Norethisterone (Norethindrone) is the tablet used to delay menstruation
For postponing a period, norethisterone (norethindrone acetate) 5 mg taken three times daily is the most effective option, particularly when started on or before cycle day 12. This progestin-only medication is superior to combined oral contraceptives for preventing breakthrough bleeding when delaying menstruation 1.
How to Use Norethisterone for Period Delay
Dosing regimen:
- 5 mg three times daily (total 15 mg/day)
- Start 3 days before expected menstruation
- Continue throughout the period you wish to avoid bleeding
- Menstruation typically occurs 2-3 days after stopping
Key advantages over combined oral contraceptives:
- Only 8% experience breakthrough spotting vs. 43% with COCs 1
- Can be started later in the menstrual cycle (up to cycle day 12)
- Higher patient satisfaction (80% willing to use again)
- Does not impair subsequent fertility 1
Alternative: Combined Oral Contraceptives
If norethisterone is unavailable, monophasic combined oral contraceptives can be used by:
- Continuing active pills without the hormone-free interval
- Skipping the placebo week and starting a new pack immediately
- Approximately 75% of women successfully postpone bleeding for 21 days using this method 2
Important limitation: COCs are less effective when started late in the cycle and have higher breakthrough bleeding rates compared to norethisterone 1.
Common Pitfalls and Caveats
With norethisterone:
- Temporary weight gain occurs but resolves after stopping 1
- Withdrawal bleeding may be heavier than usual 1
- Must be started before cycle day 12 for optimal effectiveness
Contraindications to consider:
- History of venous thromboembolism
- Active liver disease
- Hormone-sensitive cancers
- Pregnancy (must be excluded)
This is NOT emergency contraception - levonorgestrel and ulipristal acetate are used to prevent pregnancy after unprotected intercourse, not to delay periods 3.
Clinical Context
The evidence strongly supports norethisterone as first-line therapy when period postponement is desired, especially in situations where even minimal breakthrough bleeding cannot be tolerated (e.g., religious ceremonies, athletic competitions, honeymoons) 1. The medication works by maintaining the endometrium in a secretory state, preventing menstrual shedding until discontinued.