Can a female of reproductive age with potential underlying health conditions take Norethindrone (a progestin) with other birth control to delay her period?

Can Norethindrone Be Taken With Other Birth Control to Delay Period?

Yes, norethindrone can be used in addition to existing birth control to delay menstruation, but you must discontinue combined hormonal contraceptives (pills, patch, ring) and use norethindrone alone during the delay period, then resume regular contraception afterward. 1

How to Use Norethindrone for Menstrual Delay

Dosing Protocol

• Norethindrone 5 mg three times daily is the most effective regimen for menstrual delay when started on or before cycle day 12 1
• Begin norethindrone at least 3-5 days before the expected period 1
• Continue daily until menstruation is desired, then stop 1

Managing Current Birth Control

If currently on combined hormonal contraceptives (COCs, patch, or ring):

• Stop the combined hormonal method when starting norethindrone for delay 2
• Do not take both simultaneously, as this provides no additional benefit for menstrual suppression and may increase side effects 2
• After stopping norethindrone, resume regular contraception immediately 2
• Use backup contraception (condoms) for 7 days after restarting combined hormonal methods 2

If currently on progestin-only pills (POPs):

• Can transition directly to higher-dose norethindrone 5 mg three times daily without interruption 1
• The standard 0.35 mg norethindrone dose used for contraception is insufficient for reliable menstrual delay 3, 4

Effectiveness and Breakthrough Bleeding

Success Rates

• Only 8% of women experience breakthrough bleeding with norethindrone 5 mg three times daily when started appropriately in the cycle 1
• This is significantly superior to attempting menstrual delay with combined oral contraceptives (43% breakthrough bleeding rate) 1
• Starting after cycle day 12 substantially increases breakthrough bleeding risk 1

Common Side Effects

• Weight gain is common but reversible after stopping norethindrone 1
• Heavier withdrawal bleeding occurs after discontinuation compared to normal menses 1
• Irregular bleeding patterns are the most common reason for dissatisfaction 4
• No serious adverse events have been reported with short-term use 4

Critical Safety Considerations

Absolute Contraindications (Do Not Use)

• Known or suspected pregnancy 5
• Known or suspected breast cancer 5
• Undiagnosed abnormal genital bleeding 5
• Active liver disease or liver tumors 5
• Hypersensitivity to norethindrone 5

Important Drug Interactions

Norethindrone effectiveness may be reduced by enzyme-inducing medications including 5:

• Rifampin, barbiturates, phenytoin, carbamazepine
• Topiramate, oxcarbazepine, felbamate
• St. John's Wort
• Some HIV protease inhibitors

Post-Delay Contraception Management

Resuming Regular Birth Control

• Start or resume regular hormonal contraception immediately after stopping norethindrone 2
• Use backup contraception (condoms) for 7 consecutive days 2
• Perform pregnancy test if withdrawal bleeding does not occur within 3 weeks 2
• Fertility returns rapidly after norethindrone discontinuation (often shorter time to conceive than with COCs) 1

Common Pitfalls to Avoid

• Do not use standard contraceptive-dose norethindrone (0.35 mg) for menstrual delay—it is inadequate 3, 4
• Do not start norethindrone too late in the cycle (after day 12)—this dramatically increases breakthrough bleeding risk 1
• Do not continue combined hormonal contraceptives simultaneously with norethindrone for delay—stop one method 2
• Do not forget backup contraception when restarting regular birth control after the delay period 2
• Rule out pregnancy before initiating norethindrone, especially if menstrual patterns have been irregular 5

Patient Satisfaction

• 80% of women using norethindrone for menstrual delay report willingness to use this method again 1
• Satisfaction is highest when breakthrough bleeding is avoided 1
• This approach is particularly valuable when even minimal spotting cannot be tolerated (e.g., religious ceremonies, athletic competitions) 1