Can medroxyprogesterone (a progestin) be used to stop menstrual periods?

Medroxyprogesterone Can Stop Menstrual Periods

Yes, medroxyprogesterone acetate (MPA) is effective for stopping menstrual periods, with amenorrhea occurring in approximately 75% of patients after several months of depot medroxyprogesterone acetate (DMPA) use, and it can also be used acutely to stop active bleeding within 24-96 hours using high-dose oral regimens. 1, 2, 3

Mechanisms and Effectiveness

Medroxyprogesterone stops periods through multiple mechanisms:

• Endometrial suppression: MPA causes the endometrium to become atrophic with small, straight endometrial glands and decidualized stroma, eliminating the tissue that would normally shed during menstruation 2
• Ovulation inhibition: Circulating MPA inhibits the midcycle LH peak, preventing ovulation and maintaining low progesterone levels (<0.4 ng/mL) 2
• Cervical mucus thickening: Creates a thick, viscid cervical mucus barrier 2

Clinical Applications and Dosing

For Menstrual Suppression (Long-term)

DMPA injection (Depo-Provera) is the most effective option for sustained menstrual suppression:

• Dosing: 150 mg intramuscularly or 104 mg subcutaneously every 13 weeks (up to 15 weeks) 1
• Timeline to amenorrhea: Amenorrhea occurs in 75% of patients after continuous use, typically developing after ≥1 year of use 1
• Initial bleeding pattern: Nearly all patients experience menstrual irregularities initially (unscheduled bleeding/spotting), which typically improve over time 1

For Acute Bleeding Control

High-dose oral medroxyprogesterone can stop active dysfunctional uterine bleeding:

• Acute dosing: 60-120 mg total on day 1, then 20 mg daily for 10 days 3
• Effectiveness timeline: Bleeding stops in 25% within 24 hours, 29.2% on day 2,20.8% on day 3, and 25% on day 4 3
• Success rate: 100% of patients achieve acceptable bleeding reduction 3

For Menstrual Suppression in Special Populations

In oncology patients at risk for menorrhagia from thrombocytopenia:

• Medroxyprogesterone, oral contraceptives, or GnRH agonists may be used in protocols predicted to cause prolonged thrombocytopenia 1
• This is specifically for preventing menorrhagia risk, not for fertility preservation 1

Important Counseling Points

Expected Bleeding Patterns

Patients must be counseled before initiation that:

• Irregular bleeding/spotting is common initially with DMPA 1
• Amenorrhea typically develops after ≥1 year of continuous use 1
• Enhanced counseling about expected bleeding patterns reduces discontinuation rates 1

Managing Breakthrough Bleeding on DMPA

If unscheduled bleeding occurs and is unacceptable to the patient:

• NSAIDs: 5-7 days of treatment (valdecoxib or mefenamic acid shown effective) 1
• Estrogen therapy: 10-20 days of low-dose combined oral contraceptives or estrogen (if medically eligible) 1
• Alternative: Counsel on alternative contraceptive methods if bleeding persists and is unacceptable 1

Managing Amenorrhea

If amenorrhea develops and the patient finds it unacceptable:

• Provide reassurance that amenorrhea does not require medical treatment 1
• Rule out pregnancy if bleeding pattern changes abruptly to amenorrhea 1
• Counsel on alternative contraceptive methods and offer another method if desired 1, 4

Critical Safety Considerations

Bone Mineral Density Concerns

• DMPA causes reductions in bone mineral density (BMD) 1
• Substantial recovery of BMD occurs after discontinuation 1
• The American College of Obstetricians and Gynecologists does not advise limiting DMPA use to 2 years or routinely monitoring bone density 1

Contraindications for DMPA

DMPA is safe in most women with rheumatic and musculoskeletal diseases, with exceptions:

• Positive antiphospholipid antibodies 1
• High risk for osteoporosis 1

Return to Fertility

• MPA can be detected in serum for up to 9 months after a single 150 mg injection 2
• Return to fertility is delayed for several months after discontinuation 2
• Ovulation resumes when MPA levels fall below 0.1 ng/mL 2

Common Pitfalls to Avoid

• Failing to counsel about initial irregular bleeding: This is the most common reason for discontinuation and can be prevented with proper pre-treatment counseling 1
• Not ruling out pregnancy before initiating treatment: Always ensure pregnancy is excluded 4
• Assuming complete amenorrhea will occur immediately: Complete amenorrhea may be difficult to achieve initially; set realistic expectations 5
• Discontinuing effective contraception prematurely: If breakthrough bleeding occurs, treat the bleeding rather than discontinuing the method 1

Alternative Options

If medroxyprogesterone is unacceptable or ineffective:

• Levonorgestrel IUD: May decrease menstrual bleeding and is safe in all women with rheumatic diseases 1, 5
• Progestin implant: Limited data but likely safe, with <1% failure rate 1, 5
• Combined hormonal contraceptives: Can be used for menstrual suppression if no contraindications (avoid in positive antiphospholipid antibodies or very active SLE) 1, 5