What are the side effects of short-term oral Medroxyprogesterone (progestin) use?

Side Effects of Short-Term Oral Medroxyprogesterone

Short-term oral medroxyprogesterone can cause several significant side effects including irregular menstrual bleeding, thromboembolism, breast tenderness, headaches, mood changes, and weight changes. 1

Common Side Effects

• Menstrual Changes: The most common side effects involve the genitourinary system, including irregular uterine bleeding (increase, decrease, or breakthrough bleeding), spotting, and amenorrhea (absence of menstrual periods) 1

• Breast-Related Effects: Breast tenderness, mastodynia (breast pain), and galactorrhea (milk secretion) have been reported 1

• Mood and Neurological Effects:

  • Mental depression, insomnia, somnolence, dizziness, headache, and nervousness 1
  • Changes in libido may occur with continued use 2

• Gastrointestinal Effects: Nausea, abdominal discomfort, and bloating 1

• Skin and Hair Effects:

  • Sensitivity reactions including urticaria (hives), pruritus (itching), edema, and generalized rash 1
  • Acne, alopecia (hair loss), and hirsutism (hair growth) have been reported 1

Serious Side Effects

• Thromboembolic Disorders: Thrombophlebitis and pulmonary embolism are potentially serious side effects 3, 1

  • This risk is particularly important to consider when prescribing progestins to patients with advanced disease 3

• Cardiovascular Effects: Progestins may negatively impact cardiovascular risk through effects on lipid profiles, vasomotion, and carbohydrate metabolism 3

• Hepatic Effects: Cholestatic jaundice has been reported 1

• Ocular Effects: Neuro-ocular lesions such as retinal thrombosis and optic neuritis 1

• Metabolic Effects: Decreased glucose tolerance 1

• Hypersensitivity Reactions: Anaphylaxis, anaphylactoid reactions, and angioedema 1

Risk Factors and Contraindications

Medroxyprogesterone acetate should not be used in patients with:

• Unusual vaginal bleeding 1
• Current or past history of certain cancers 1
• History of stroke or heart attack 1
• Current or past history of blood clots 1
• Current or past liver problems 1
• Pregnancy or suspected pregnancy 1

Special Considerations

• Dosing: For short-term use, such as for abnormal uterine bleeding or absence of menstrual period, medroxyprogesterone acetate is typically given in doses ranging from 5 to 10 mg daily for 5 to 10 days 1

• Monitoring: Regular follow-up (every 3 to 6 months) is recommended to assess the continued need for treatment and to evaluate for side effects 1

• Weight Changes: Weight gain or loss may occur with medroxyprogesterone use 1

• Fluid Retention: Edema/fluid retention has been reported 1

Clinical Implications

• Pre-treatment counseling about potential side effects significantly improves continuation rates and patient satisfaction 4, 5

• Short-term use (less than 5 years) of medroxyprogesterone with an estrogen in the immediate postmenopausal period for vasomotor symptoms does not appear to be associated with increased risk of breast cancer, cardiovascular disease, or cognitive decline 6, 7

• When used for hormone replacement therapy in patients with premature ovarian insufficiency, medroxyprogesterone acetate has been shown to effectively induce secretory endometrium when combined with estrogen 3

• For patients with cancer, progestins like medroxyprogesterone acetate may be considered to increase appetite in anorectic patients with advanced disease, but clinicians must be aware of the potential serious side effects, particularly thromboembolism 3