Duration of Provera (Medroxyprogesterone Acetate) for Abnormal Uterine Bleeding
For chronic abnormal uterine bleeding, oral medroxyprogesterone acetate should be administered for 10 days each month for a minimum of 3-6 months, with close monitoring thereafter. 1
Treatment Duration by Clinical Context
Adolescents with Anovulatory Bleeding
- Administer oral medroxyprogesterone acetate once daily for 10 days each month for at least 3 months, followed by close monitoring. 1
- This cyclic regimen provides endometrial protection while allowing withdrawal bleeding. 1
Reproductive-Age Women with Anovulatory Bleeding
- For women not requiring contraception or fertility, prescribe oral medroxyprogesterone acetate for 10 days each month for 6 months. 1
- This duration allows adequate endometrial stabilization and bleeding control. 1
Perimenopausal Women
- Administer medroxyprogesterone acetate for days 18-25 of a 25-day cycle when combined with conjugated equine estrogens. 1
- Continue this regimen for 6 months or until bleeding is controlled. 1
Acute Bleeding Episodes
- For hemodynamically unstable patients with acute abnormal uterine bleeding, high-dose injectable or oral progestin-only medications may be used short-term. 2
- One effective acute regimen combines depo-medroxyprogesterone acetate 150 mg intramuscularly with oral medroxyprogesterone acetate 20 mg every 8 hours for 3 days only. 3
- This short-term high-dose approach achieves bleeding cessation within a mean of 2.6 days. 3
Injectable Depo-Provera Considerations
Standard Dosing Schedule
- Depo-medroxyprogesterone acetate (DMPA) 150 mg is administered intramuscularly every 13 weeks (up to 15 weeks maximum). 2
- For endometrial hyperplasia without atypia, two injections over 6 months (one injection every 3 months) achieved 91.8% regression rates. 4
Long-Term Use Monitoring
- DMPA can be continued long-term for bleeding control, but requires assessment at each injection interval. 2
- No routine follow-up visits are required between injections, but patients should return for concerns or when reinjection is needed. 2
Management of Breakthrough Bleeding During Treatment
While on Oral Medroxyprogesterone Acetate
- If heavy or prolonged bleeding persists during treatment, consider NSAIDs for 5-7 days. 2, 5
- Alternatively, add hormonal treatment with combined oral contraceptives or estrogen for 10-20 days if medically eligible. 2
While on Injectable DMPA
- For breakthrough bleeding with DMPA, NSAIDs for 5-7 days are first-line. 5, 6
- Hormonal treatment with COCs or estrogen for 10-20 days can be considered if medically eligible. 6
Important Clinical Caveats
When to Discontinue or Reassess
- If bleeding persists beyond the initial treatment course (3-6 months) and the patient finds it unacceptable, counsel on alternative contraceptive methods and offer another option. 2
- Evaluate for underlying gynecologic problems (fibroids, polyps, STDs, pregnancy, medication interactions) if bleeding persists despite adequate treatment duration. 2
Contraindications in Specific Populations
- In women with spontaneous coronary artery dissection (SCAD), cyclic oral progestin treatment reduces bleeding by 87% but requires careful clinical judgment given cardiovascular considerations. 2
- For these high-risk patients, progestin-eluting intrauterine devices may be preferable to systemic progesterone for long-term management. 2
Endometrial Protection Timeline
- When using estrogen for pubertal induction or hormone therapy, add progestin for endometrial protection 2-3 years after starting estrogen or when breakthrough bleeding occurs. 2
- Administer medroxyprogesterone acetate 100-200 mg daily for 12-14 days every 28 days for endometrial protection. 2
Follow-Up Assessment
- Assess patient satisfaction with the method and any health status changes at follow-up visits. 2, 7
- Monitor weight changes, as this is a common concern with medroxyprogesterone acetate. 2
- No specific maximum duration is established for cyclic oral medroxyprogesterone acetate when used for anovulatory bleeding, but reassess need every 6 months. 1