How It Works
As a contraceptive, norethindrone works by altering the environment of the reproductive tract. It thickens the cervical mucus, creating a physical barrier that makes it significantly more difficult for sperm to enter the uterus and reach an egg. Additionally, it thins the lining of the uterus (the endometrium), which makes it less receptive to the implantation of a fertilized egg.
When used to treat conditions like endometriosis or abnormal bleeding, norethindrone works by counteracting the effects of estrogen on the uterine lining. It prevents the overgrowth of the endometrium, which can reduce the heaviness of menstrual flow and alleviate the pain associated with endometrial tissue growing outside the uterus.
| Quick Facts | |
|---|---|
| Common Brands | Heather, Camilla, Errin, Jolivette, Nora-BE, Sharobel, Aygestin |
| Drug Class | Progestin; Oral Contraceptive |
| Generic Status | Generic is available |
| Availability | Prescription only |
Dosing
For contraception, norethindrone is typically dosed as one 0.35 mg tablet daily. The tablet is designed to be taken at the same time every day.
For other conditions like endometriosis or abnormal uterine bleeding, the dosage is generally higher, ranging from 2.5 mg to 10 mg. It may be taken for specific days during the menstrual cycle as directed by a doctor.
Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
FDA-Approved Uses
Norethindrone is FDA-approved as an oral contraceptive to prevent unwanted pregnancy.
Off-Label Uses
You may see norethindrone prescribed for uses that are not “FDA-approved.” This is a common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.
Health providers may prescribe norethindrone tablets for the following off-label uses:
- Delaying the onset of a menstrual period for travel or surgery
- Management of heavy menstrual bleeding (menorrhagia)
- Symptom reduction for premenstrual syndrome (PMS)
- Hormone replacement therapy (HRT) in combination with estrogen
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Side Effects
Like any hormonal medication, norethindrone can cause side effects as the body adjusts to the new hormone levels. Many of these are mild and resolve within the first three to six months of use. Other side effects can be more serious and require prompt medical attention.
Common Side Effects
- Nausea
- Vomiting
- Breakthrough bleeding or spotting
- Changes in menstrual flow
- Weight gain
- Acne
- Headache
- Breast tenderness
- Missed periods
- Mood changes or irritability
- Dizziness
Serious Side Effects
Serious side effects are rare, but it’s important to know what to look for if they do occur.
- Severe allergic reactions: Call your doctor immediately if you have symptoms such as wheezing, breathing difficulties, a racing heart, fever, or swelling of the face, lips, mouth, tongue, or throat.
- Neurological concerns and stroke: Get emergency help for sudden numbness or weakness in the face, arms, or legs, confusion, trouble speaking, vision changes, or a loss of balance and coordination.
- Blood clots: Be alert for pain, swelling, or warmth in the legs, as well as chest pain or shortness of breath.
- Liver injury: Symptoms of liver issues include right-side upper belly pain, loss of appetite, light-colored stools, dark urine, or yellowing of the skin and eyes.
- New or worsening migraines: Report any new or significantly more intense headaches or migraine attacks to your doctor.
- Gallbladder issues: Serious stomach pain accompanied by nausea, vomiting, or fever can indicate gallbladder problems.
- Mood changes: Monitor for worsening mood, feelings of depression, or significant emotional shifts.
- Blood pressure changes: This medication may cause an increase in blood pressure.
- Unusual vaginal changes: Report any undiagnosed vaginal bleeding, or discharge that has an unusual odor or causes itching.
- Ectopic pregnancy: This medication may increase the risk of a pregnancy occurring outside the uterus. Seek immediate medical attention if you experience sudden or severe stomach pain.
- Ovarian cysts: Norethindrone can lead to the development of fluid-filled sacs on the ovaries. While these often disappear without treatment, they can cause severe abdominal pain if they rupture or twist.
Call your doctor immediately if you experience any concerning or prolonged symptoms.
Pharmacist Tips
Follow the Three-Hour Rule
For contraception, norethindrone must be taken at the same time every day. If you are more than three hours late to take the pill, it is recommended that you use a backup method of birth control (such as a barrier method with condoms) for the next 48 hours.
Consistency Is Key
Setting a daily alarm on your phone is recommended to ensure you maintain the schedule required for maximum effectiveness.
Manage Nausea With Timing
If the medication causes stomach upset or nausea, you can consider taking it with food or right before bed to reduce those side effects.
Monitor Your Cycles
It may help to keep a calendar of your bleeding patterns. Spotting is common during the first few months, but tracking it can help your doctor determine if the dose is right for you.
There Are Generally No Placebos
Unlike combination pills, norethindrone packs usually do not contain “sugar pills.” Instead, you take an active hormone pill every day with norethindrone.
Drug Interactions
Norethindrone can interact with several types of medications, which may decrease its effectiveness or increase the risk of side effects. Potential interactions include:
- Anti-seizure drugs: Certain seizure medications like carbamazepine, phenytoin, and phenobarbital can speed up the metabolism of norethindrone, making it less effective.
- Rifampin (rifampicin): While most common antibiotics do not interfere with norethindrone, Rifampin is a known interaction that significantly reduces contraceptive efficacy.
- Antifungals: The antifungal drug griseofulvin may decrease the effectiveness of the medication.
- St. John’s wort: This herbal supplement is known to decrease the effectiveness of hormonal contraceptives.
- HIV medications: Certain antiretroviral drugs can alter the levels of hormones in your blood.
Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.
FAQs
Do I have to take norethindrone at the exact same time every single day?
You should try to take norethindrone at the same time every day. Because norethindrone has a short half-life and has effects that begin to wear off after 24 hours, taking it at the same time is essential to its effectiveness in preventing pregnancy.
What happens if I take my pill late?
If you take the pill more than three hours past your scheduled time, it is considered a “missed dose.” You should generally take the pill as soon as you remember and use a backup method of birth control for the following 48 hours, such as a barrier method with condoms.
Why do I have spotting and bleeding since starting this pill?
Breakthrough bleeding or spotting is the most common side effect of progestin-only pills. This usually occurs because the lining of the uterus becomes thin and fragile. For most patients, this stabilizes after 3 to 6 months of consistent use.
Will norethindrone completely stop my periods?
It is possible that periods will stop when taking norethindrone. Some patients find that their periods become light or disappear entirely (amenorrhea) while taking norethindrone. This is generally considered safe, but you should take a pregnancy test if you miss a period and have not been consistent with your pill timing.
Why did my doctor prescribe this “mini-pill” instead of a regular birth control pill?
Doctors typically recommend the mini-pill for individuals who cannot tolerate estrogen medications. This includes those who are breastfeeding, have a history of blood clots, suffer from certain types of migraines, or have high blood pressure.
Does norethindrone cause weight gain?
Some patients report slight weight changes or fluid retention when taking norethindrone. While clinical studies show a minimal average weight gain for most people, individual experiences vary.
Can I use norethindrone to delay or skip a period for a vacation?
Providers may prescribe a specific higher dose of norethindrone (usually 5 mg) to be taken a few days before an expected period to delay its onset. Consult your doctor before taking norethindrone to delay or skip a period.
Why is my acne suddenly getting worse on this pill?
As a progestin, norethindrone can have slight androgenic effects in some people, which may stimulate oil production and lead to acne breakouts.
Is it safe to take norethindrone while breastfeeding my baby?
Norethindrone is generally considered safe to take while breastfeeding a baby. Unlike pills containing estrogen, norethindrone does not interfere with milk production and is commonly prescribed for breastfeeding parents.
How does a pill without estrogen prevent me from getting pregnant?
Norethindrone prevents pregnancy in two main ways. It thickens the cervical mucus so sperm cannot reach the egg, and it thins the uterine lining so an egg cannot implant.
Are there any “sugar pills” or placebo days in a norethindrone pack?
There are no sugar pills in a norethindrone pack. Norethindrone packs consist of 28 active pills. There are no hormone-free days. You must take one active pill every day to maintain its contraceptive effects.
Can I use norethindrone to treat bleeding from endometriosis?
Standard medical guidelines suggest norethindrone is an effective treatment for endometriosis pain and bleeding as it helps suppress the growth of endometrial tissue. You should talk with your doctor about whether they recommend norethindrone in your situation.
Do I need to use a backup method when I first start taking this?
If you start taking norethindrone on the first day of your period, you are typically protected immediately. If you start at any other time, it is generally recommended to use a backup method for the first 48 hours, such as a barrier contraception like condoms.
Does this medication cause mood swings or depression?
Some patients report increased irritability or low mood. This may be because hormonal changes can affect chemicals in the brain called neurotransmitters. Talk to your doctor if you have mood swings or depression while taking norethindrone.
Can antibiotics or other medications make norethindrone less effective?
Most antibiotics do not affect norethindrone’s effectiveness, but rifampicin (Rifampin) and certain herbal supplements like St. John’s wort can reduce the drug’s efficacy.
Does this pill increase my risk of developing ovarian cysts?
Because the mini-pill does not always stop ovulation, small follicles can sometimes develop into functional ovarian cysts. These usually resolve on their own.
Can I take acetaminophen while taking this?
Yes, there is no known interaction between acetaminophen and norethindrone. Check with your doctor about whether they recommend you take acetaminophen.
Why do I sometimes feel dizzy or nauseous after taking my daily dose?
Nausea is a common side effect of hormonal shifts. Taking norethindrone with food or at bedtime can help alleviate these symptoms.
Comparable Medications
Norethindrone, drospirenone (Slynd), levonorgestrel (Alesse), norgestimate and ethinyl estradiol (Ortho Tri-Cyclen), or medroxyprogesterone acetate (Depo-Provera)?
There are several medications that your doctor can prescribe in place of norethindrone. Here are a few possible alternatives below:
Drospirenone
This is a newer type of progestin-only pill. Unlike norethindrone, it has a 24-hour "missed pill" window, making it more forgiving if taken late. A Slynd pack contains 24 active pills with 4 placebos.
Levonorgestrel and ethinyl estradiol
This is a combination pill containing both a progestin (levonorgestrel) and an estrogen. It works primarily by suppressing ovulation and allows for more predictable withdrawal bleeding during the placebo week.
Norgestimate-Ethinyl Estradiol
From $24.99
This is another combination oral contraceptive that uses a triphasic dosing schedule where hormone levels change weekly to mimic a natural cycle. It is commonly used off-label to treat acne.
Medroxyprogesterone Prefilled Syringe
From $89.98
This drug is an injectable form of progestin given every three months. It provides long-acting contraception without the need for a daily pill, though it may take longer for fertility to return after stopping.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.