What is the typical dosage and usage of Provera (medroxyprogesterone) 10mg?

Provera (Medroxyprogesterone Acetate) 10mg: Dosage and Usage

Provera 10mg is primarily used for secondary amenorrhea (10mg daily for 10 days), abnormal uterine bleeding (10mg daily for 10 days starting on cycle day 16), and endometrial protection in postmenopausal women on estrogen therapy (10mg daily for 12-14 consecutive days per month). 1

Primary Indications and Dosing

Secondary Amenorrhea

• Administer 10mg daily for 10 days to induce optimal secretory transformation of an endometrium adequately primed with estrogen 1
• Therapy may be started at any time in cases of secondary amenorrhea 1
• Progestin withdrawal bleeding typically occurs within 3-7 days after discontinuing therapy 1

Abnormal Uterine Bleeding (Hormonal Imbalance)

• Give 10mg daily for 10 days beginning on cycle day 16 to produce optimal secretory transformation 1
• Alternative timing: may begin on calculated day 21 of the menstrual cycle 1
• Progestin withdrawal bleeding usually occurs within 3-7 days after stopping 1
• Patients with recurrent episodes may benefit from planned menstrual cycling with medroxyprogesterone acetate 1

Endometrial Protection in Postmenopausal Women

• For women on 0.625mg daily conjugated estrogens: administer 10mg daily for 12-14 consecutive days per month 1
• Can begin either on cycle day 1 or day 16 1
• A progestin should be initiated when estrogen is prescribed for postmenopausal women with a uterus to reduce endometrial cancer risk 1
• Start at the lowest effective dose, though this has not been definitively determined 1

Alternative Dosing Regimens

Sequential Hormone Replacement Therapy

• In sequential regimens: 10mg of MPA for 12-14 days per month when combined with transdermal or oral estradiol 2
• This dosing provides endometrial protection while inducing withdrawal bleeding 2

Continuous Combined Therapy

• For continuous regimens without withdrawal bleeding: minimum 2.5mg MPA daily 2
• This approach avoids monthly bleeding episodes 2

Important Clinical Considerations

Cardiovascular Risk Factors

• For women with cardiovascular risk factors, consider micronized progesterone instead of medroxyprogesterone acetate 3
• Micronized progesterone may have a more favorable cardiovascular and thromboembolism risk profile compared to MPA 2

Monitoring and Duration

• Re-evaluate patients every 3-6 months to determine if treatment is still necessary 1
• Use the lowest effective dose for the shortest duration consistent with treatment goals 1
• If withdrawal bleeding does not occur within 3 weeks, pregnancy testing is advised 3

Endometrial Surveillance

• Perform adequate diagnostic measures (endometrial sampling when indicated) to rule out malignancy in cases of undiagnosed persistent or recurring abnormal vaginal bleeding 1
• This is critical before initiating therapy and during follow-up 1

Common Pitfalls and Caveats

Contraindications

• Do not use in patients with unusual vaginal bleeding, current or past certain cancers, stroke/heart attack history, active blood clots, liver problems, or pregnancy 1
• Pregnancy must be ruled out before starting therapy 1

Expected Side Effects

• Menstrual irregularities are common and generally not harmful 2
• Breakthrough bleeding, spotting, or amenorrhea may occur 1
• Other common effects include breast tenderness, headaches, weight changes, and mood alterations 1
• Enhanced counseling about expected bleeding patterns reduces discontinuation rates 2

Special Populations

• In adolescents using DMPA (depot form), weight gain status at 6 months predicts future excessive weight gain 2
• DMPA causes bone mineral density reductions, though substantial recovery occurs after discontinuation 2
• For lactating women, the hormone passes into breast milk 1

Alternative Formulations

Injectable DMPA (Depo-Provera)

• 150mg intramuscularly every 12 weeks (up to 15 weeks) for contraception 2, 4
• Highly effective contraceptive with failure rate comparable to modern copper IUDs 4
• Independent of user's daily memory, requiring only 12-weekly appointments 4

Treatment of Endometrial Hyperplasia

• Depo-Provera injection every 3 months for 6 months (2 doses total) achieved 91.8% regression of non-atypical endometrial hyperplasia 5
• This was significantly more effective than oral cyclic norethisterone acetate (67.1% regression) 5

Endometriosis Management

• Oral medroxyprogesterone acetate 30-50mg daily for 90-120 days effectively treats endometriosis 6, 7
• Improvement or remission occurred in all cases in one study, with 90% pregnancy rate in women with fertile partners 7