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Norethindrone For Delayed Menstruation | Oral Tablets, USP 5 mg

Introduction

This treatment plan reviews the risks and benefits of the treatment we are recommending. Please make sure to read it and the manufacturer's pamphlet that comes with the medicine. The manufacturer's pamphlet contains the full information on interactions, side effects, and other important information you should know about the medicine before you start.

Instructions

You have stated that you wish to take oral hormonal medication to delay menstruation. This medication is a progestin only form of hormones, and delaying your period using this medication is an “off-label” use for Norethindrone Acetate 5mg. This medication should be taken 3 times daily, 8 hours apart.

When to Start

Take 1 tablet three times daily, starting three days before the expected onset of menstruation. Take for 10 days. Menstruation usually follows within 2-3 days of finishing the treatment.

Active Ingredients

Norethindrone (progestin analog)

Allergies/Contraindications

True anaphylactic allergic reactions to progestin hormones are extremely rare because the active ingredients in these medications mimic naturally occurring hormones in your body. However these medications do have other ingredients that may cause allergic reactions. If you experience any of the symptoms below, you should immediately go to the emergency room or call 911.

Allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.

There are several contraindications to taking hormones. If you have any of the following conditions please let your doctor know prior to starting medication:

• Long QT syndrome
• Adrenal insufficiency
• Current or history of estrogen or progesterone sensitive cancer
• Hepatic tumors
• Pregnancy
• Renal impairment
• Undiagnosed abnormal uterine bleeding
• Taking hepatitis c drugs (ombitasvir/paritaprevir/ritonavir with or without dasabuvir)
• History of migraine with aura

Additionally, if you have taken ella emergency contraception within the last 5 days, both the ella and the Norethindrone Acetate 5mg will be less effective.

Use is also contraindicated in people at high risk of having a blood clot or arterial or venous thrombotic diseases including:

• Cerebrovascular disease or history of strokes
• Coronary artery disease or history of heart attack
• Diabetes mellitus with vascular disease
• Current or history of DVT (deep vein thrombosis) or PE (pulmonary Embolus)
• Hypercoagulopathies (easy to make blood clots) (inherited or acquired),
• Hypertension or high blood pressure (uncontrolled)
• Sudden development of severe headaches or migraines (with or without aura) while on medication
• Change in frequency or quality of existing migraine diagnosis while on medication
• Thrombogenic valvular or rhythm diseases of the heart (eg, subacute bacterial endocarditis with valvular disease or atrial fibrillation)

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop or discover that one of these conditions applies to you please stop taking this medicine and call or message us immediately.

Pregnancy and Breastfeeding

Isolated reports of decreased milk production and very rare reports of jaundice in breastfeeding infants have been noted. In general, adverse events related to infant growth and development have not been reported.

The manufacturer of norethindrone acetate recommends that caution be used if administered to a breastfeeding person.

Emergency Side Effects

This medicine can cause dangerous and potentially life threatening side effects. If any of the emergency side effects listed in the manufacturer's pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in-person.

• Anaphylaxis/anaphylactoid reaction (shortness of breath, difficulty breathing, facial swelling or edema, tongue swelling)
• Jaundice (yellowing of skin and eyes)
• Sudden development of severe headaches or migraines (with or without aura)
• Change in frequency or quality of existing migraine diagnosis
  
  

Other Side Effects

• Sun sensitivity
• Edema (swelling in legs)
• Worsening of varicose veins
• Mood changes
• Chloasma (brownish skin, on the forehead, nose, upper lip, and cheeks)
• Amenorrhea (loss of period)
• Breast Changes: breast enlargement, discharge, tenderness, pain
• Increased or decreased weight
• Changes in menstrual flow
• Abdominal cramps, bloating, nausea, vomiting
• Breakthrough bleeding, spotting, changes in secretions
• Yeast infection
• Change in sexual drive
• Acne
  
  

Medications, Supplements and Foods

We have evaluated your health history and the specific health information you provided us, however, if anything changes and you start or discover that you are taking any of the medicines, foods, or supplements listed below, call or message us before you take the medicine. Some of these can cause your medication to be less effective and cause more severe or dangerous side effects:

• Rifampin
• Anticonvulsants or anti-seizure medications such as carbamazepine (Tegretol®), phenytoin (Dilantin®), oxcarbazepine (Trileptal®), primidone or topiramate (Topamax®)
• Antifungal medications such as griseofulvin (Gris-PEG®), ketoconazole (Extina®, Nizoral®, Xolegel®)
• Antiretrovirals: ritonavir, ombitasvir, paritaprevir, dasabuvir
• Herbal medications such as St. John’s wort, Saw Palmetto, Alfalfa, Garlic Pills, Flax Seed
• HIV Medications
• Modafinil (Provigil®)
  
  

Accurate Information

We have evaluated the specific health information you provided and are making our recommendations based on it. If you forgot to provide or incorrectly provided that information we may misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. If you need to clarify or update any information about your health you can message or call us anytime.

Treatment Failure/Missed Doses

The effectiveness of hormonal oral contraception is very high when it is consistently taken and doses are not missed.

Missed dose: Take as soon as remembered.

Accepting or Declining Our Recommendation

You should evaluate this information as well as the manufacturer's pamphlet, and any input from your in-person healthcare team, or other relevant information to decide if this treatment plan is appropriate for you. You are free to decline our treatment recommendations.

Alternative Treatment

We have based our recommendation on your specific case and current medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can't provide. Message us or talk to your doctor in-person to discuss alternative treatments. While using Norethindrone 5mg to delay your period, this will not prevent pregnancy, therefore you should not rely on this method for pregnancy prevention and should use a backup method if you're having reproductive intercourse such as:

• Oral contraceptives
• Implanon implant contraceptives
• Intrauterine device (IUD)
• Contraceptive injections
• Transdermal patches
• Vaginal rings
• Male or female condoms
• Diaphragm
• Spermicide
  
  

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person doctor, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.