Noriday

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Noriday on Prescriptsy

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Noriday is a progestogen-only pill (POP), sometimes called the "mini-pill," containing norethisterone 350 micrograms. It is taken once daily, every day without a break, to prevent pregnancy.

Unlike the combined oral contraceptive pill, Noriday does not contain oestrogen, making it suitable for women who cannot or prefer not to take oestrogen-containing contraceptives.

Noriday is manufactured by Pfizer and is a prescription-only medicine (POM) in the United Kingdom. It is available free of charge on the NHS.

Contraception is a fundamental aspect of reproductive healthcare, enabling women and their partners to plan pregnancies and make informed decisions about family size and timing.

An estimated 3.1 million women in the UK use hormonal contraception, and the progestogen-only pill is one of the most widely used methods, particularly among women who are breastfeeding, have risk factors that preclude oestrogen use, or simply prefer a progestogen-only approach.

This page provides a comprehensive clinical overview of Noriday, including how it works, dosage guidance, side effects, important safety warnings, and how to obtain a prescription in the United Kingdom.

Important safety information about Noriday

• Noriday must be taken at the same time each day, within a 3-hour window. If you are more than 3 hours late, contraceptive protection is reduced.
• Noriday does not protect against sexually transmitted infections. Use condoms for STI protection.
• If you become pregnant while taking Noriday, there is a higher proportion of ectopic pregnancies compared with non-hormonal conception. Seek urgent medical advice if you develop lower abdominal pain, missed periods, or unusual bleeding.
• Enzyme-inducing medicines (including St John's wort) can reduce the effectiveness of Noriday. Use alternative contraception if taking these medicines.
• Noriday is safe to use during breastfeeding from day 1 postpartum.

Understanding progestogen-only contraception

Progestogen-only pills contain a single active hormone: a synthetic progestogen. They differ from combined oral contraceptives (COCs), which contain both an oestrogen and a progestogen.

The absence of oestrogen means that POPs do not carry the same risks of venous thromboembolism (VTE), arterial thromboembolism, or oestrogen-related side effects that are associated with COCs.

This makes the POP suitable for a wider range of women, including those with a history of VTE, migraine with aura, hypertension, smokers over the age of 35, and breastfeeding mothers.

Two types of POP are available in the UK: traditional POPs containing norethisterone 350 micrograms (Noriday, Norgeston containing levonorgestrel) and newer POPs containing desogestrel 75 micrograms (Cerazette, Cerelle, Feanolla, Zelleta).

The key clinical difference is that desogestrel POPs consistently inhibit ovulation (in approximately 97% of cycles), whereas traditional norethisterone POPs inhibit ovulation in only about 50 to 60% of cycles.

This difference has two practical implications: first, desogestrel POPs offer a 12-hour missed pill window compared with the 3-hour window for Noriday; second, bleeding patterns may differ, with desogestrel POPs more likely to cause amenorrhoea.

How Noriday works: mechanism of action

Noriday prevents pregnancy through two primary mechanisms and one secondary mechanism. The primary mechanism is the thickening of cervical mucus.

Norethisterone at the 350-microgram dose causes the cervical mucus to become thicker, more viscous, and less permeable to sperm.

This creates a physical and biochemical barrier that prevents sperm from entering the uterus and reaching the fallopian tubes to fertilise an egg.

This effect is established within approximately 48 hours of starting the POP and is maintained as long as the pill is taken consistently within the 3-hour daily window.

If a dose is late by more than 3 hours, the cervical mucus may begin to thin, and contraceptive protection is reduced.

The second mechanism involves changes to the endometrium (womb lining). Continuous progestogen exposure makes the endometrium thinner and less receptive, reducing the likelihood of implantation should fertilisation occur.

The third mechanism is ovulation suppression, which occurs in approximately half of cycles.

In cycles where ovulation is not suppressed, the cervical mucus and endometrial effects provide the primary contraceptive protection.

The combination of these three mechanisms gives Noriday a Pearl Index of approximately 0.3 to 1.0 with perfect use and approximately 9 with typical use (reflecting the impact of missed or late pills).

The stricter timing requirement compared with desogestrel POPs means that adherence to the 3-hour window is the single most important factor determining effectiveness.

Clinical evidence and UK prescribing guidance

Progestogen-only pills have been available in the UK since the 1970s and are well-established in clinical practice.

The FSRH guideline on progestogen-only pills (updated 2019) provides comprehensive guidance on prescribing, effectiveness, and management.

The guideline notes that all POPs are effective contraceptives when taken correctly and that the choice between a traditional POP (Noriday) and a desogestrel POP (Cerazette) should be based on individual factors including tolerance of the 3-hour timing requirement, bleeding pattern preferences, and previous experience with hormonal contraception.

NICE guidance on contraception recommends that women be offered a choice of methods with clear information about effectiveness, advantages, disadvantages, and side effects.

Long-acting reversible contraceptives (LARCs), including the intrauterine system (Mirena), implant (Nexplanon), and injectable (Depo-Provera), are recommended as first-line options because they do not rely on daily adherence.

However, many women prefer the autonomy and reversibility of oral contraception, and the POP remains a popular choice, particularly for women who want to avoid oestrogen.

Noriday compared with other progestogen-only options

The desogestrel POP (Cerazette, Cerelle, Feanolla) is the most commonly prescribed POP in the UK and has largely replaced traditional POPs in many practices.

Its advantages include consistent ovulation suppression (giving higher efficacy in typical use), a 12-hour missed pill window (more forgiving of timing errors), and a higher rate of amenorrhoea (which some women prefer).

However, some women experience unwanted side effects on desogestrel (such as persistent acne, breast tenderness, or mood changes) and tolerate norethisterone better.

Individual response to different progestogens varies, and switching between them is reasonable if one is not tolerated.

The progestogen-only injectable (Depo-Provera, medroxyprogesterone acetate 150 mg every 13 weeks) provides highly effective contraception without daily adherence but is associated with delayed return of fertility (up to 12 months after the last injection) and possible bone mineral density reduction with prolonged use.

The progestogen-only implant (Nexplanon, etonogestrel) provides up to 3 years of highly effective contraception and is the most effective reversible method available, but it requires insertion and removal by a trained clinician.

The levonorgestrel intrauterine system (Mirena) provides up to 5 years of contraception and dramatically reduces menstrual blood loss but requires fitting by a trained clinician.

Dosage and administration

Take one Noriday tablet daily at the same time, without breaks between packs. When you finish one pack of 28 tablets, start the next pack the following day.

There is no hormone-free interval.

The 3-hour timing window means that if your usual time is 8 AM, you must take the tablet by 11 AM at the latest to maintain full protection.

Setting a daily phone alarm is strongly recommended.

If starting for the first time, begin on day 1 of your menstrual cycle for immediate protection. Starting at any other time requires 2 days of additional contraception.

After childbirth, the FSRH recommends starting on day 21; if breastfeeding, it can be started from day 1.

Detailed missed pill, vomiting, and diarrhoea guidance is provided in the dosage section above.

Side effects of Noriday

Common side effects

Irregular menstrual bleeding is the most common side effect and the leading reason for discontinuation. Patterns may include frequent, prolonged, infrequent, or absent bleeding.

Around 20 to 50% of users experience irregular bleeding in the first few months, which often settles with continued use.

Other common effects include headache, breast tenderness, nausea, mood changes, and acne.

Uncommon and rare side effects

Functional ovarian cysts may develop, as Noriday does not consistently suppress ovulation. These are usually asymptomatic and resolve spontaneously.

If pregnancy occurs on the POP, the proportion of ectopic pregnancies is higher than in non-hormonal conception; symptoms such as one-sided abdominal pain and abnormal bleeding require urgent assessment.

There is no consistent evidence that POPs increase VTE risk. Rare effects include cholestatic jaundice and allergic skin reactions.

When to seek urgent medical advice

Seek immediate medical help if you develop sudden severe lower abdominal pain (possible ectopic pregnancy), persistent heavy bleeding, signs of an allergic reaction (rash, swelling, breathing difficulty), or yellowing of the skin or eyes.

Call 999 if symptoms are severe. Contact your GP or call NHS 111 for persistent mood changes, troublesome irregular bleeding, or pelvic pain.

Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Noriday is contraindicated in known or suspected pregnancy, undiagnosed vaginal bleeding, known or suspected sex-steroid-dependent malignancies (including current breast cancer), severe hepatic impairment, active liver disease or liver tumours, and known hypersensitivity to norethisterone or any excipient.

Special precautions

Women with past breast cancer (5 or more years ago with no recurrence) may use the POP after careful discussion (UKMEC 3).

Women with current breast cancer must not use it (UKMEC 4). Diabetic women should monitor blood glucose more closely when starting Noriday.

The 3-hour missed pill window requires strict adherence; women who struggle with this should consider a desogestrel POP (12-hour window) or a LARC.

Drug interactions

Enzyme-inducing medicines (rifampicin, carbamazepine, phenytoin, phenobarbital, primidone, some antiretrovirals, St John's wort) significantly reduce POP effectiveness.

Women taking these drugs should use an alternative contraceptive method not affected by enzyme induction (copper IUD, injectable, or IUS).

Ulipristal acetate (ellaOne) may reduce POP effectiveness; use additional contraception for 2 days after restarting.

Pregnancy and breastfeeding

Noriday is contraindicated in pregnancy. If pregnancy is suspected, stop the pill and take a pregnancy test. Noriday is safe during breastfeeding from day 1 postpartum.

Only negligible amounts of norethisterone pass into breast milk, and no adverse effects on infants have been observed.

How to get Noriday in the UK

Noriday is a prescription-only medicine available free on the NHS. You can obtain a prescription from your GP, a sexual health clinic, or a contraception clinic.

Some authorised online prescribers registered with the GPhC also provide POP prescriptions. Contraception is free of charge throughout the UK, including England, Scotland, Wales, and Northern Ireland.

Lifestyle advice while taking Noriday

The single most important lifestyle factor is consistent daily timing. Set a phone alarm and keep a spare pack available.

If you travel across time zones, adjust your pill-taking time gradually to maintain the 3-hour window.

Noriday does not interact with alcohol, but excessive alcohol consumption can impair your ability to remember to take the pill on time.

Attend regular cervical screening as invited by the NHS. Be breast-aware and report any changes to your GP.

If you experience bothersome side effects, do not stop the pill without discussing alternatives with your prescriber.

Sources

• Noriday Tablets, Summary of Product Characteristics (EMC)
• Norethisterone, British National Formulary (BNF)
• FSRH Clinical Guideline: Progestogen-Only Pills
• Progestogen-only pill, NHS
• MHRA Yellow Card Scheme