Administering Provera (Medroxyprogesterone) to Patients on Lupron (Leuprolide)
Yes, Provera (medroxyprogesterone acetate) can be safely administered to patients on Lupron (leuprolide acetate) and is sometimes used as part of "add-back therapy" to manage side effects of GnRH agonist treatment.
Rationale for Combined Use
Lupron (leuprolide) is a GnRH agonist that initially stimulates and then suppresses gonadotropin secretion, resulting in decreased sex hormone production. This medication is commonly used for:
- Prostate cancer
- Endometriosis
- Uterine fibroids
- Central precocious puberty
- Fertility treatments 1
Provera (medroxyprogesterone acetate) can be used alongside Lupron for several purposes:
- Add-back therapy: To mitigate side effects of GnRH agonist-induced hypogonadism
- Contraception: When additional contraceptive effect is needed
- Management of breakthrough bleeding: To control irregular bleeding patterns
Evidence Supporting Combined Use
Research has demonstrated that adding medroxyprogesterone to leuprolide treatment can be beneficial:
A study examining long-term treatment of premenstrual syndrome used leuprolide with estrogen and medroxyprogesterone acetate (10 mg/day for 10 days after 4,8, and 12 cycles of GnRH-a therapy) as add-back therapy 2
The combination helped prevent bone density loss and provided endometrial protection while maintaining the therapeutic effects of the GnRH agonist 2
Clinical Considerations
When administering Provera to patients on Lupron, consider:
Dosing and Administration
- Depot medroxyprogesterone acetate (DMPA) is typically given as 150 mg IM injection every 13 weeks (up to 15 weeks) or 104 mg subcutaneously 3
- For add-back therapy with Lupron, oral medroxyprogesterone may be used in cycles (e.g., 10 mg/day for 10 days) 2
Potential Side Effects
- Menstrual irregularities are common initially but typically improve over time 3
- Weight gain may occur in some patients 4, 5
- Bone mineral density effects should be monitored, especially with long-term use 3
Special Populations
For patients with SLE or antiphospholipid antibodies (aPL):
- Progestin-only methods (including Provera) are preferred over combined estrogen-progestin contraceptives in aPL-positive patients 3
- For fertility preservation in SLE patients requiring gonadotoxic therapy, GnRH agonists like Lupron have shown good safety and efficacy profiles 3
Monitoring Recommendations
- Regular assessment of menstrual patterns
- Weight monitoring
- Consider calcium (1300 mg) and vitamin D (600 IU) supplementation and regular weight-bearing exercise for skeletal health 3
- For long-term use, monitor bone mineral density
Contraindications
The combination should be avoided in patients with:
- History of breast cancer
- Active liver disease
- Previous venous thromboembolic events or stroke
- Coronary heart disease 3
For patients with positive aPL, estrogen-containing contraceptives should be avoided, but progestin-only methods like Provera can be considered 3.
In summary, Provera can be safely administered to patients on Lupron, and this combination is sometimes deliberately used to manage side effects of GnRH agonist therapy while maintaining its therapeutic benefits.