Medroxyprogesterone for Inducing Menstruation in Women with Amenorrhea
Medroxyprogesterone acetate (MPA) is effective for inducing menstruation in women with amenorrhea and should be administered at doses of 5-10 mg daily for 5-10 days. 1
Mechanism and Dosing
- Medroxyprogesterone acetate is a progestin that induces withdrawal bleeding by promoting endometrial shedding after treatment discontinuation 1
- For treating amenorrhea, the FDA-approved dosing is 5-10 mg daily for 5-10 days 1
- After completing the course, withdrawal bleeding typically occurs within 3-7 days of stopping the medication 2
Patient Selection
- Appropriate for women with secondary amenorrhea where pregnancy has been ruled out 3
- Particularly useful in cases where estrogen levels are adequate but progesterone is deficient 1
- Effectiveness correlates with endometrial thickness as measured by transvaginal ultrasound 2
Monitoring and Expected Outcomes
- Withdrawal bleeding occurs in approximately 93% of women following a 5-day course of medroxyprogesterone acetate 2
- Time to menstruation varies based on dosage but typically occurs within 2 weeks after completing treatment 1
- If no withdrawal bleeding occurs after treatment, further evaluation for other causes of amenorrhea is warranted 3
Special Considerations for Post-DMPA Amenorrhea
- For women with amenorrhea following depot medroxyprogesterone acetate (DMPA) use, switching to a combined hormonal method may be more effective than using oral medroxyprogesterone 4
- Prolonged amenorrhea following DMPA is well-documented, with return to fertility typically taking 9-18 months after discontinuation 3
- If amenorrhea persists beyond 18 months after DMPA discontinuation, further evaluation is warranted 3
Alternative Approaches
- For women who do not respond to medroxyprogesterone or find it unacceptable, other contraceptive methods should be discussed 5
- Combined hormonal contraceptives may be considered as an alternative for inducing menstruation in women with amenorrhea 5
- Intrauterine devices (IUDs) are another option, with progesterone-eluting IUDs potentially beneficial for some patients 5
Common Pitfalls to Avoid
- Failing to rule out pregnancy before initiating treatment 3
- Not considering underlying pathologies such as thyroid dysfunction, hyperprolactinemia, or polycystic ovary syndrome 3
- Assuming amenorrhea is solely due to hormonal imbalance without proper evaluation, especially when it persists despite treatment 3
- Not addressing patient concerns about fertility if pregnancy is desired 3
Long-term Considerations
- Cyclic medroxyprogesterone treatment has been shown to increase bone density in women with menstrual disturbances 6
- For women with recurrent amenorrhea, regular cyclic treatment (10 mg/day for 10 days per month) may be beneficial for bone health 6
- If amenorrhea persists and the woman finds it unacceptable, counseling on alternative contraceptive methods should be provided 5