women with regular menstrual cycles (variation ≤2 days) 4
• Patient satisfaction was significantly higher, with 80% willing to use this method again 1

Important Contraindications and Warnings

Do not prescribe norethindrone for menstrual delay if the patient has: 2

• Known or suspected pregnancy
• History of blood clots (legs, lungs, eyes, brain)
• Liver impairment or disease
• Known or suspected breast cancer
• Undiagnosed vaginal bleeding
• Hypersensitivity to norethindrone

Critical safety warning: Norethindrone is contraindicated in pregnancy and may cause fetal harm, including masculinization of female external genitalia and hypospadias in male fetuses if taken during the first trimester 2

Expected Side Effects

Patients should be counseled about common effects:

• Significant weight gain during treatment (resolves after cessation) 1
• Heavier withdrawal bleeding compared to normal menses (p < 0.04) 1
• Possible breakthrough bleeding, though less common than with combined oral contraceptives 1

Serious adverse effects requiring immediate discontinuation: 2

• Sudden vision changes (partial/complete loss, blurred vision, double vision)
• Signs of blood clots (leg pain/swelling, chest pain, shortness of breath)
• Sudden onset of bulging eyes or migraine
• Stroke or heart attack symptoms

Clinical Pearls

Key advantages of norethindrone over combined oral contraceptives for menstrual delay:

• Superior efficacy in preventing breakthrough bleeding 1
• Can be initiated later in the menstrual cycle with reasonable success 1
• Does not impair subsequent fertility (time to conceive was actually shorter in norethindrone users, p < 0.03) 1
• Ideal when even minimal breakthrough bleeding cannot be tolerated 1

Common pitfall to avoid: Starting too late in the cycle increases breakthrough bleeding risk, though norethindrone remains more effective than combined oral contraceptives even with late initiation 1

Patient counseling point: This is an off-label use of norethindrone; the FDA-approved indications are secondary amenorrhea, endometriosis, and abnormal uterine bleeding due to hormonal imbalance 2