From the Guidelines
If there is no withdrawal bleed after taking Provera, the next step is to have a pregnancy test if it has been 3 weeks, as recommended by the U.S. selected practice recommendations for contraceptive use, 2013 1. This approach prioritizes ruling out pregnancy as a cause for the lack of withdrawal bleeding, which is a critical step given the potential consequences of an undiagnosed pregnancy.
- The recommendation to wait for 3 weeks before testing for pregnancy allows for the detection of pregnancy at a stage when it can be most accurately confirmed.
- After pregnancy has been ruled out, further evaluation may include assessing hormone levels and potentially conducting a pelvic ultrasound to investigate other causes of amenorrhea, such as low estrogen levels or uterine abnormalities.
- It is essential to consult with a healthcare provider for personalized guidance, as the absence of withdrawal bleeding can be due to various factors, including polycystic ovary syndrome (PCOS), hypothalamic dysfunction, premature ovarian insufficiency, or anatomical abnormalities.
- The healthcare provider may consider alternative treatments or adjustments to the current regimen based on the results of these evaluations, emphasizing the importance of a comprehensive approach to managing amenorrhea.
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 FDA drug label does not answer the question.
From the Research
Next Steps After No Withdrawal Bleed Following Provera
If there is no withdrawal bleed after taking Provera (medroxyprogesterone acetate), the following steps can be considered:
- Evaluate the patient's medical history and current health status to determine the cause of the absent withdrawal bleed 2, 3.
- Consider alternative treatments, such as switching to a different contraceptive method or adding estrogen therapy, to induce vaginal bleeding 2.
- Monitor the patient's endometrial thickness and assess for any potential risks or complications associated with the absence of withdrawal bleeding 3, 4.
- If the patient is experiencing abnormal uterine bleeding, consider treatment with ormeloxifene or medroxyprogesterone acetate to reduce bleeding and improve hemoglobin levels 4.
Potential Causes and Risks
The absence of withdrawal bleeding after Provera may be related to various factors, including:
- Duration of Provera use and amenorrhea 2
- Body mass index (BMI) of the patient 2
- Presence of underlying medical conditions, such as polycystic ovary syndrome (PCOS) or thyroid disorders 3
- Potential risks associated with the absence of withdrawal bleeding, including endometrial hyperplasia or cancer 5
Treatment Options
Treatment options for patients with no withdrawal bleed after Provera may include:
- Switching to a different contraceptive method, such as Cyclofem 2
- Adding estrogen therapy to induce vaginal bleeding 2
- Using ormeloxifene or medroxyprogesterone acetate to reduce abnormal uterine bleeding 4
- High-dose oral medroxyprogesterone acetate therapy for patients with atypical endometrial hyperplasia or endometrial cancer 5