Recommended Dose of Oral Medroxyprogesterone Acetate (Provera)
For endometrial protection in postmenopausal women with a uterus taking estrogen, use medroxyprogesterone acetate 5-10 mg daily for 12-14 days per month (cyclic regimen) or 2.5 mg daily (continuous regimen). 1
Dosing by Clinical Indication
Endometrial Protection (Most Common Use)
The FDA-approved dosing and clinical guidelines clearly establish two regimens 2:
Cyclic regimen:
- 5-10 mg daily for 12-14 consecutive days per month while taking continuous estrogen
- This produces monthly withdrawal bleeding but provides superior endometrial protection
- Clinical trials demonstrate 10 mg for 12 days reduced endometrial hyperplasia from 28% to 3% compared to estrogen alone 2
Continuous combined regimen:
- 2.5 mg daily taken continuously with estrogen
- Aims for amenorrhea (though breakthrough bleeding common initially)
- Associated with reduced endometrial cancer risk over 13 years of follow-up 3
Abnormal Uterine Bleeding or Absent Periods
5-10 mg daily for 5-10 days 2
- This induces withdrawal bleeding in women with anovulation
- Higher doses (60-120 mg first day, then 20 mg daily for 10 days) have been used for acute heavy bleeding in adolescents, stopping bleeding within 24-96 hours 4
Endometriosis Treatment
30-50 mg daily for 90 days 5, 6
- Research shows 30 mg daily effective for minimal-to-moderate endometriosis
- 50 mg daily used for moderate-to-severe disease with 80% symptom improvement
Critical Dosing Considerations
The 10-12 day duration matters: Progestogen must be given for at least 12 days per month to adequately protect the endometrium 3, 1. Shorter durations or long-cycle therapy (every 3 months) lack validation and may increase endometrial cancer risk 3, 1.
Dose-dependent ovulation suppression: 5 mg daily does NOT reliably suppress ovulation in all women, while 10 mg daily consistently inhibits ovulation 7. This is relevant if contraception is a goal.
Start with lowest effective dose: For menopausal hormone therapy, begin with 2.5 mg continuous or 5 mg cyclic, escalating to 10 mg cyclic only if breakthrough bleeding persists or endometrial monitoring indicates inadequate protection 1.
Important Safety Warnings
Recent evidence shows prolonged depot MPA (injection) use >4 years or starting after age 31 increases meningioma risk (RR 2.43) 8, 9. While oral MPA shows lower risk (RR 1.18), this warrants caution with extended use beyond 5 years 8. The number needed to harm is high (3,020 for oral), but patients should be counseled about this emerging risk, particularly with long-term use.
Never use MPA alone without estrogen in postmenopausal women unless treating specific conditions like endometriosis or abnormal bleeding. The combination with estrogen is what provides cardiovascular and bone benefits while the progestogen protects the endometrium 3, 1.