Provera for Cessation of Menses
Provera (medroxyprogesterone acetate) is NOT recommended for cessation of menses when used as the oral formulation, but depot medroxyprogesterone acetate (DMPA/Depo-Provera) injections effectively achieve menstrual suppression and amenorrhea in most patients with continued use. 1
Key Distinction: Formulation Matters
The FDA drug label explicitly states that oral medroxyprogesterone acetate is NOT recommended for amenorrhea or dysfunctional uterine bleeding due to its prolonged action and unpredictable withdrawal bleeding timing. 2 The oral formulation transforms proliferative endometrium into secretory endometrium but does not reliably suppress menses. 2
DMPA (Depo-Provera) Injectable: The Effective Option
For menstrual suppression, DMPA 150 mg intramuscularly every 13 weeks (or 104 mg subcutaneously) is highly effective:
- Amenorrhea occurs in nearly all patients after ≥1 year of continuous use 1
- Initial menstrual irregularities are present in nearly all patients, but these typically improve over time with progression toward amenorrhea 1
- The levonorgestrel IUD provides an alternative for menstrual suppression when estrogen is contraindicated, avoiding DMPA's bone density effects 1
Clinical Applications for Menstrual Suppression
DMPA is particularly useful for specific populations requiring menstrual cessation:
- Disabled, nonambulatory adolescents where menstrual suppression is needed while avoiding exogenous estrogen and bone density concerns 1
- Patients with dysmenorrhea seeking relief from painful menses 1
- Medical conditions requiring long-term menstrual suppression where estrogen is contraindicated 1
Important Counseling Points
Before initiating DMPA for menstrual suppression, patients must understand:
- Irregular bleeding and spotting are common initially and generally not harmful 1
- Amenorrhea develops gradually, typically after several injections 1
- Enhanced counseling about expected bleeding patterns reduces discontinuation rates 1
- Weight gain occurs in some but not all patients; weight status at 6 months predicts future excessive weight gain 1
- Bone mineral density decreases with use, requiring calcium (1300 mg daily), vitamin D (600 IU), weight-bearing exercise, and smoking cessation 1
Management of Persistent Bleeding on DMPA
If heavy or prolonged bleeding persists despite DMPA use and is unacceptable to the patient:
- NSAIDs for 5-7 days during bleeding episodes 1
- Low-dose combined oral contraceptives or estrogen for 10-20 days (if medically eligible) 1
- Consider alternative contraceptive methods if bleeding remains unacceptable 1
Common Pitfall to Avoid
Do not prescribe oral medroxyprogesterone acetate tablets expecting reliable menstrual cessation. 2 The oral formulation is designed for other indications and will not predictably suppress menses. Only the depot injectable formulation (DMPA) achieves reliable amenorrhea with continued use. 1