What is Provera (medroxyprogesterone acetate) used for?

What is Provera Used For?

Provera (medroxyprogesterone acetate) is primarily used for contraception (as injectable Depo-Provera), hormone replacement therapy in combination with estrogen, treatment of abnormal uterine bleeding, and as palliative therapy for advanced endometrial or renal carcinoma. 1, 2

Primary Clinical Indications

Contraception (Injectable DMPA/Depo-Provera)

• Injectable depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive administered intramuscularly or subcutaneously every 3 months (13 weeks). 1, 3
• The typical use failure rate is 6%, with perfect use failure rate of 0.2%. 4
• DMPA works through multiple mechanisms: inhibiting ovulation by suppressing the LH surge, thickening cervical mucus, and inducing endometrial atrophy. 5
• Both provider-administered and self-administered subcutaneous formulations are acceptable options, with self-administration showing higher continuation rates. 1
• No time limit exists for DMPA use—the American College of Obstetricians and Gynecologists explicitly states that use should not be limited to 2 years despite FDA black box warnings about bone mineral density. 3, 4

Hormone Replacement Therapy

• Oral medroxyprogesterone acetate is used in combination with estrogen to provide endometrial protection in postmenopausal women with an intact uterus. 4, 6
• Doses of 2.5 mg, 5 mg, or 10 mg daily are used in continuous combined regimens, with 5 mg and 10 mg showing better endometrial protection and higher rates of amenorrhea. 6
• However, natural micronized progesterone is increasingly preferred over synthetic progestins like Provera due to superior cardiovascular and metabolic safety profiles. 4

Abnormal Uterine Bleeding

• Medroxyprogesterone acetate induces endometrial atrophy and can control heavy bleeding associated with anovulation. 7
• The progestin causes the endometrium to become atrophic with small, straight endometrial glands and decidualized stroma. 5

Cancer Treatment (Palliative)

• For advanced endometrial or renal carcinoma, initial doses of 400-1000 mg per week intramuscularly are recommended, with maintenance doses as low as 400 mg per month if disease stabilizes. 2
• Medroxyprogesterone acetate is used as adjunctive and palliative treatment in advanced inoperable cases, not as primary therapy. 2

Fertility Preservation in Endometrial Cancer

• Continuous progestin therapy (including medroxyprogesterone) may be used in highly selected patients with stage IA, grade 1 endometrioid adenocarcinoma who desire fertility preservation. 3
• This approach requires close monitoring with endometrial sampling every 3-6 months and achieves durable complete response in approximately 50% of patients. 3
• Hysterectomy is recommended if cancer persists after 6 months of progestin therapy. 3

Important Clinical Considerations

Contraindications and Precautions

• Monthly injectables containing medroxyprogesterone acetate are inappropriate for patients with heart failure due to fluid retention risk. 1
• For patients with pre-existing osteoporosis risk factors, alternative contraceptive methods may be preferable. 3
• Verify no contraindications to progestin therapy exist before initiating treatment. 8

Duration of Use and Monitoring

• For contraceptive use, counsel patients continuing DMPA beyond 2 years about skeletal health measures: 1,300 mg daily calcium, 600 IU daily vitamin D, regular weight-bearing exercise, and smoking cessation. 3
• Routine bone density monitoring is not recommended after 2 years of DMPA use unless other osteoporosis risk factors are present. 3
• No routine blood work is required during ongoing DMPA use. 3

Return to Fertility

• Return to fertility may be delayed 9-18 months after discontinuing injectable DMPA. 3, 8
• MPA can be detected in serum for as long as 9 months after a single 150 mg injection, and ovulation resumes when MPA levels fall below 0.1 ng/mL. 5

Common Pitfalls to Avoid

• Do not discontinue DMPA at 2 years based solely on duration concerns, as this increases risk of unintended pregnancy without clear benefit. 3, 4
• Do not routinely order bone density scans after 2 years of DMPA use unless other osteoporosis risk factors are present. 3
• Weight gain at 6 months (>5% increase) is a strong predictor of future excessive weight gain with ongoing DMPA use and warrants counseling. 3