Delaying menstruation
Patients already taking COCs
- Menstruation can be delayed by skipping the pill free break (for monophasic 21-day pills) [off label]. Advice differs for other pill types.
For patients not taking hormonal contraception
- Norethisterone 5mg three times daily, started 3 days before the expected menses can be prescribed. Menstruation will occur 2-3 days after stopping taking the norethisterone. Norethisterone is partially metabolised to ethinylestradiol and a daily dose of 10-20mg of norethisterone is estimated to be equivalent to taking a 20-30microgram COC. Norethisterone should be avoided in women at increased risk of VTE. There is some limited evidence to suggest medroxyprogesterone acetate 10mg three times a day may offer a safer alternative for high risk women (off label prescribing).