Alternatives to Aygestin If You Can't Fill Your Prescription

When your pharmacy tells you they don't have Aygestin (Norethindrone Acetate) in stock — and you're running low — it's natural to feel anxious. This is a medication that many women depend on daily for conditions like endometriosis, abnormal uterine bleeding, or secondary amenorrhea. Going without it isn't really an option.

The good news is that there are legitimate alternatives your doctor can prescribe. But here's the important part: never switch medications on your own. Always talk to your prescriber before changing to a different drug, even if it's in the same class.

This guide covers what Aygestin does, how it works, and which alternatives might be right for you.

What Is Aygestin?

Aygestin is the brand name for Norethindrone Acetate, a synthetic progestin. It comes as a 5 mg oral tablet and is prescribed for three main conditions:

• Endometriosis: It causes the ectopic endometrial tissue to shrink, reducing pain and inflammation.
• Secondary amenorrhea: It helps trigger a period in women who have stopped menstruating (for reasons other than pregnancy or menopause).
• Abnormal uterine bleeding: It stabilizes the endometrial lining to reduce heavy or irregular bleeding caused by hormonal imbalance.

For a complete overview, read our article on what Aygestin is, its uses, and dosage.

How Does Aygestin Work?

Norethindrone Acetate works by mimicking the hormone progesterone in your body. It:

• Induces secretory changes in the endometrial lining
• Suppresses ovulation in many patients
• Thins the endometrial tissue, both in the uterus and in ectopic locations (endometriosis)
• Alters cervical mucus

It's the acetic acid ester of norethindrone and is twice as potent as norethindrone on a weight-for-weight basis. This is important to understand because norethindrone (0.35 mg, used in mini-pills like Camila or Errin) is a different product and is not interchangeable with Norethindrone Acetate 5 mg.

Learn more in our detailed explainer: How does Aygestin work?

Alternative #1: Medroxyprogesterone Acetate (Provera)

Medroxyprogesterone Acetate (MPA), sold under the brand name Provera, is the most commonly prescribed alternative to Norethindrone Acetate. Like Aygestin, it's a synthetic progestin available in oral tablet form.

How It's Used

• Amenorrhea: 5 to 10 mg daily for 5 to 10 days
• Abnormal uterine bleeding: 5 to 10 mg daily for 5 to 10 days, starting on day 16 or 21 of the menstrual cycle
• Endometrial protection: 2.5 to 5 mg daily (continuous) when used with estrogen therapy

Pros

• Widely available and very affordable (generic typically costs $4 to $15 for a 30-day supply)
• Extensive clinical track record
• FDA-approved for similar indications

Cons

• May not be as effective as Norethindrone Acetate for endometriosis pain in some patients
• Similar side effect profile (weight gain, mood changes, breakthrough bleeding)

Alternative #2: Levonorgestrel IUD (Mirena)

The Mirena IUD releases levonorgestrel, a progestin, directly into the uterus. It's FDA-approved for heavy menstrual bleeding and is widely used off-label for endometriosis.

How It's Used

• Inserted by a healthcare provider in an office visit
• Provides continuous progestin therapy for up to 8 years
• Delivers medication locally to the uterus with minimal systemic absorption

Pros

• Set-it-and-forget-it — no daily pills to remember
• Lower systemic side effects than oral progestins
• Highly effective for reducing heavy bleeding
• Also provides contraception

Cons

• Requires a healthcare provider visit for insertion and removal
• May not be appropriate for all endometriosis patients, especially those with disease outside the pelvis
• Upfront cost can be higher ($0 to $1,300 depending on insurance), though most insurance plans cover it

Alternative #3: Megestrol Acetate (Megace)

Megestrol Acetate is another synthetic progestin sometimes used for endometrial conditions. It's available in oral tablet and liquid forms.

How It's Used

• Doses vary widely depending on the condition (40 to 320 mg daily)
• More commonly used for endometrial hyperplasia or cancer than for the conditions Aygestin treats

Pros

• Available in liquid form for patients who have difficulty swallowing tablets
• Can be effective for endometrial hyperplasia

Cons

• Not FDA-approved for endometriosis or amenorrhea
• Higher risk of weight gain and appetite stimulation compared to other progestins
• Not a first-line alternative for most patients switching from Aygestin

Alternative #4: Elagolix (Orilissa)

Elagolix, sold as Orilissa, is a newer medication specifically FDA-approved for moderate to severe endometriosis pain. It works differently from progestins — it's a GnRH antagonist that reduces estrogen levels.

How It's Used

• 150 mg once daily (for up to 24 months) or 200 mg twice daily (for up to 6 months)
• Oral tablet taken by mouth

Pros

• Specifically designed and approved for endometriosis pain
• Different mechanism of action — may work when progestins haven't been effective
• Oral tablet form (no procedures needed)

Cons

• Significantly more expensive — can cost $900 to $1,000+ per month without insurance
• Reduces estrogen, which can cause bone density loss with long-term use
• Not appropriate for amenorrhea or abnormal uterine bleeding
• May require prior authorization from insurance

How to Decide Which Alternative Is Right for You

The best alternative depends on why you're taking Aygestin:

• For amenorrhea or abnormal bleeding: Medroxyprogesterone Acetate (Provera) is usually the most straightforward switch.
• For endometriosis: Provera, Mirena, or Orilissa may all be options, depending on your symptoms and treatment history.
• If cost is a concern: Generic Medroxyprogesterone is typically the most affordable option at around $4 to $15 per month.

Your doctor knows your medical history and can recommend the best fit. Don't be afraid to ask about side effects, cost, and how the alternative compares to what you've been taking.

Final Thoughts

Not being able to fill your Aygestin prescription is stressful, but you have options. Several effective alternatives exist, and your healthcare provider can help you find one that works for your specific situation.

Before switching, try using Medfinder to see if Norethindrone Acetate is available at a pharmacy near you — the shortage may not affect every location. And for more background on why Aygestin can be hard to locate, read why Aygestin is so hard to find in 2026.