Medroxyprogesterone Acetate Dosage and Treatment Duration
The recommended dosage of medroxyprogesterone acetate varies by indication, with standard doses ranging from 5-10 mg daily for 5-14 days for gynecological indications, while higher doses (200-600 mg daily) are used for cancer cachexia and 30-50 mg daily for endometriosis treatment. 1, 2, 3, 4
Gynecological Indications
Secondary Amenorrhea
- 5-10 mg daily for 5-10 days 1
- Progestin withdrawal bleeding typically occurs within 3-7 days after discontinuing therapy 1
Abnormal Uterine Bleeding
- 5-10 mg daily for 5-10 days, beginning on day 16 or 21 of the menstrual cycle 1
- For optimal secretory transformation of endometrium primed with estrogen, 10 mg daily for 10 days beginning on day 16 of the cycle 1
Endometrial Protection with Estrogen Therapy
- 5-10 mg daily for 12-14 consecutive days per month in postmenopausal women receiving daily 0.625 mg conjugated estrogens 1
- Can be started on day 1 or day 16 of the cycle 1
- For women with premature ovarian insufficiency (POI), medroxyprogesterone is preferred to other progestogens due to less negative effects on lipid metabolism and fewer androgenic effects 2
Sequential vs. Continuous Regimens
- Sequential regimen: 10 mg medroxyprogesterone acetate for 12-14 days per month 5
- Continuous regimen: 2.5 mg medroxyprogesterone acetate daily (for patients who prefer to avoid withdrawal bleeding) 5
Endometriosis Treatment
- 30 mg daily for 90 days has shown improvement or remission in all cases in one study 4
- Higher dose of 50 mg daily for four months has demonstrated 80% improvement in symptoms 3
- Both regimens induce amenorrhea and anovulation during treatment 3, 4
Cancer Cachexia
- 200-600 mg daily; liquid formulation may be less expensive and more bioavailable than tablets 2
- Benefits include improved appetite and weight gain 2
- Risks include edema, thromboembolism, and adrenal insufficiency 2
Endometrial Carcinoma
- 200 mg daily is recommended for advanced or recurrent endometrial carcinoma 6
- Higher doses (1,000 mg daily) have not shown improved response rates and may actually be less effective 6
- Response rates are higher in well-differentiated tumors and those with positive progesterone receptor status 6
Administration Routes
- Oral administration is standard for most indications 1
- Subcutaneous depot medroxyprogesterone acetate (DMPA-SC, 104mg/0.65mL) is available for contraception 7
- Self-administered subcutaneous DMPA should be made available as an additional approach to deliver injectable contraception 2
Treatment Duration
- For gynecological indications: typically 5-14 days per month or cycle 1
- For endometriosis: 90 days to 4 months 3, 4
- For endometrial carcinoma: until disease progression or unacceptable toxicity 6
- For contraception (DMPA): injections every 13 weeks (up to 15 weeks) 2
Monitoring and Follow-up
- Annual clinical review for women with POI using hormone replacement therapy 2
- No routine monitoring tests required but may be prompted by specific symptoms or concerns 2
- For fertility-preserving therapy in endometrial cancer patients using medroxyprogesterone, assessment of response should be performed at 6 months 2
Common Side Effects and Precautions
- Breakthrough bleeding, especially in sequential regimens, typically resolves within the first 3 months 5
- Other common side effects include breast tenderness, mood changes, and bloating 5, 1
- Contraindicated in patients with current or history of breast cancer, stroke, heart attack, blood clots, or liver problems 1
- May increase risk of heart attacks, strokes, breast cancer, and blood clots when used with estrogens 1
Remember that medroxyprogesterone acetate is not for pregnant women, as there may be an increased risk of minor birth defects if taken during the first 4 months of pregnancy 1.