Norethindrone 15 mg Daily for Menstrual Delay
Yes, continue norethindrone at 15 mg daily (typically divided as 5 mg three times daily) throughout the period when menstruation needs to be delayed, without interruption. 1
Dosing Regimen for Menstrual Delay
- Start norethindrone 5 mg three times daily (total 15 mg/day) on or before cycle day 12 for optimal efficacy in preventing breakthrough bleeding 1
- Continue the medication daily without interruption for the entire duration you wish to delay menstruation 1
- Do not stop taking the medication during the delay period, as this will trigger withdrawal bleeding 1
Expected Outcomes with This Regimen
- Norethindrone at this dose is superior to combined oral contraceptives for preventing breakthrough bleeding when started late in the cycle 1
- Only 8% of women experience spotting with norethindrone 15 mg daily, compared to 43% with combined oral contraceptives 1
- Patient satisfaction is significantly higher (80% willing to choose this method again) 1
Important Clinical Considerations
Expected Side Effects
- Temporary weight gain is common but resolves after stopping the medication 1
- Expect a heavier withdrawal bleed when you stop taking norethindrone compared to a normal period 1
- The medication must be taken at consistent times each day for maximum effectiveness 2
When to Stop
- Discontinue norethindrone when you are ready to allow menstruation to occur 1
- Withdrawal bleeding typically begins 2-3 days after stopping the medication 3
- Fertility returns rapidly after discontinuation 2, 1
Critical Warnings
Do Not Stop Early
- Stopping the medication before the desired delay period ends will trigger menstruation 1
- Continuous daily administration is essential—there should be no pill-free intervals during the delay period 2
Contraindications to Rule Out
Before continuing this regimen, ensure the patient does not have: 4
- Active or history of thromboembolic disease
- Hepatic dysfunction or liver disease
- Undiagnosed vaginal bleeding
- Pregnancy (rule out before starting)
- Breast cancer or other hormone-sensitive malignancies
Monitoring Requirements
- Baseline pregnancy test before initiation 4
- Blood pressure monitoring 4
- Assess for severe headaches with focal neurologic symptoms (requires immediate discontinuation) 2
Common Pitfall to Avoid
The most common error is stopping norethindrone too early or taking it inconsistently. The medication only works to delay menstruation when taken continuously at the prescribed dose throughout the entire period when bleeding must be avoided 2, 1. Any interruption or dose reduction will likely result in breakthrough bleeding or withdrawal bleeding.