Norethisterone for Menstrual Suppression
Norethisterone acetate 5 mg by mouth three times daily (total daily dose 15 mg) is used to delay a scheduled menstrual bleed in adults without contraindications. [1]
The medication should be started before the expected onset of menses and continued until a withdrawal bleed is desired. [1], [2]
Medication Selection Algorithm
- Norethisterone acetate is selected for short-term menstrual delay when a progestogen-only approach is desired. [1]
- Norethisterone acetate is not the only menstrual suppression option, and alternative regimens include combined hormonal contraception or other progestin-based options depending on clinical context. [3]
Key Dose Recommendation
- Norethisterone acetate (norethisterone 5 mg tablets) is dosed at 5 mg by mouth three times daily (15 mg/day). [1], [2]
- Dosing is used to delay the next period by starting before the expected onset of menses. [1], [2]
Initiation Timing
- Norethisterone acetate is started 3 days before the expected start of the menstrual period to delay bleeding. [1], [2]
Discontinuation for Breakthrough/Withdrawal Bleeding
- Norethisterone acetate is continued only for the planned suppression interval and is stopped when bleeding is acceptable or desired. [1]
Targets or Goals of Therapy
- The therapeutic goal is delayed onset of the next menstrual bleeding for the planned interval. [1], [2]
Common Pitfalls to Avoid
- Starting norethisterone acetate too late relative to the expected period onset can reduce effectiveness for delaying the bleed. [1], [2]
- Using higher-than-licensed dosing for delay is not recommended because the licensed delay regimen is 5 mg three times daily. [2]
Contraindication Screening Requirement
- Contraindications and risk factors should be reviewed prior to use of norethisterone acetate because adverse effects and risks differ by patient risk profile. [2], [3]
Practical Dosing Statement
- Norethisterone acetate 5 mg by mouth three times daily, beginning 3 days before expected menses, is the appropriate labeled regimen for menstrual delay/suppression in adults without contraindications. [1], [2]