Medroxyprogesterone Acetate Dosing for Transgender Men to Eliminate Menstruation
For transgender men seeking to eliminate menstruation, continuous oral medroxyprogesterone acetate (MPA) should be administered at a dose of 10 mg daily. 1, 2
Dosing Recommendations
The dosing of MPA for menstrual suppression in transgender individuals should follow these guidelines:
- Initial dose: 10 mg oral MPA daily on a continuous regimen
- Administration: Take at the same time each day, preferably at bedtime to minimize side effects like drowsiness
- Duration: Continuous administration without breaks to maintain amenorrhea
This dosing recommendation is based on evidence showing that 10 mg daily is effective for ovulation inhibition, while lower doses of 5 mg may not consistently prevent ovulation in all individuals 1.
Mechanism of Action
MPA works through several mechanisms to eliminate menstruation:
- Inhibits the midcycle luteinizing hormone (LH) surge
- Suppresses ovulation
- Creates atrophic changes in the endometrium
- Thickens cervical mucus
When administered continuously at adequate doses, MPA can effectively suppress menstruation by maintaining progesterone levels that prevent endometrial proliferation and subsequent shedding 3.
Expected Outcomes
When using MPA at 10 mg daily:
- Amenorrhea can be expected in approximately 75% of individuals 4
- Breakthrough bleeding may occur in about 20% of users, particularly during the first few months 4
- Testosterone levels may be significantly reduced, which can be beneficial in transgender men also receiving testosterone therapy 2
Monitoring and Follow-up
- Initial evaluation at 3-6 months after starting therapy
- Annual clinical reviews thereafter 5
- Monitor for:
- Achievement of amenorrhea
- Breakthrough bleeding
- Side effects (mood changes, weight changes, etc.)
- Blood pressure
Potential Side Effects
Common side effects of MPA include:
- Mood swings (reported in about 13% of transgender individuals) 2
- Weight changes
- Headaches
- Breast tenderness
- Decreased bone mineral density with long-term use
Important Considerations
- MPA is not FDA-approved specifically for menstrual suppression in transgender individuals, but is used off-label for this purpose
- For transgender men also on testosterone therapy, MPA may be used initially to ensure complete menstrual suppression, but may eventually be discontinued once testosterone therapy alone achieves amenorrhea
- Natural micronized progesterone has a better safety profile than synthetic progestins like MPA, but may be less effective for complete menstrual suppression 5
Alternative Options
If MPA is not tolerated or contraindicated, consider:
- Continuous combined oral contraceptives
- Levonorgestrel IUD
- GnRH agonists (though these are more expensive and have more side effects)
Remember that the goal of therapy is to eliminate menstruation to reduce gender dysphoria while minimizing side effects and risks to overall health.