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Norethindrone Acetate 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.

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. You should wait to start Norethindrone Acetate 5 days after Ella administration.

This medication is not approved for pregnancy prevention. Ensure to use a back up method with reproductive intercourse.

When to Start

Take 1 tablet three times a day, starting three days before your period is expected to begin. Follow the instructions on your prescription for how long to continue taking the tablets. Your period will usually start 2 to 3 days after you finish the medication.

Active Ingredients

• Norethindrone Acetate (Progestin)
  
  

Allergies/Contraindications

This medicine, like all medications, may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please do not take the medicine and call or message us or see your doctor in person.

• Norethindrone Acetate
  
  

Conditions

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

• Pregnancy
• Advised not to take hormones
• Long QT syndrome
• Adrenal insufficiency
• Current or history of estrogen or progesterone sensitive cancer (breast, uterine, ovarian)
• Liver disease
• Kidney disease
• Undiagnosed abnormal uterine bleeding
• Taking hepatitis c drugs (ombitasvir/paritaprevir/ritonavir with or without dasabuvir)
• History of a stroke
• History of a heart attack
• Coronary artery disease
• Heart rhythm diseases
• Valvular heart disease
• Diabetes mellitus with vascular disease
• Current or history of DVT (deep vein thrombosis) or PE (pulmonary Embolus)
• Blood clotting disorders
• Uncontrolled high blood pressure
• Sudden development of severe headaches or migraines (with or without aura)
• Change in frequency or quality of existing migraine diagnosis while on medication
• Lupus with or without antiphospholipid antibodies
• Scleroderma with antiphospholipid antibodies
  
  

Pregnancy and Breastfeeding

Norethindrone acetate is contraindicated during pregnancy as it may cause fetal harm when administered to pregnant women. Several reports suggest an association between intrauterine exposure to progestational drugs in the first trimester of pregnancy and congenital abnormalities in male and female fetuses. Some progestational drugs induce mild virilization of the external genitalia of female fetuses. You should use a backup method if you’re having reproductive intercourse while taking this medication.

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.

Medications, Supplements and Foods

We have evaluated the specific health information you provided us, however if 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 dangerous interactions with the medicine we are prescribing you and we will help you evaluate that risk and decide on an appropriate treatment plan. Please ensure your chart is up to date with your current medications, allergies, and medical conditions so your provider can safely treat you as this list may not be all inclusive.

• Phenytoin (Dilantin)
• Carbamazepine (Tegretol)
• Barbiturates (used for seizures, mood disorders, migraines, etc.)
• Primidone (Mysoline)
• Oxcarbazepine (Trileptal)
• Rifampin (Rifadin or Rimactane)
• Isotretinoin (Accutane)
• Tuberculosis medications
• HIV medications
• St John’s Wort
• Ella (Ulipristal Acetate)
  
  

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.

• Sudden onset of chest pain
• Shortness of breath
• Difficulty or painful swallowing
• Severe skin rash and/or itching
• Facial or throat swelling
• Blurred vision
• 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
• Visual changes
• Sudden severe onset headaches
• One sided or persistent leg pain with or without swelling
• Weakness or numbness in your extremities
• Trouble speaking
  
  

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, duration, and timing
• Abdominal cramps, bloating, nausea, vomiting
• Breakthrough bleeding, spotting, changes in secretions
• Yeast infection
• Change in sexual drive
• Acne
  
  

Accurate Information

We have evaluated your health history and your specific health information you provided and determined it is safe to proceed with this treatment at this time. If your health history changes including diagnoses or medications please message or call us before you take the medicine to ensure it's safe to proceed. Some medications and conditions can cause dangerous interactions with the medicine we are prescribing and we will help you evaluate that risk and decide on an appropriate treatment plan.

Treatment Failure/Missed Doses

This treatment is not guaranteed to be effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency, call 911 or seek immediate medical help in person. You may need to seek alternative treatment such as those listed below or in the follow up plan.

Missed dose: Take as soon as remembered.

Misdiagnosis or Delayed Diagnosis

Through telehealth, there is also a risk that we misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. This risk exists with a doctor in person as well but they may have additional resources to aid their evaluation. We use evidence-based practice and guidelines as well as clinical decision-making to minimize these risks.

Accepting or Declining Our Recommendation

We have based our recommendation on your specific case and 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.

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.

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