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Key facts about Noriday

• Noriday has generally been replaced by the newer, simpler desogestrel POP.
• Noriday can be up to 99% effective if taken correctly, meaning that fewer than 1 woman in 100 per year becomes pregnant whilst using the POP.
• 3 hour late-pill time window before contraceptive cover is lost.
• Some women, who can't take pills containing oestrogen, because of medical problems, may be able to take a POP such as Noriday instead.
• Women over 35 who smoke can take POP including Noriday.
• Vomiting and severe diarrhoea may prevent Noriday from working.
• Noriday does not protect against sexually transmitted diseases and women at risk of these should use condoms as well.
• Women sometimes get light irregular bleeding after starting a POP. This usually settles within the first few months, often into a pattern of very infrequent or no bleeds.

How Noriday stops pregnancy

Noriday thickens the mucus at the neck of the womb (cervix), making it more difficult for sperm to pass through. There are also changes to the lining of the womb making it thinner and so less easy for a fertilised egg to be implanted. In some women, Noriday may also stop egg release from the ovaries (ovulation).

Obtaining Noriday online

Dr Fox supplies 3-12 months of Noriday, if you have already been using it for over a year.

There is a short online questionnaire to assess suitability and eligibility for POP.

Women ordering from Dr Fox are recommended to provide GP details and consent to a notification letter being sent to inform their GP.

Most contraception, including Noriday, can be obtained free through the NHS from GPs and sexual health clinics. Under 16s can obtain contraception, without parents or guardians being informed, if the young person is assessed as competent, informed, and not vulnerable to exploitation or abuse.

Taking Noriday POP

Take your tablet at the same time every day. Swallow the tablet whole. Unlike a combined oral contraceptive pill, there is no 7 day pill-free break with POP. When one 28 day blister strip is finished, another is started straight away, with no break in between.

Starting Noriday

Noriday can be started on any day of the menstrual cycle, but if not started during the first five days after the period begins, additional contraception, usually condoms, will be needed, for the first 48 hours. The rules are a little complicated and are regularly reviewed by the FSRH (Faculty of Sexual and Reproductive Health) so may differ from those in the patient information leaflet. See NHS contraception guide - progestogen-only pill for further details.

Missed pill rules for Noriday

Because Noriday does not reliably prevent ovulation, there are only 3 hours before the contraceptive effect drops after missing a tablet.

Forgotten pills:

• If you are less than 3 hours late:
  • Take the missed tablet as soon as you remember and take the next one at the usual time. It will still protect you from pregnancy.
• If you are more than 3 hours late:
  • You may not be completely protected against pregnancy.
  • Take a tablet as soon as you remember and take the next one at the usual time. This may mean taking two in one day. This is not harmful. (If you have forgotten more than one tablet you don't need to take the earlier missed ones). Continue to take your tablets as usual but you must also use an extra method, such as a condom, for the next 48 hours.
  • If you are more than 3 hours late taking your tablet and have had sex it is best to use emergency contraception - consult your pharmacist, GP or sexual health clinic.
  • If you missed one or more tablets in the very first 2 days of taking your tablets and had unprotected intercourse in the week before missing the tablets, you may become pregnant. Speak to your GP or a sexual health clinic.

If you vomit or have severe diarrhoea:

• If you vomit, or have severe diarrhoea within 3-4 hours after taking your tablet, the active ingredient may not have been completely absorbed.
• Take another pill as soon as possible. If this pill is also vomited additional precautions (condoms) are needed until you have been taking Noriday consistently for 48 hours.

Standby emergency contraception is available online from Dr Fox, but should not be ordered for immediate use as the postal service cannot be relied on to deliver in time.

Pharmacies, GP surgeries, GUM, and sexual health clinics can all provide rapid access to emergency contraception when it is needed.

NHS - Where can I get emergency contraception?

Suitability of Noriday

There is a short online medical questionnaire to ensure treatment is suitable.

Dr Fox cannot supply Noriday if any of the following apply:

• Allergy to norethisterone.
• Lactose intolerance.
• History of breast, ovarian, or uterine (womb) cancer.
• Liver cancer or severe liver disease.
• Previous thrombosis (blood clot).
• Diabetes.
• Epilepsy.
• Tuberculosis.
• Unexplained vaginal bleeding.

Some women who cannot take combined contraceptive pills (combining oestrogen and progestogen) can take POP, including Noriday. If in doubt, discuss with your GP or a specialist sexual health advisor.

Noriday can usually be taken right up to the menopause or the age of 55 years.

Breastfeeding and pregnancy

Breastfeeding women can safely take Noriday. However, women who are exclusively breastfeeding an infant under 6 months of age, and whose periods have not resumed, do not need to take contraception, as this lactational amenorrhoea (LAM) is over 98% effective at preventing pregnancy. If POPs are taken inadvertently during pregnancy, this will not usually adversely affect the pregnancy. A doctor or specialist sexual health advisor should be consulted.

Pros and cons

Pros

• Sex life can continue as normal, pills are taken daily and sex can be spontaneous.
• Can be taken whilst breastfeeding.
• Does not contain oestrogen, which some women cannot take.
• Can be taken by smokers over 35.
• Can reduce the occurrence and intensity of premenstrual syndrome and lighten periods.

Cons

• Must be taken regularly at the same time each day.
• No protection from sexually transmitted infections.
• Irregular bleeding pattern, initially.

Possible side effects

Vaginal bleeding may occur at irregular intervals while using Noriday. This could be light spotting or heavier like a period. There may not be any bleeding at all but some bleeding is very common, especially in the first few months. The bleeding usually improves after taking Noriday for 3 months and continues to improve the longer you take it. If bleeding is very heavy or prolonged you should consult your GP.

Most women can take Noriday without significant side effects. Possible side effects include acne, breast tenderness, increased or decreased sex drive, headache and migraines, though migraines and mood changes often improve on POP. Whilst POPs reduce the total risk of pregnancy, around 1 in 10 pregnancies that do occur may be ectopic.

Alternatives to Noriday

The modern alternative POP to Noriday (norethisterone) is a desogestrel POP, which in most cases is the preferred POP, as it is believed to be the most effective POP contraceptive. Other alternatives include the COC or a Long-acting reversible contraception such as injections, implants, and intrauterine devices or systems.

Other medicines and Noriday

Some medicines may stop Noriday from working properly. These include medicines used for the treatment of:

• Epilepsy (e.g. primidone, phenytoin, carbamazepine, oxcarbazepine, felbamate, and phenobarbital).
• Tuberculosis (e.g. rifampicin).
• HIV infections (e.g. ritonavir), or other infectious diseases (e.g. griseofulvin).
• Stomach upset.
• Depressive moods (the herbal remedy St. John's Wort).

Please speak to your GP about contraception if you are on any of the above medications as Noriday and other POPs may be unsuitable for you or you may need extra monitoring.

For a fuller list of side effects and details of interacting medicines see the patient information leaflets supplied with pills.

Risks

There is a small increased risk of ovarian cysts, but these are not usually dangerous and will usually disappear without treatment.

It is possible that there may be a small increased risk of breast cancer, but at present there is no research evidence of this and the risk would decrease with time after stopping Noriday.

Further information

• NHS - Your contraception guide
• NIHR/UCL - Contraception Choices
• Frequently Asked Questions: Progestogen-only pill