Continuous Oral Progesterone for Menorrhagia with Submucosal Fibroid
Yes, Provera (medroxyprogesterone acetate) can be used as continuous oral progesterone therapy for menorrhagia due to submucosal fibroids, but it is not the optimal first-line choice—levonorgestrel-IUD is superior, and Provera's efficacy is modest compared to other options. 1, 2, 3
First-Line Medical Management
Levonorgestrel-releasing intrauterine device (LNG-IUD) is the most effective progesterone-only option, reducing menstrual blood loss by 71-95% and demonstrating superior efficacy to both oral and intramuscular medroxyprogesterone acetate in head-to-head trials. 4, 3
In a randomized trial of perimenopausal women with menorrhagia, LNG-IUD was statistically superior to both oral medroxyprogesterone acetate (5 mg daily) and depot medroxyprogesterone acetate for reducing bleeding scores and improving hemoglobin levels. 3
Oral contraceptive pills and progestin-containing IUDs are recommended as first-line medical management for reducing bleeding symptoms associated with fibroids. 1, 2
Provera (Medroxyprogesterone Acetate) Specifics
Oral medroxyprogesterone acetate at 5 mg daily continuously can reduce menorrhagia, with 70% of patients experiencing improvement in bleeding patterns and 30% achieving amenorrhea after 6 months. 5
A pilot study showed that depot medroxyprogesterone acetate (150 mg monthly) reduced mean fibroid volume by 33% and uterine volume by 48% over 6 months, though this was intramuscular rather than oral administration. 5
Critical FDA caveat: Injectable medroxyprogesterone acetate is NOT recommended for dysfunctional uterine bleeding or secondary amenorrhea due to its prolonged action and unpredictable withdrawal bleeding timing—oral therapy is specifically recommended for these conditions instead. 6
Alternative Medical Options
Tranexamic acid is an effective nonhormonal alternative that reduces bleeding symptoms without hormonal side effects. 1, 2
GnRH agonists or antagonists are second-line options that reduce bleeding and significantly shrink fibroid volume by 18-30%, often used preoperatively to optimize anemia before surgery. 1, 2, 7
- These agents require add-back estrogen-progestin therapy to mitigate hypoestrogenic side effects (hot flashes, bone loss) and are FDA-approved for fibroid-related heavy menstrual bleeding. 1
Critical Consideration for Submucosal Fibroids
For submucosal fibroids specifically, hysteroscopic myomectomy is the procedure of choice for lesions <5 cm, offering definitive treatment with shorter hospitalization and faster recovery. 2, 7
Medical management controls bleeding but does not eliminate the fibroid, and symptoms typically recur after medication cessation. 1, 7
In the setting of severe anemia, preoperative medical therapy (GnRH agonists or progestins) plus iron supplementation is recommended to optimize hemoglobin before definitive surgical management. 1
Common Pitfall
Do not use oral medroxyprogesterone acetate expecting significant fibroid shrinkage—while it may modestly reduce volume (33% in one study), this is far less effective than GnRH agonists (45-72% reduction) or selective progesterone receptor modulators like ulipristal acetate (65-67% reduction). 1, 5