What is the effect of Depo-Provera (medroxyprogesterone) injection on menorrhagia (heavy bleeding)?

From the Guidelines

Depo-Provera injection is a viable treatment option for heavy bleeding, and the standard dose is 150 mg administered as an intramuscular injection every 12 weeks, as recommended by the most recent guidelines 1.

Key Considerations

• The medication works by suppressing ovulation and thinning the endometrial lining, which typically reduces or eliminates menstrual bleeding over time.
• Many women experience significant improvement after the first injection, though it may take up to three months for full effect.
• Common side effects include irregular spotting initially, weight gain, headaches, mood changes, and decreased bone density with long-term use.

Treatment Approach

• Before starting treatment, a pregnancy test should be performed as the medication should not be used during pregnancy.
• The injection must be administered by a healthcare provider, and patients should schedule regular follow-up appointments to monitor response and side effects.
• While using Depo-Provera, calcium and vitamin D supplementation may be recommended to protect bone health, as suggested by previous studies 1.

Important Considerations

• This treatment is reversible, though fertility may take 6-12 months to return after discontinuation.
• For those with certain conditions like breast cancer, liver disease, undiagnosed vaginal bleeding, or history of stroke or blood clots, alternative treatments should be considered, as indicated by earlier guidelines 1.

Management of Bleeding Irregularities

• If bleeding persists, or if the woman requests it, medical treatment can be considered, including NSAIDs or hormonal treatment, as outlined in the most recent guidelines 1.
• If an underlying health condition is found, treat the condition or refer for care, as emphasized by the guidelines 1.

From the Research

Treatment Options for Heavy Menstrual Bleeding

• Non-steroidal anti-inflammatory drugs (NSAIDs) reduce prostaglandin levels, which are elevated in women with excessive menstrual bleeding, and may have a beneficial effect on dysmenorrhoea 2, 3, 4.
• NSAIDs are more effective than placebo at reducing heavy menstrual bleeding but less effective than either tranexamic acid, danazol, or the levonorgestrel-releasing intrauterine system (LNG IUS) 2, 3, 4.
• The levonorgestrel-releasing intrauterine system is superior to combined oral contraceptive pills (OCPs) and NSAIDs for reducing menstrual bleeding in women with abnormal uterine bleeding presumed secondary to endometrial dysfunction 5.
• Antifibrinolytics, such as tranexamic acid, are superior to NSAIDs for menstrual bleeding reduction 5.
• A study comparing flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device found that the levonorgestrel-releasing intrauterine contraceptive device was the most effective treatment, reducing menstrual blood loss by 81.6% after 3 months, 88.0% after 6 months, and 95.8% after 12 months 6.

Effectiveness of Depoprovera Injection

• There is no direct evidence in the provided studies regarding the effectiveness of Depoprovera injection for heavy menstrual bleeding.
• However, the studies suggest that progestins, such as those found in Depoprovera, can be effective in reducing menstrual bleeding 5.
• Further research is needed to determine the effectiveness of Depoprovera injection specifically for heavy menstrual bleeding.

Comparison of Treatment Options

• The studies suggest that the levonorgestrel-releasing intrauterine system is a highly effective treatment option for heavy menstrual bleeding, with a reduction in menstrual blood loss of up to 95.8% after 12 months 6.
• Tranexamic acid and danazol are also effective treatment options, but may have more adverse events than NSAIDs 2, 3, 4.
• NSAIDs are less effective than the levonorgestrel-releasing intrauterine system, tranexamic acid, and danazol, but may still be a useful treatment option for some women 2, 3, 4.