From the FDA Drug Label
DOSAGE AND ADMINISTRATION The suspension is intended for intramuscular administration only. Endometrial or renal carcinoma— doses of 400 mg to 1000 mg of DEPO-PROVERA Sterile Aqueous Suspension per week are recommended initially. The FDA drug label does not answer the question.
From the Research
The recommended dose of medroxyprogesterone acetate (MPA) for managing postmenopausal bleeding with negative endometrial samples is typically 10 mg daily for 10-14 days per month, or 20 mg daily for 12-14 days per month in a cyclic regimen. This treatment is usually continued for 3-6 months, with follow-up evaluation to assess response. For women who cannot tolerate oral medication, MPA is also available as an injectable form (Depo-Provera) at 150 mg intramuscularly every 3 months. The goal of MPA therapy is to stabilize the endometrium and reduce abnormal bleeding by counteracting unopposed estrogen stimulation, which is often the cause of postmenopausal bleeding.
Some key points to consider when using MPA for postmenopausal bleeding include:
- Close monitoring is necessary, even with negative endometrial samples, as persistent bleeding despite treatment warrants further investigation, possibly including hysteroscopy 1.
- Side effects may include breast tenderness, bloating, mood changes, and headaches.
- Before starting treatment, a thorough evaluation including transvaginal ultrasound to measure endometrial thickness is recommended to rule out endometrial hyperplasia or malignancy.
- The choice of dose and regimen may depend on individual patient factors, such as the presence of other medical conditions or the use of other medications.
It's worth noting that the evidence for MPA use in postmenopausal bleeding is based on studies such as those by 2 and 3, which demonstrated the efficacy and safety of MPA in reducing bleeding and protecting the endometrium. However, the most relevant and recent study for this specific question is 1, which provides guidance on the optimal dosing regimen for MPA in postmenopausal women with negative endometrial samples.