From the Guidelines
Provera (medroxyprogesterone acetate) is an effective treatment for abnormal uterine bleeding (AUB), with a recommended regimen of 10 mg orally daily for 10-14 days, as supported by the most recent guidelines 1. For acute management of heavy bleeding, a higher dose of 20 mg three times daily for 7 days can be used. After the initial treatment, cyclic therapy can be continued with 10 mg daily for 10-14 days each month to regulate cycles. To implement this treatment:
- Confirm the diagnosis of AUB and rule out other causes like pregnancy or malignancy, as outlined in the American College of Obstetricians and Gynecologists (ACOG) guidelines 1.
- Prescribe Provera as outlined above.
- Advise patients that withdrawal bleeding typically occurs 3-7 days after stopping the medication.
- Follow up in 1-3 months to assess response and adjust treatment if needed. Provera works by stabilizing the endometrium and inducing organized shedding, counteracting the effects of unopposed estrogen, which can lead to endometrial hyperplasia and irregular bleeding, as described in the management of bleeding irregularities while using contraception 1. The treatment options for AUB should be based on the patient's preferences, treatment goals, and medical history, and may include hormonal treatment, nonsteroidal anti-inflammatory drugs (NSAIDs), or antifibrinolytic agents, as outlined in the U.S. selected practice recommendations for contraceptive use, 2024 1.
From the FDA Drug Label
Medroxyprogesterone acetate inhibits (in the usual dose range) the secretion of pituitary gonadotropin which, in turn, prevents follicular maturation and ovulation. Because of its prolonged action and the resulting difficulty in predicting the time of withdrawal bleeding following injection, medroxyprogesterone acetate is not recommended in secondary amenorrhea or dysfunctional uterine bleeding.
The use of Provera (medroxyprogesterone) in Abnormal Uterine Bleeding (AUB) is not recommended due to its prolonged action and the resulting difficulty in predicting the time of withdrawal bleeding following injection, as stated in the drug label 2.
From the Research
Use of Provera (Medroxyprogesterone) in Abnormal Uterine Bleeding (AUB)
- Provera (medroxyprogesterone) is used to treat abnormal uterine bleeding (AUB) in various patient populations, including adolescents, women of reproductive age, and perimenopausal women 3.
- In adolescents, medroxyprogesterone acetate is administered orally once a day for 10 days each month for at least 3 months to manage anovulatory dysfunctional uterine bleeding 3.
- For women of reproductive age with anovulatory bleeding, oral medroxyprogesterone acetate is administered for 10 days each month for 6 months 3.
- In perimenopausal patients, dysfunctional uterine bleeding may be treated with cyclic progestin or cyclic conjugated equine estrogens for 25 days, along with concomitant administration of medroxyprogesterone acetate for days 18 to 25 3.
- A study comparing two different duration regimens of medroxyprogesterone acetate found that a 10-day regimen was more effective in regulating menstrual cycles and stopping AUB-O (abnormal uterine bleeding due to ovulatory dysfunction) than a 15-day regimen 4.
- Medroxyprogesterone acetate has also been used in combination with other therapies, such as non-steroidal anti-inflammatory drugs, antifibrinolytic agents, and gonadotropin-releasing hormone agonists, to manage AUB 5, 6.
- A pilot study found that a progestogen-only treatment regimen using depo-medroxyprogesterone acetate and oral medroxyprogesterone acetate was effective in stopping acute abnormal uterine bleeding in nonpregnant, premenopausal women 7.
Patient Populations and Treatment Regimens
- The choice of treatment regimen and patient population depends on various factors, including the underlying cause of AUB, patient age, and medical history 3, 4, 5, 6, 7.
- Hormonal therapies, including progestin-only preparations and combined hormonal contraceptives, are commonly used to treat AUB, especially in women with ovulatory dysfunction and endometrial causes of bleeding 6.