Provera (Medroxyprogesterone Acetate) Dosing for Amenorrhea
For amenorrhea, administer medroxyprogesterone acetate (MPA) 10 mg orally daily for 12-14 days per month to induce withdrawal bleeding. 1
Standard Dosing Regimen
Sequential (Cyclic) Regimen:
- MPA 10 mg daily for 12-14 days every 28 days is the evidence-based dose for inducing withdrawal bleeding in amenorrheic patients 1
- This regimen successfully induces withdrawal bleeding in 80-93% of women 1, 2
- Administer during the last 12-14 days of each 28-day cycle when combined with estrogen therapy 1
Continuous Regimen (Alternative):
- MPA 2.5-5 mg daily without interruption can be used when amenorrhea is the desired outcome rather than cyclic bleeding 1
- This approach induces amenorrhea in 40-73% of women by 6-12 months 1, 3
Clinical Context and Administration
When Used With Estrogen Therapy:
- Pair MPA 10 mg daily for 12-14 days with transdermal 17β-estradiol 50-100 μg daily for women with premature ovarian insufficiency or postmenopausal hormone therapy 1
- The 12-14 day duration is critical—shorter durations provide inadequate endometrial protection 4
Progestin Challenge Test:
- Absence of withdrawal bleeding after MPA administration indicates either insufficient endogenous estrogen or underlying endometrial pathology requiring further evaluation 1
- Endometrial thickness measured by transvaginal ultrasound correlates significantly with bleeding response 2
Alternative Progestogen Options
If MPA is not tolerated or contraindicated:
- Norethindrone acetate 1 mg daily offers superior cardiovascular and metabolic profile compared to MPA 5
- Dydrogesterone 10 mg daily for 12-14 days per month is another alternative with enhanced oral bioavailability 5
- Micronized progesterone 200 mg daily for 12-14 days per month is preferred when cardiovascular risk is a concern 4
Important Clinical Considerations
Contraception vs. Hormone Replacement:
- If contraception is needed alongside amenorrhea treatment, combined hormonal contraceptives containing 17β-estradiol may be preferable to MPA alone 1
- For women not requiring contraception, the sequential MPA regimen with estrogen is appropriate 1
Monitoring and Follow-up:
- Rule out pregnancy before initiating therapy if the woman's regular bleeding pattern changes abruptly to amenorrhea 6
- No routine laboratory monitoring is required unless specific symptoms arise 4
- Annual clinical review focusing on compliance and symptom control is recommended 4
Common Pitfall:
- Never use progestogen for fewer than 12 days per cycle in sequential regimens—this provides inadequate endometrial protection 4
- The 12-14 day duration mimics the natural luteal phase and is essential for proper endometrial shedding 5
Side Effects and Tolerability
- Amenorrhea induced by DMPA (depot medroxyprogesterone) does not require medical treatment and is not harmful—provide reassurance 6
- Breakthrough bleeding or spotting may occur but generally decreases with continued use 6
- MPA has documented adverse effects on lipid profiles and carbohydrate metabolism compared to natural progesterone 5