Is Depo Provera (medroxyprogesterone) effective for treating endometriosis?

Depo-Provera for Endometriosis Treatment

Depot medroxyprogesterone acetate (DMPA, Depo-Provera) is effective for treating endometriosis-associated pain and is recommended as a viable treatment option for endometriosis management. 1

Mechanism and Efficacy

DMPA works by:

• Suppressing ovulation and reducing estrogen levels
• Creating a hypoestrogenic environment that inhibits endometriotic lesion growth
• Providing consistent hormonal suppression to reduce inflammation and pain

Studies have demonstrated that DMPA is effective for managing endometriosis symptoms:

• DMPA has been shown to be effective for endometriosis-associated pain 1
• In comparative studies, DMPA was found to be as effective as GnRH agonists (leuprolide) in reducing endometriosis symptoms 2
• A randomized controlled trial showed that 91.8% of patients with DMPA achieved regression of endometrial hyperplasia compared to 67.1% with norethisterone acetate 3

Administration and Dosing

• DMPA is administered as a single injection every 13 weeks (up to 15 weeks) using a dose of either 150 mg intramuscular or 104 mg subcutaneous 4
• The subcutaneous formulation (DMPA-SC 104) has been specifically studied for endometriosis treatment 2
• Treatment duration typically involves multiple injections over months to maintain symptom control

Advantages of DMPA for Endometriosis

1. Convenience: Single injection every 3 months improves compliance compared to daily medications 4
2. Bone health: Less impact on bone mineral density compared to GnRH agonists 2
3. Additional benefits:
   • Improvement in dysmenorrhea
   • Protection against iron-deficiency anemia
   • Protection against endometrial cancer 4
4. Long-term maintenance: Effective for long-term therapy after conservative surgery to prevent recurrence 5

Potential Side Effects and Considerations

• Menstrual irregularities: Nearly all patients experience this initially, but it typically improves over time 4
• Weight changes: Some patients may experience weight gain, with approximately 21% experiencing early weight gain (>5% at 6 months) 4
• Delayed return to fertility: Typically 9-18 months after discontinuation 4
• Bone mineral density: While there are concerns about BMD loss with long-term use, studies comparing DMPA to GnRH agonists show less BMD impact with DMPA 2

Comparative Effectiveness

• A randomized controlled trial showed that 72.5% of patients were satisfied with DMPA treatment for endometriosis-associated pain after 1 year of therapy 6
• When compared to combined oral contraceptives with very-low-dose danazol, DMPA showed better control of dysmenorrhea at 1-year assessment 6
• In a comparison with levonorgestrel-releasing intrauterine system (LNG-IUS), both treatments were effective for symptom control and recurrence prevention, though LNG-IUS showed better compliance and positive effects on bone mineral density 5

Patient Selection and Monitoring

DMPA may be particularly suitable for:

• Patients with moderate to severe endometriosis pain
• Those who prefer less frequent dosing
• Patients with contraindications to estrogen-containing therapies
• Women who have had conservative surgery and need maintenance therapy

Monitoring recommendations:

• Regular assessment of symptom control
• Counseling about potential menstrual changes before initiation
• Calcium and vitamin D supplementation (at least 1300 mg calcium and 600 IU vitamin D daily) 4
• Weight-bearing exercise to promote skeletal health 4

In conclusion, DMPA represents an effective, safe, and convenient treatment option for endometriosis-associated pain, with efficacy comparable to other hormonal treatments but with the advantage of less frequent administration.