Can Provera (medroxyprogesterone) 10mg stop breakthrough bleeding associated with Mirena (levonorgestrel)?

Management of Breakthrough Bleeding with Mirena IUD

Provera (medroxyprogesterone acetate) 10mg can effectively stop breakthrough bleeding associated with Mirena (levonorgestrel) IUD use and is an appropriate treatment option for this condition.

Understanding Breakthrough Bleeding with Mirena

• Breakthrough bleeding or spotting is a common side effect with levonorgestrel IUDs like Mirena, especially during the first year of use 1
• With Mirena, menstrual patterns typically become more irregular initially, though overall bleeding usually decreases over time, with many women eventually experiencing amenorrhea 1
• Irregular bleeding is generally not harmful but can be bothersome to patients 2

First-Line Assessment and Management

1. Rule out underlying conditions:

   • Before treating breakthrough bleeding, exclude underlying gynecological problems such as:
     • Pregnancy
     • Sexually transmitted infections
     • Pathologic uterine conditions (fibroids, polyps)
     • Cervical pathology (including cervical cancer) 1, 3

2. First-line treatment options:

   • NSAIDs for short-term treatment (5-7 days)
     • Mefenamic acid (500 mg three times daily) or celecoxib (200 mg daily) have shown significant cessation of bleeding within 7 days 2

Using Medroxyprogesterone (Provera) for Breakthrough Bleeding

• Dosing recommendation: Medroxyprogesterone acetate 10mg daily for 5-10 days is appropriate for abnormal uterine bleeding 4
• The FDA label specifically indicates medroxyprogesterone acetate for abnormal uterine bleeding due to hormonal imbalance in doses of 5-10mg daily for 5-10 days 4
• Progestin withdrawal bleeding typically occurs within 3-7 days after discontinuing medroxyprogesterone acetate therapy 4

Alternative Treatment Options

If medroxyprogesterone is ineffective or contraindicated:

• Low-dose combined oral contraceptives for short-term treatment (10-20 days) can be considered for medically eligible patients 1, 5
• Estrogen therapy (if medically eligible) for short-term treatment (10-20 days) 1
• For persistent, troublesome bleeding despite treatment, counseling about alternative contraceptive methods may be appropriate 1

Important Considerations and Precautions

• Breakthrough bleeding with Mirena typically improves over time - approximately 18% of users experience prolonged bleeding, but this often resolves with continued use 2
• Enhanced counseling about expected bleeding patterns and reassurance can improve continuation rates 2
• Medroxyprogesterone acetate may cause side effects including:
  • Breast tenderness
  • Breakthrough bleeding or spotting
  • Irregular periods
  • Headaches
  • Mood changes 4

Follow-up Recommendations

• If bleeding persists after initial treatment with medroxyprogesterone, consider:
  • Repeating the course of treatment
  • Trying an alternative treatment approach (NSAIDs or hormonal options)
  • Reevaluating for underlying pathology if bleeding patterns worsen or change significantly 1, 2
• For persistent unacceptable bleeding despite treatment, discuss alternative contraceptive methods 1

Remember that while breakthrough bleeding can be bothersome, Mirena remains highly effective for contraception with a failure rate of less than 1% and maintains high user satisfaction through extended use 6.