Heavy Menstrual Bleeding: Progestin-Only Hormone Therapy

If you are unable to take estrogen or if you do not respond to combination (estrogen and progestin) pills, your clinician may prescribe either norethindrone (Camilla®), norethindrone acetate (Aygestin®) or depot medroxyprogesterone acetate (DMPA, Depo–Provera®), three kinds of progestin–only hormone medicine. These medicines stop your body from ovulating. Many teens will not have a period. Taking progestin (synthetic, or man–made progesterone) medication in this form is very similar to the natural progesterone that is made by your body.

Are there any reasons why I wouldn’t be able to take Progestin–only hormone therapy?

Tell your clinician if you have epilepsy (seizures), migraines, asthma, blood clots, heart, or kidney problems as these should be discussed when considering any hormone therapy. You should not take any kind of progestin if you are pregnant; have cancer, or severe liver disease. You should also tell your clinician if you have diabetes, high blood pressure, high cholesterol or you have been diagnosed with depression in the past. Your clinician will discuss with you whether it is safe for you to take progestin-only hormone therapy.

What are the side effects?

Most teens and young women have few or no side effects while taking progestin–only medication. Possible side effects can include breakthrough bleeding or spotting, changes in weight, acne, breast enlargement, feeling bloated, headache/migraines, and nausea or vomiting.  In addition, DMPA can decrease bone density (thinning of the bones), which is usually reversible after stopping DMPA.

Hormone medications can affect people differently. Some teens will have very irregular bleeding while taking progestin–only hormone therapy, especially during the first 6 months of treatment. Breakthrough bleeding is less common the longer you are on hormonal therapy.

How is norethindrone taken?

Norethindrone 0.35 mg (Camilla® and many other options) is a pill that you swallow. Each pill contains 0.35 mg of norethindrone. The pill comes in a packet of 4 weeks and you take 1 pill a day.

You should take norethindrone at the same time every day as prescribed by your health care provider.

What should I expect will happen to my menstrual bleeding if I am taking norethindrone?

If you take norethindrone at the same time each day in the dose prescribed by your clinician, your menstrual bleeding should become less and it may stop completely. Some people on norethindrone continue to have monthly periods but the periods should be lighter and shorter.

How is norethindrone acetate taken?

Norethindrone acetate (Aygestin®) is a pill that you swallow. Each pill contains 5 mg of norethindrone acetate.

Your clinician will tell you whether to take 0.5, 1, 1.5, or 2 tablets (2.5, 5, 7.5, or 10 mg). You should take norethindrone acetate at the same time every day as prescribed by your health care provider. At Boston Children’s Hospital, we generally recommend that you do not take more than 10 mg of norethindrone acetate a day.

What should I expect will happen to my menstrual bleeding if I am taking norethindrone acetate?

If you take norethindrone acetate at the same time each day in the dose prescribed by your clinician, your menstrual bleeding should stop completely. If you do not miss doses or take breaks off norethindrone acetate, you should not get periods at all.

How is depot medroxyprogesterone acetate given?

Depot medroxyprogesterone acetate (DMPA, Depo–Provera®) is an injection that is given in a muscle (in the buttocks, arm, or thigh) approximately every 3 months. The first shot is usually given within the first 5 days of your menstrual cycle (during your period). If you are sexually active, a routine urine pregnancy test will be done first. The next shot needs to be scheduled within 11–13 weeks.

What should I expect will happen to my menstrual bleeding if I am getting DMPA injections?

If you get DMPA injections every 11-13 weeks (or as recommended by your clinician), your menstrual bleeding may become irregular, become heavier, become lighter, or stop completely. The longer you continue to get DMPA injections, the more likely it is that you will have fewer, lighter, or shorter periods, or no periods at all. After one year of getting DMPA injections (that is, after 4 injections), about one-half of women stop getting their periods.

What if I am having sex? Is it OK to take these medications?

Be sure to let your clinician know if you are sexually active when you are discussing which hormone medication to use to manage your heavy menstrual bleeding. Although norethindrone acetate can keep you from ovulating, this medication has not had studies to become an FDA approved form of birth control. The DMPA and norethindrone 0.35 mg/day are methods of birth control. None of these medications protect you from sexually transmitted infections (STIs). Always use condoms when you have sexual intercourse.

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