Compare Aygestin (Norethindrone) with Alternatives for Hormone Therapy

When you’re prescribed Aygestin (norethindrone), it’s usually because your body needs extra progesterone - whether to regulate your cycle, treat endometriosis, or manage abnormal bleeding. But Aygestin isn’t the only option. Many women wonder: Aygestin vs. what? Is there something better, cheaper, or easier to tolerate? The answer isn’t one-size-fits-all. It depends on your symptoms, side effects, budget, and what your body responds to.

What Aygestin Actually Does

Aygestin contains norethindrone, a synthetic version of progesterone. Unlike estrogen-based birth control, it works alone. That makes it a go-to for women who can’t take estrogen - maybe because of migraines with aura, blood clots, or breast cancer history. It thickens cervical mucus, thins the uterine lining, and sometimes stops ovulation. Doses vary: 5 mg daily for endometriosis, 2.5-10 mg for bleeding issues, and higher doses for certain cancers.

Side effects are common but usually mild: bloating, headaches, mood swings, spotting, or weight gain. About 1 in 5 women stop taking it because of these. That’s why alternatives matter.

Provera (Medroxyprogesterone Acetate)

Provera is the most direct alternative. It’s also a synthetic progesterone, but chemically different from norethindrone. Many doctors switch patients from Aygestin to Provera if side effects don’t improve. Provera is often cheaper - generic versions cost as little as $10 a month at Walmart or Costco. It’s taken for 5-10 days a month to trigger a period, or daily for continuous therapy.

But Provera has a reputation for causing more fatigue and depression than norethindrone. A 2023 study in the Journal of Women’s Health found that 27% of women on Provera reported low mood, compared to 18% on norethindrone. If you’re already feeling anxious or low, this might not be your best bet.

Oral Contraceptives with Progestin (like Loestrin, Alesse, or Ortho Tri-Cyclen)

These combine estrogen and progestin. They’re not pure progesterone pills like Aygestin, but they’re often used for the same reasons - irregular periods, heavy bleeding, acne, or PMS. If you’re okay with estrogen, these can be more effective at regulating cycles. They also offer predictable monthly bleeding, which some women prefer.

The downside? Estrogen increases risk of blood clots, especially in women over 35, smokers, or those with high blood pressure. If you’ve been told you can’t take estrogen, these aren’t options. But if you can, they’re often more effective than Aygestin alone for cycle control.

Levonorgestrel IUD (Mirena, Liletta, Kyleena)

For long-term relief, the levonorgestrel IUD is a game-changer. It releases a tiny amount of progestin directly into the uterus - no daily pills. Within 3-6 months, most women see dramatically lighter periods, or none at all. It’s 99% effective for birth control and lasts 3-7 years depending on the brand.

Studies show 85% of women with heavy bleeding report improvement within 6 months. Side effects? Spotting in the first few months, cramping, and rare expulsion. But once you’re past that, many say it’s life-changing. Cost-wise, the upfront price is high ($800-$1,300), but insurance usually covers it. Over time, it’s far cheaper than buying pills every month.

Tranexamic Acid (Lysteda)

This isn’t a hormone. It’s a non-hormonal option for heavy menstrual bleeding. Tranexamic acid works by helping blood clot - it doesn’t change your hormones at all. You take it only during your period, usually 3-4 days a month. No daily pills. No mood swings. No weight gain.

A 2022 trial in Obstetrics & Gynecology showed women using tranexamic acid reduced blood loss by 40-50%. It’s especially good if your main problem is bleeding, not pain or irregular cycles. Side effects are rare - maybe a headache or stomach upset. But if you have a history of blood clots, you can’t use it.

Endometrial Ablation

If pills and IUDs haven’t worked and you’re done having kids, ablation might be worth considering. This is a minor procedure - done in a doctor’s office - that destroys the uterine lining. No hormones needed. Most women have much lighter periods or stop bleeding altogether.

It’s not birth control. You still need contraception afterward. But for women who’ve tried multiple hormone options and still bleed heavily, ablation can be the final solution. Recovery is quick - a day or two of cramping. Success rates are around 90% for reducing bleeding.

Choosing the Right Alternative

Here’s how to decide:

• Want to avoid estrogen? Stick with progestin-only options: Aygestin, Provera, or the IUD.
• Need cycle control? Combination birth control pills may work better than Aygestin alone.
• Just want to stop heavy bleeding? Try tranexamic acid first - it’s fast, non-hormonal, and low-risk.
• Want long-term relief? The IUD lasts years and often eliminates monthly pills entirely.
• Done with periods and kids? Ablation is a permanent fix - no drugs, no daily routine.

Cost matters too. Aygestin can run $60-$100 a month without insurance. Provera? $10-$20. The IUD? $0-$1,300 upfront, then nothing for years. Tranexamic acid? Around $50-$80 a month, but you only take it 3-4 days a month.

What Not to Do

Don’t switch from Aygestin to something else on your own. Hormonal changes can trigger breakthrough bleeding, mood crashes, or even ovulation if you’re using it for birth control. Always talk to your doctor first.

Also, don’t assume cheaper means better. Provera might cost less, but if it makes you feel worse, it’s not a win. The best option is the one you can stick with - and that’s different for everyone.

Real Stories, Real Results

Sarah, 34, from Halifax, switched from Aygestin to the Mirena IUD after 18 months of spotting and irritability. "I thought I’d miss the pill routine, but I forgot I had it. No more daily pills, no mood swings. My periods stopped. It’s the best thing I’ve done for my health."

Janet, 41, had heavy bleeding for years. She tried Aygestin, then Provera. Neither helped much. Her doctor suggested tranexamic acid. "I take two pills during my period, and the bleeding drops to normal. No side effects. I don’t feel like I’m on hormones anymore."

These aren’t outliers. They’re common outcomes. The key is matching the treatment to your life, not just your diagnosis.

When to Ask for a Second Opinion

If you’ve tried two or more alternatives and still have symptoms, ask for a referral to a reproductive endocrinologist. Sometimes what looks like a hormone problem is actually PCOS, thyroid issues, or fibroids. Blood tests and ultrasounds can rule those out.

Don’t settle for "this is just how it is." There’s almost always another option.

Next Steps

Write down your biggest problem: Is it bleeding? Pain? Mood? Cost? Then list your top three alternatives based on what you’ve read. Bring that list to your next appointment. Ask: "Which of these makes the most sense for me?" Don’t let fear of change keep you stuck. The right option is out there - you just need to find your fit.