Norethindrone

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jan 23, 2023

Warnings

Norethindrone Risks, Warnings, and Complications

Norethindrone can cause serious adverse effects in certain groups of people. Talk to your doctor about alternative birth control methods if you are at a high risk of complications from the hormonal properties of norethindrone. Some of the potential risks of taking norethindrone include:

ABNORMAL VAGINAL BLEEDING: Progestogen-only contraceptives like norethindrone can cause abnormal or irregular vaginal bleeding as a side effect. However, irregular vaginal bleeding can also be a sign of something more serious, like an infection or cancer. Call your doctor if you experience irregular vaginal bleeding. Also, tell your doctor if you do not have menstrual periods, so they can check for pregnancy.
OVARIAN CYSTS AND ECTOPIC PREGNANCY: In a small number of people who get pregnant while on norethindrone, it results in an ectopic pregnancy (the fertilized egg is implanted outside the uterus). Norethindrone can also increase your risk of ovarian cysts (tiny fluid-filled sacs in the ovaries). Ovarian cysts often go away without needing any treatment. Call your healthcare provider immediately if you develop sudden severe stomach pain while on norethindrone so that they can check for ectopic pregnancy or ovarian cysts.
INCREASED RISK OF CANCER: The combined contraceptive pill is known to increase the risk of breast cancer, cervical cancer, and liver tumors. It is unclear whether norethindrone (progestogen-only pills) also increases the risk of these cancers. Talk to your doctor about the risks of taking hormonal contraceptives like norethindrone.

Precautions Before Starting Norethindrone

Tell your doctor if you have ever had an allergic reaction to norethindrone, other types of progestogen therapy, combined oral contraceptives, or any other drugs. Your pharmacy can give you a list of active and inactive ingredients in norethindrone tablets.

Give your doctor a complete medical history. Norethindrone may not be right for people with certain health conditions, such as breast cancer, liver tumors, or liver disease. Tell your doctor if you have abnormal vaginal bleeding, diabetes mellitus, or if you are a smoker.

Give your doctor or pharmacist a complete list of your other medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products, especially St. John’s Wort. This can help avoid possible drug interactions between norethindrone and your other medications.

Tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy, or are nursing an infant with breast milk. Pregnant or breastfeeding women should talk to their healthcare provider about the risks versus benefits of oral contraceptives.

Precautions During Use of Norethindrone

Keep all your healthcare appointments. Take norethindrone on the first day of your menstrual period. If you start the pill on any other day, use a backup method of contraception for 48 hours.

Call your doctor if you have a positive home pregnancy test or other signs and symptoms of pregnancy, such as nausea and breast tenderness while on norethindrone.

If you miss a period while taking oral norethindrone, you could be pregnant. If you have taken all your doses as directed and you miss one period, continue taking norethindrone. However, if you have not taken the pill as directed or if you miss two periods, call your doctor and use a backup method of birth control until you have a pregnancy test.

Tell all your healthcare professionals you are taking norethindrone before any surgical treatment, including dental procedures.

If you vomit while on norethindrone, you should use a backup method of contraception for 48 hours. Talk to your doctor about an appropriate backup method before starting norethindrone.

Your doctor will tell you when to start taking the pill after childbirth, abortion, or miscarriage.

Avoid smoking while taking norethindrone hormone therapy because it can increase your risk of myocardial infarction (heart attack) and stroke.

Norethindrone Drug Interactions

Certain medicines can affect how well norethindrone works. Taking norethindrone with other medicines can also increase the risk of severe adverse effects. Your doctor may change the doses of your medications or monitor you carefully for adverse effects if there are known interactions between norethindrone and your other medicines.

The following medications can have possible interactions with norethindrone:

Medications such as bosentan (Tracleer) used to treat pulmonary arterial hypertension.
Anti-seizure medications like carbamazepine (Carbatrol, Tegretol, Epitol, Equetro, others), oxcarbazepine (Trileptal), topiramate (Topamax, Qudexy, Trokendi, in Qsymia), felbamate (Felbatol), phenobarbital, and phenytoin (Dilantin, Phenytek).
Antifungal medications like griseofulvin (Gris-PEG).
Tuberculosis (TB) medications like rifampin (Rimactane, Rifadin, in Rifater).
Medications prescribed to people with HIV such as atazanavir (Reyataz, in Evotaz), fosamprenavir (Lexiva), darunavir (Prezista, in Symtuza, in Prezcobix), lopinavir (in Kaletra), ritonavir (Norvir, in Viekira Pak, in Kaletra), nelfinavir (Viracept), tipranavir (Aptivus) and saquinavir (Invirase).

The above list may not include all the possible interactions of norethindrone. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal remedies. Also, tell your healthcare provider if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and over-the-counter medicines.

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