When Vaginal Bleeding Stops After Provera
Withdrawal bleeding typically occurs within 3 to 7 days after discontinuing Provera (medroxyprogesterone acetate) therapy, and this bleeding pattern is consistent whether used for secondary amenorrhea or abnormal uterine bleeding. 1
Expected Timeline for Bleeding Cessation
For Oral Provera (Cyclic Use)
- Withdrawal bleeding begins 3-7 days after stopping the medication and represents the expected therapeutic response 1
- This applies to both secondary amenorrhea treatment (5-10 mg daily for 5-10 days) and abnormal uterine bleeding management (5-10 mg daily for 5-10 days) 1
- The bleeding itself typically lasts several days, similar to a normal menstrual period 1
For Depo-Provera (Injectable Contraceptive)
The bleeding pattern differs significantly from oral formulations:
- Initial irregular bleeding is common and typically improves over 6-12 months of continued use 2, 3
- In one study, 58% of patients reported bleeding after the first 3 months, declining to only 10% still experiencing slight bleeding at 12 months in the higher dose groups 2
- By 24 months, amenorrhea (no bleeding) occurred in all women receiving 5 mg or 10 mg daily continuous combined therapy 2
- For the 150 mg intramuscular injection used as contraception, irregular or excessive menstrual bleeding diminishes with long-term use, with a high percentage becoming amenorrheic over time 3
Acute Bleeding Management with Provera
When Provera is used to stop acute abnormal uterine bleeding (rather than induce withdrawal bleeding):
- Bleeding cessation occurs rapidly, with a mean time of 2.6 days when using combination therapy of depo-medroxyprogesterone acetate 150 mg IM plus oral medroxyprogesterone acetate 20 mg every 8 hours for 3 days 4
- All patients in this study stopped bleeding within 5 days 4
- For chronic fibroid-related menorrhagia treated with monthly Depo-Provera 150 mg, 30% became amenorrheic and 70% showed improvement in bleeding pattern after 6 months 5
Important Clinical Considerations
Breakthrough Bleeding During Continuous Use
- Breakthrough bleeding or spotting is a common side effect, especially during the first 3-6 months, and generally improves with continued use 6
- NSAIDs (mefenamic acid 500 mg three times daily or ibuprofen) are first-line treatment for breakthrough bleeding during days of active bleeding only 6, 7
Prior Oral Contraceptive Use
- Switching directly from oral contraceptives to Depo-Provera significantly reduces bleeding duration in the first 6 months (5.7 days vs. 17.1 days total bleeding) 8
- This effect does not persist beyond 6 months 8
When to Reassess
- If withdrawal bleeding does not occur within 3 weeks after completing oral Provera therapy, pregnancy testing is warranted 9
- Persistent irregular bleeding beyond 3-6 months requires evaluation for underlying pathology including pregnancy, sexually transmitted infections, and uterine conditions (polyps, fibroids) 6, 7, 10