Can You Prescribe Provera 10 mg Daily for This Patient?
Yes, you can safely prescribe Provera (medroxyprogesterone) 10 mg daily to this 43-year-old hypertensive patient on amlodipine and telmisartan to manage abnormal uterine bleeding. Progestin-only therapy is specifically recommended as first-line hormonal treatment for women with hypertension and carries no increased cardiovascular risk in this population 1.
Safety in Hypertensive Patients
- Progestin-only contraceptives are the preferred first-line hormonal option for women with hypertension according to ACOG guidelines, as they demonstrate no increased cardiovascular risk 1.
- Combined hormonal contraceptives are absolutely contraindicated in hypertensive women due to 6-9 fold increased MI risk and 8-15 fold increased stroke risk, but progestin-only methods do not carry these risks 1.
- There are no significant drug interactions between oral progesterone and common antihypertensive medications like amlodipine or telmisartan 1.
Dosing and Duration
For abnormal uterine bleeding, prescribe medroxyprogesterone 10 mg daily for 10 days beginning on day 16 of the menstrual cycle 2. This FDA-approved regimen produces optimal secretory transformation of the endometrium 2.
- Progestin withdrawal bleeding typically occurs within 3-7 days after discontinuing therapy 2.
- For patients with recurrent episodes, planned menstrual cycling with medroxyprogesterone can be beneficial 2.
- Continue treatment for 3-6 months, then reassess 1.
- Cyclic oral progestin (10 days per month for 6 months) is effective for anovulatory dysfunctional uterine bleeding and reduces bleeding by 87% 3, 1.
Critical Pre-Treatment Requirements
Before prescribing, you must exclude:
- Pregnancy (perform pregnancy test) 4
- Undiagnosed abnormal genital bleeding requiring endometrial sampling 1, 2
- Known or suspected breast cancer 1
- Active or history of venous thromboembolism 1
- Known liver dysfunction 1
Monitoring Requirements
- Check blood pressure every 6 months while on progestin therapy, even though progestin-only methods are safe in hypertension 1.
- If bleeding persists beyond 3 months despite treatment, further investigation with imaging or hysteroscopy is indicated 5.
Alternative Considerations
If oral progestin is not tolerated or fails:
- Levonorgestrel IUD (20 μg/day) is the most effective medical option, reducing menstrual blood loss by 71-95% with efficacy comparable to endometrial ablation 1, 5.
- The IUD provides local endometrial effects with minimal systemic progesterone absorption, making it particularly suitable for hypertensive women 4.
- It remains effective for up to 5 years 1.
Common Pitfalls to Avoid
- Do not use combined hormonal contraceptives in this hypertensive patient—they are absolutely contraindicated 1.
- Do not prescribe NSAIDs or tranexamic acid if the patient has any cardiovascular disease history, as these carry thrombotic risks 4.
- Ensure adequate diagnostic workup per PALM-COEIN classification to rule out structural causes (polyps, adenomyosis, leiomyomas, malignancy) before attributing bleeding to ovulatory dysfunction 4, 5.