What is the recommended dosage and treatment duration for Medroxyprogesterone (a progestin)?

Recommended Dosage and Treatment Duration for Medroxyprogesterone

The recommended dosage of medroxyprogesterone acetate varies by indication, with 5-10 mg daily for 5-10 days being appropriate for secondary amenorrhea and abnormal uterine bleeding, while 10 mg daily for 12-14 days per month is recommended when used with estrogen therapy in postmenopausal women. 1

Dosage Recommendations by Indication

Secondary Amenorrhea

• 5-10 mg daily for 5-10 days 1
• Progestin withdrawal bleeding typically occurs within 3-7 days after discontinuing therapy 1
• Treatment can be initiated at any time in cases of secondary amenorrhea 1

Abnormal Uterine Bleeding Due to Hormonal Imbalance

• 5-10 mg daily for 5-10 days, beginning on the calculated 16th or 21st day of the menstrual cycle 1
• For optimal secretory transformation of the endometrium, 10 mg daily for 10 days beginning on the 16th day of the cycle is suggested 1
• Patients with recurrent episodes of abnormal uterine bleeding may benefit from planned menstrual cycling with medroxyprogesterone acetate 1

Hormone Replacement Therapy (HRT) in Postmenopausal Women

• 5-10 mg daily for 12-14 consecutive days per month when used with daily 0.625 mg conjugated estrogens 1
• Can be started on either the 1st or 16th day of the cycle 1
• For sequential regimens in women with premature ovarian insufficiency (POI), 10 mg daily for 12-14 days per month is recommended 2
• For continuous regimens, 2.5 mg daily is suggested 2

Endometrial Cancer Prevention

• When used as part of fertility-preserving therapy for endometrial cancer, higher doses of 400-600 mg/day of medroxyprogesterone acetate or 160-320 mg/day of megestrol acetate are recommended 2

Injectable Contraception (DMPA)

• 150 mg intramuscularly or 104 mg subcutaneously every 13 weeks (up to 15 weeks) 2
• Self-administered subcutaneous DMPA is now available as an additional approach to deliver injectable contraception 2

Treatment Duration

For Menstrual Disorders

• Short-term treatment of 5-10 days per cycle 1
• Can be used cyclically for planned menstrual cycling in patients with recurrent abnormal bleeding 1

For Hormone Replacement Therapy

• Should be continued until the average age of spontaneous menopause (45-55 years) in women with POI 2
• After menopause age, continuation should be based on individual risk assessment 2
• Annual clinical review is recommended, with particular attention to compliance 2

For Endometriosis

• Treatment duration of 1 year has shown efficacy for pelvic pain associated with endometriosis 3
• For fertility-preserving therapy in endometrial cancer, assessment of response should be performed at 6 months 2

Special Considerations

Side Effects and Monitoring

• Common side effects include breakthrough bleeding, spotting, irregular periods, amenorrhea, headaches, and weight changes 1
• No routine monitoring tests are required but may be prompted by specific symptoms or concerns 2
• For cancer cachexia management, when used at 200-600 mg/day, monitor for potential side effects including edema, thromboembolism, and adrenal insufficiency 2

Contraindications

• Should not be used in patients with current or history of thrombophlebitis, thromboembolic disorders, cerebral vascular disease, liver dysfunction or disease, or known or suspected breast cancer 1
• Not recommended for pregnancy testing or during pregnancy due to potential risk of minor birth defects 1

Practical Recommendations

• Start at the lowest effective dose and adjust based on clinical response 1
• For adolescents with premature ovarian insufficiency, begin cyclic progestogens after at least 2 years of estrogen therapy or when breakthrough bleeding occurs 2
• For injectable contraception, many providers schedule visits every 11-12 weeks to allow for missed or delayed visits 2
• When transitioning from DMPA to other contraceptive methods, timing is important as return to fertility may be delayed for several months after discontinuation 4