From the Guidelines
For managing breakthrough bleeding in patients on Hormone Replacement Therapy (HRT), the recommended dose of medroxyprogesterone is 200 mg for 12–14 days every 28 days, as this regimen has been shown to provide endometrial protection and a lower risk of cardiovascular disease and venous thromboembolism 1. When considering the treatment of breakthrough bleeding in HRT users, it's essential to choose a progestin that not only controls bleeding but also minimizes risks.
- Medroxyprogesterone (MP) is considered the first choice among progestins due to its favorable profile, including lower risks of cardiovascular disease and venous thromboembolism when administered cyclically 1.
- The dose of 200 mg of MP for 12–14 days every 28 days is specified for sequential regimens, which are commonly used to manage breakthrough bleeding in HRT users.
- It's crucial to note that the choice of progestin and the regimen should be individualized based on patient factors, including the presence of any contraindications or preferences.
- Other options like MPA, dydrogesterone, or norethisterone may be considered as second choices, but their use should be guided by the specific clinical context and patient needs 1.
- The management of breakthrough bleeding should also include monitoring for any adverse effects and adjusting the treatment as necessary to ensure the best possible outcomes for the patient.
From the Research
Medroxyprogesterone Dose for Breakthrough Bleeding Whilst Taking HRT
- The recommended dose of medroxyprogesterone for managing breakthrough bleeding in patients on Hormone Replacement Therapy (HRT) is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 4 compares the effectiveness of levonorgestrel-releasing intrauterine system (LNG-IUS) with oral medroxyprogesterone acetate (10 mg/d orally for 12 days a month for 3 months) in treating endometrial hyperplasia.
- Study 5 mentions that most progestogens, including medroxyprogesterone, were only available as oral formulations, and most studies demonstrated endometrial protection for the progestogen dose and time period examined.
- The studies suggest that progestogens, including medroxyprogesterone, are used to prevent endometrial hyperplasia in women taking HRT, but the optimal dose for managing breakthrough bleeding is not specified 2, 3, 5, 6.
Comparison of Medroxyprogesterone with Other Progestogens
- Study 4 found that the treatment response rate was higher in the LNG-IUS group (89.3%) compared to the medroxyprogesterone group (70.4%).
- Study 6 found that LNG-IUS achieved a highly significant therapeutic response rate compared with oral progestins, including medroxyprogesterone, after 3,6,12, and 24 months of treatment.
- The studies suggest that LNG-IUS may be a more effective treatment option for endometrial hyperplasia compared to oral medroxyprogesterone 4, 6.