What is the proper usage and dosage of Provera (medroxyprogesterone acetate)?

Proper Usage and Dosage of Provera (Medroxyprogesterone Acetate)

Medroxyprogesterone acetate (Provera) should be administered according to specific indications, with subcutaneous depot medroxyprogesterone acetate (DMPA-SC) now recommended as a self-administered option for contraception at 104 mg every 13 weeks. 1

Contraceptive Use

Depot Medroxyprogesterone Acetate (DMPA) for Contraception

• DMPA is administered every 13 weeks (up to 15 weeks without requiring additional contraceptive protection) 1
• Two formulations are available:
  • Intramuscular (DMPA-IM): 150 mg deep intramuscular injection 1, 2
  • Subcutaneous (DMPA-SC): 104 mg subcutaneous injection 1
• Self-administered DMPA-SC is now recommended as an additional approach to deliver injectable contraception, alongside provider-administered options 1
• First-year typical use pregnancy rate is approximately 6% 1

Administration Considerations

• DMPA can be initiated on the same day as the visit ("quick start") if pregnancy is reasonably ruled out 1
• Backup contraception (condoms or abstinence) should be used for at least the first week after initiation 1
• No routine follow-up is required, but patients should be encouraged to contact their provider for side effects, desire to change methods, or questions about re-injection 1
• For self-administration, patients need proper instruction on injection technique and sharps disposal 1

Hormone Replacement Therapy

For Premature Ovarian Insufficiency

• When used as part of hormone replacement therapy, MPA can be administered:
  • 10 mg daily for 12-14 days per month in sequential regimens 1
  • 2.5 mg daily in continuous regimens 1
• Can be combined with estrogen (typically 17β-estradiol) for hormone replacement therapy 1

Treatment of Gynecological Conditions

Endometriosis

• Oral dosage: 50 mg daily for treatment courses of several months 3, 4
• Injectable DMPA (150 mg every 3 months) is effective for long-term management of endometriosis-associated pelvic pain 4

Endometrial or Renal Carcinoma

• Initial dosage: 400 mg to 1000 mg per week administered intramuscularly 5
• Maintenance dosage: May be reduced to 400 mg per month if improvement is noted 5
• Used as adjunctive and palliative treatment in advanced inoperable cases 5

Side Effects and Monitoring

Common Side Effects

• Menstrual irregularities (nearly universal initially, often improving over time) 1, 2
• Weight gain (variable among patients) 1
• Headache, breast tenderness, hair loss, and changes in libido 1

Bone Health Considerations

• DMPA causes reductions in bone mineral density 1
• FDA black-box warning exists regarding decreased BMD among DMPA users 1
• Substantial recovery of BMD occurs after discontinuation 1

Special Considerations

• Pre-use counseling is essential to minimize the impact of menstrual changes 2
• Self-administered DMPA-SC should be offered through shared decision-making, focusing on patient preferences 1
• For contraceptive use, DMPA is independent of intercourse and requires only remembering quarterly injections 2
• When used for cancer treatment, medroxyprogesterone acetate is not recommended as primary therapy 5
• High-dose MPA (≥500-1000 mg/day IM) has been used for advanced breast cancer treatment with approximately 30% objective remission rate 6

Practical Administration Tips

• For self-administered DMPA-SC, provide clear instructions on injection technique and proper disposal of needles 1
• When using multi-dose vials, special care to prevent contamination is essential 5
• Consider scheduling follow-up visits at 11-12 weeks for adolescents to allow for missed or delayed visits 1