What are all the ways to administer Provera (medroxyprogesterone) for amenorrhea?

Administration Methods for Medroxyprogesterone (Provera) in Amenorrhea

For secondary amenorrhea, medroxyprogesterone acetate (Provera) should be administered orally at 5-10 mg daily for 5-10 days to induce withdrawal bleeding. 1

Oral Administration Options

Standard Regimen for Secondary Amenorrhea

• Dosage: 5-10 mg daily
• Duration: 5-10 days
• Timing: Can be started at any time in cases of secondary amenorrhea
• Expected outcome: Withdrawal bleeding typically occurs within 3-7 days after discontinuing therapy 1

Optimum Secretory Transformation Regimen

• Dosage: 10 mg daily
• Duration: 10 days
• Timing: For endometrium adequately primed with estrogen (either endogenous or exogenous)
• Purpose: To produce optimal secretory transformation of the endometrium 1

Cyclic Regimen for Recurrent Abnormal Bleeding

• Dosage: 5-10 mg daily
• Duration: 5-10 days
• Timing: Beginning on day 16 or day 21 of the menstrual cycle
• Benefit: Patients with recurrent episodes of abnormal uterine bleeding may benefit from planned menstrual cycling 1

Alternative Administration Methods

Twice Daily Dosing

• Dosage: 5 mg twice daily (total 10 mg/day)
• Duration: 5 days
• Efficacy: 93% withdrawal bleeding response rate 2
• Note: This regimen showed similar efficacy to dydrogesterone 10 mg twice daily

Postmenopausal Women with Endometrial Hyperplasia

• Dosage: 5-10 mg daily
• Duration: 12-14 consecutive days per month
• Timing: Beginning on day 1 or day 16 of the cycle
• Purpose: For women receiving daily 0.625 mg conjugated estrogens 1

Factors Affecting Treatment Success

• Endometrial thickness: Significantly correlates with bleeding response 2
• Endogenous estrogen levels: Limited predictive value for withdrawal bleeding 2
• Duration of treatment: Longer duration may increase amenorrhea rates in continuous regimens 3

Clinical Considerations

• Withdrawal bleeding typically occurs within 3-7 days after discontinuing medroxyprogesterone therapy 1
• For patients with recurrent abnormal uterine bleeding, planned menstrual cycling with medroxyprogesterone may be beneficial 1
• Endometrial thickness as measured by transvaginal sonography correlates significantly with bleeding response 2
• The lowest effective dose should be used, starting with 5 mg daily and increasing if needed 1

Monitoring and Follow-up

• If amenorrhea persists despite treatment and is unacceptable to the patient, consider alternative contraceptive methods 4
• If a woman's regular bleeding pattern changes abruptly to amenorrhea, consider ruling out pregnancy if clinically indicated 4
• For persistent or recurring abnormal vaginal bleeding, adequate diagnostic measures such as endometrial sampling should be undertaken to rule out malignancy 1

Common Side Effects

• Headaches
• Hot flashes
• Irregular bleeding initially
• Breast tenderness
• Nausea

By following these administration protocols for medroxyprogesterone in amenorrhea, clinicians can effectively induce withdrawal bleeding in most patients while minimizing side effects.