Norethindrone

What is Norethindrone?

Norethindrone is a type of progestogen-only birth control pill. This means that unlike other contraceptive pills, it does not not contain estrogen. It is taken continuously and does not allow for a monthly withdrawal bleed.

How does Norethindrone work?

Norethindrone contains progestogen, a female sex hormone that is involved in regulating ovulation. Norethindrone works by maintaining higher levels of progestogen, preventing ovulation (the release of an egg from the ovary). If you don’t ovulate, then there is no egg to be fertilised by the sperm, so you should not get pregnant. Norethindrone also has a thickening effect on the mucus in the cervix, making it harder for sperm to access the uterus, and affects the uterine lining to prevent implantation by a fertilized egg. 

How effective is Norethindrone?

When taken correctly, Norethindrone is 99.5% effective in preventing pregnancy. Taking into account women who miss a pill, Norethindrone is thought to be around 95% effective.

Remember, Norethindrone will NOT prevent you from contracting STIs. The only form of contraception to offer some protection against STIs is male condoms.  

Active ingredients

The active ingredient in Norethindrone is Norethindrone 0.35 mg. Norethindrone is a synthetic version of the female sex hormone progestogen.

Inactive ingredients

The inactive ingredients in Norethindrone are colloidal silicon dioxide, corn starch, D&C Yellow No. 10, ethyl cellulose, lactose anhydrous, magnesium stearate, microcrystalline cellulose, povidone, sodium starch glycolate, methylene chloride, isopropyl alcohol and talc.

Norethindrone dosage

Your doctor will decide your dose depending on your personal requirements. The usual dosage of Norethindrone is 1 x 0.35 mg tablet taken once daily at the same time each day.

How to start Norethindrone

Read the package instructions carefully and never start a new form of oral contraceptive without first consulting a doctor. You are recommended to start taking Norethindrone on the first day of your period. If you do decide to take your first pill on a different day, make sure to use an additional form of contraception, such as condoms, for the first 48 hours after starting Norethindrone.

If you are switching to Norethindrone from a combined oral contraceptive, start it on the first day after you finish the last active pill in the current pack of your previous contraceptive. If your current combined oral contraceptive contains inactive pills, do not take these before starting Norethindrone. If you are switching to Norethindrone from a different progestogen-only pill, you can switch treatments at any time.  

How to take Norethindrone

Take your Norethindrone pill at the same time each day. To help you remember, try and make this a part of your daily routine: for example, take your pill every morning when you brush your teeth. Norethindrone is more likely to be ineffective if you take your pill late or miss a pill. When you reach the end of a pack, start the next pack the following day without taking a break. It is important to always have a new pack ready when you are nearing the end of your current one. 

If you are late taking your pill, take it as soon as you remember and continue with the next one at the normal time. However, you will need to use a barrier method of contraception, such as a condom, for the next 48 hours to avoid accidental pregnancy. If you vomit soon after taking your pill, you will also need to use additional protection for 48 hours.   

What do I do if I forget to take my pill?

You should try to take Norethindrone at the same time every day. If you forget to take your pill at the right time, but you remember within 3 hours, you should take the missed pill immediately. The next day, you should take your pill at the usual time. You will not need to use other forms of contraception if you take the pill within 3 hours of the usual time. 

If you are more than 3 hours late to take your pill, you should take one pill as soon as you remember (even if you’ve missed more than one) followed by the next pill at the usual time, even if this means taking two pills in one day. Then, continue to take the rest of the pills as normal. As you are outside the 3 hour time window, you will need to use additional forms of contraception, such as condoms for at least the next 48 hours. During this time, the cervical mucus will thicken to prevent conception, but it will take 7 days from the time you missed the pill, until your ovulation pattern is affected, so you may wish to use additional contraception for the full 7 days. 

Norethindrone side effects

As with all medications, you may experience side effects while taking Norethindrone. If you experience any of the following signs of an allergic reaction, stop taking Norethindrone and seek immediate medical attention:

• Difficulty breathing

• Hives or a severe, itchy rash

• Swelling of the face, lips, tongue or throat.

If you experience any of the following severe side effects, stop taking Norethindrone and speak to your doctor as soon as possible:

• Sudden numbness or weakness

• Migraine headaches

• Sudden onset headache with confusion, pain behind your eyes and/or problems with speech, vision or balance

• Depressive symptoms including, sleep problems and mood changes

• Swelling or pain in your hands, feet or legs

• Rapid weight gain

• Severe pelvic pain

• Chest pain, especially if it spreads to the arm of shoulder.

• Fever

• Dark coloured urine

• Yellowing of the skin or eyes (jaundice)

• Clay-coloured stools

• Stomach pain

Less severe side effects include:

• Nausea

• Vomiting

• Feeling bloated

• Stomach cramps

• Breast tenderness

• Breast swelling

• Weight changes

• Changes in your periods, such as a lighter or heavier flow and changes in regularity of your periods

• Vaginal itching

• Vaginal discharge

• Headaches

• Dizziness

• Skin itching

• Rash

• Darkening of skin or freckles

• Acne

• Hair growth

These side effects are often mild and tend to stop over time. However, if they are bothering you, speak to a doctor for advice. It may be that a different type of hormonal contraceptive is better suited to you.

Contraindications

Do NOT take Norethindrone if:

• You are allergic to Norethindrone or any of the other ingredients in this medication (see ‘Ingredients’ above)

• You are pregnant, might be pregnant, or are trying to get pregnant

• You have breast cancer

• You have unexplained vaginal bleeding between periods

• You have liver tumors, either benign or cancerous

• You have acute liver disease

Drug interactions

Before taking Norethindrone, tell your doctor if you are taking any other medications, including those purchased over the counter without a prescription. The following medicines may reduce the effectiveness of Norethindrone:

• Medicines for epilepsy or seizures, including Phenytoin, Carbamazepine and Phenobarbital

• Medicines for tuberculosis, including Rifampicin

Before beginning any new medications, make sure your doctor or pharmacist is aware that you are also taking Norethindrone.

Norethindrone vs Errin

Errin is a brand name for the generic drug Norethindrone. Both contain the same active ingredient and work in the same way, although the generic drug may be cheaper.

Alternatives to Norethindrone

There are many different types of hormonal birth control, and it is not unusual to try a few different ones before finding one that works for you. progestogen-only pills such as Norethindrone are more suitable for women who are particularly sensitive to estrogen, and in some cases can be used while breastfeeding. Most women start off with a combined oral contraceptive containing both progestogen and estrogen. The main difference is that combined contraceptives allow a break for a withdrawal bleed once in every 28 day cycle.

If you don’t want to take a pill every day, you can try a form of hormonal contraception that is not taken orally. These include the implant (Implanon, Nexplanon), the shot (Depo-Provera), the patch (Xulane), and the intrauterine device (IUD, Mirena, ParaGard, Skyla, Liletta, Kyleena). In particular, the IUD may be appropriate for women with contradictory health conditions, such as diabetes or hypertension, as it works locally on the lower reproductive system. Speak to your doctor or health worker for information and advice about these types of contraception.

If you do not wish to use hormonal contraceptives at all, or have experienced problems with them in the past, you may choose to rely on barrier contraceptive methods. These include the cervical cap (FemCap) and Male and Female Condoms. It is worth noting that male condoms are the only form of contraception to offer protection against STIs.