What is the dose of Provera (medroxyprogesterone acetate) for managing abnormal uterine bleeding?

Provera Dosing for Abnormal Uterine Bleeding

For abnormal uterine bleeding due to ovulatory dysfunction, give medroxyprogesterone acetate (Provera) 10 mg orally once daily for 10 days each month (typically days 16-25 of the menstrual cycle), which effectively reduces menstrual blood loss and regulates cycles. 1

Dosing Regimens Based on Clinical Scenario

Chronic Anovulatory Bleeding (Standard Regimen)

• Administer medroxyprogesterone acetate 10 mg orally once daily for 10 days per month (days 16-25 of cycle) for at least 3-6 months 2, 1
• This 10-day protocol (days 16-25) is superior to the 15-day protocol (days 11-25) for achieving regular menstrual cycles and stopping abnormal bleeding 1
• For adolescents specifically, use the same 10 mg daily for 10 days each month for at least 3 months with close monitoring thereafter 2

Acute Heavy Bleeding (Intensive Regimen)

• Give depo-medroxyprogesterone acetate 150 mg intramuscularly as a single injection PLUS medroxyprogesterone acetate 20 mg orally every 8 hours for 3 days (9 doses total) 3
• This combination stops bleeding in all patients within 5 days, with mean cessation time of 2.6 days 3
• High-dose estrogen is an alternative for acute bleeding episodes causing hypovolemia 2

Ovulatory Dysfunctional Bleeding (Higher Dose)

• Use medroxyprogesterone acetate 5-10 mg orally three times daily from day 5-25 of the cycle for women with ovulatory dysfunction and heavy bleeding 4
• This higher-dose, longer-duration regimen effectively reduces measured menstrual blood loss from 110-113 mL to 71-76 mL in ovulatory women 4

Important Clinical Considerations

When Provera Is Most Appropriate

• Provera is effective for women with cyclic heavy bleeding related to the menstrual cycle 5
• Oral progestins administered for 21 days per month reduce menstrual blood loss in women with ovulatory dysfunction 5
• For reproductive-age women with anovulatory bleeding who do not require contraception, cyclic progestin is the treatment of choice 2

When Alternative Treatments Are Superior

• The levonorgestrel-releasing IUD (LNG-IUD) is more effective than oral Provera, reducing menstrual blood loss by 71-95% and should be considered first-line 5, 6
• For women requiring contraception, combined oral contraceptives are preferred over Provera alone 2
• NSAIDs can be added to any hormonal regimen to further reduce bleeding volume 5

Treatment Duration and Follow-up

• Three cycles of the 10-day protocol are typically sufficient to achieve bleeding cessation 1
• Continue treatment for 6 months for perimenopausal women with anovulatory bleeding 2
• If bleeding persists despite treatment, further investigation with imaging or hysteroscopy is mandatory 7, 5

Critical Contraindications

• Do not use in known or suspected pregnancy 6
• Avoid in women with current or history of thromboembolism 6
• Do not give with undiagnosed vaginal bleeding until malignancy is ruled out 6
• Contraindicated in women with liver disease 6

Common Pitfalls to Avoid

• Always rule out pregnancy, structural causes (polyps, fibroids, adenomyosis), and malignancy before attributing bleeding to hormonal imbalance 6
• Endometrial sampling is necessary in women over 45 years or those with risk factors for endometrial cancer before starting treatment 7, 8
• The 15-day protocol (days 11-25) is less effective than the 10-day protocol (days 16-25) and should be avoided 1
• Do not continue Provera indefinitely without reassessment—if bleeding persists after 3-6 months, investigate for underlying pathology 7, 5