Provera 10mg BID for Menstrual Suppression
Oral medroxyprogesterone acetate (Provera) 10mg twice daily is NOT effective for menstrual suppression and should not be used for this purpose. 1
The Critical Distinction: Injectable vs. Oral Formulations
The American Academy of Pediatrics explicitly states that depot medroxyprogesterone acetate (DMPA) injections should be used for menstrual suppression, as oral medroxyprogesterone acetate is not effective for this purpose. 1 This is a fundamental point that clinicians must understand—the same medication in different formulations produces dramatically different outcomes for menstrual suppression.
Why Oral Provera Fails for Menstrual Suppression
- The FDA-approved indications for oral medroxyprogesterone acetate tablets are limited to treating absent menstrual periods, abnormal uterine bleeding (at 5-10mg daily for 5-10 days), and preventing endometrial hyperplasia in postmenopausal women on estrogen. 2
- There is no FDA indication or guideline support for using oral medroxyprogesterone acetate at any dose for achieving amenorrhea or menstrual suppression. 2
- Research on cyclical oral progestogens demonstrates they are significantly less effective than other medical therapies for reducing menstrual blood loss and do not reliably achieve amenorrhea. 3
The Effective Alternative: DMPA Injections
For patients requiring menstrual suppression, DMPA 150mg intramuscularly every 13 weeks (or 104mg subcutaneously) is the appropriate medroxyprogesterone formulation. 1
Expected Outcomes with Injectable DMPA
- Amenorrhea occurs in approximately 57% of patients by the end of the first year of continuous use. 4
- Nearly all patients achieve amenorrhea after ≥1 year of continuous use. 1
- Initial menstrual irregularities are present in nearly all patients but typically improve over time with progression toward amenorrhea. 5, 1
Clinical Applications Where DMPA Excels
- Disabled, nonambulatory adolescents requiring menstrual suppression while avoiding exogenous estrogen and bone density concerns. 1
- Patients with dysmenorrhea seeking relief from painful menses. 1
- Women who cannot tolerate estrogenic side effects of combined oral contraceptives or the pain/bleeding associated with IUDs. 6
Essential Counseling to Prevent Discontinuation
Enhanced counseling about expected bleeding patterns significantly reduces discontinuation rates. 1 Patients must understand:
- Irregular bleeding and spotting are common initially and generally not harmful. 1
- Amenorrhea develops gradually, typically after several injections, not immediately. 1
- Weight gain occurs in some but not all patients; weight status at 6 months predicts future excessive weight gain. 5, 1
Managing Bone Density Concerns
- DMPA causes reductions in bone mineral density. 5
- All patients require calcium (1300mg daily), vitamin D (600 IU), and regular weight-bearing exercise. 5, 1
- The American College of Obstetricians and Gynecologists does not advise limiting DMPA use to 2 years or routinely monitoring bone density, recognizing that unwanted pregnancy risks outweigh bone density concerns. 5
Alternative Options When Estrogen is Contraindicated
The CDC recommends considering the levonorgestrel IUD for menstrual suppression when estrogen is contraindicated, as this avoids DMPA's bone density effects. 1 The levonorgestrel IUD demonstrates:
- Effective menstrual suppression in adolescent patients with complex medical conditions. 5
- Continuation rates exceeding 75% at 1 year with high satisfaction. 7
Common Pitfall to Avoid
Do not prescribe oral medroxyprogesterone acetate (Provera tablets) expecting menstrual suppression—this represents a fundamental misunderstanding of the medication's formulation-specific effects. If a patient presents requesting "Provera for menstrual suppression," clarify whether they mean the injectable DMPA formulation (which works) versus oral tablets (which do not work for this indication). The 10mg BID oral dosing mentioned in the question has no evidence base and is not an FDA-approved regimen for any indication. 2