What is the recommended Provera (medroxyprogesterone) regimen for a female patient of childbearing age to cease menstruation for umrah?

Provera Regimen for Menstrual Suppression During Umrah

For menstrual suppression during Umrah, administer oral medroxyprogesterone acetate 10 mg daily starting 3-5 days before the expected menstrual period and continuing throughout the pilgrimage duration. 1

Recommended Dosing Protocol

Timing of Initiation

• Start medroxyprogesterone acetate 3-5 days before the anticipated menstrual period to ensure adequate endometrial suppression before bleeding would typically begin 1
• The medication can be initiated at any time if secondary amenorrhea is already present 1
• For women with regular cycles, calculate the start date based on typical cycle length 1

Dosage

• 10 mg daily is the optimal dose for inducing secretory transformation and menstrual suppression 1
• This dose provides adequate endometrial stabilization to prevent breakthrough bleeding 1, 2
• Lower doses (5 mg) may be insufficient for reliable menstrual suppression in this context 1

Duration

• Continue daily administration throughout the entire Umrah period without interruption 1
• Do not discontinue until after returning from pilgrimage, as withdrawal bleeding typically occurs 3-7 days after stopping the medication 1
• Plan for at least 7-10 days of continuous use, extending as needed based on pilgrimage duration 1

Key Clinical Considerations

Expected Outcomes

• Menstrual suppression success rates are high when initiated before the expected period 2
• Approximately 75% of women achieve amenorrhea with continuous progestin therapy 2
• Breakthrough bleeding occurs in approximately 20% of users, particularly in the first cycle of use 2

Contraindications to Screen For

Before prescribing, ensure the patient does not have: 1

• Current pregnancy (perform pregnancy test if any uncertainty)
• Unusual vaginal bleeding of unknown cause
• Known or suspected breast cancer or other hormone-sensitive malignancies
• Active thromboembolism or history of thromboembolic disorders
• Active liver disease
• Known hypersensitivity to medroxyprogesterone acetate

Counseling Points

• Inform patients that withdrawal bleeding will occur 3-7 days after discontinuation, so they should plan accordingly after returning home 1
• Advise about potential side effects including breast tenderness, headache, bloating, and mood changes 1
• Emphasize the importance of not missing doses, as even one missed dose may trigger breakthrough bleeding 1
• This is NOT a contraceptive regimen—additional contraception is required if sexually active 1

Common Pitfalls to Avoid

Timing Errors

• Do not start too early (more than 5-7 days before expected menses), as this unnecessarily prolongs exposure and increases side effect risk without additional benefit 1
• Do not start after bleeding has already begun, as this will not reliably stop active menstruation and breakthrough bleeding becomes more likely 1

Dosing Mistakes

• Do not use 5 mg daily for menstrual suppression, as this lower dose is inadequate for reliable cycle control in this short-term context 1
• Do not use the injectable formulation (Depo-Provera 150 mg IM) for this indication, as it is designed for long-term contraception with effects lasting 3 months and potential delayed return to normal menses 3, 4

Inadequate Patient Preparation

• Do not assume all patients understand their cycle timing—many women cannot accurately predict their next period 5
• Have patients track their cycles for 2-3 months before travel if possible to improve timing accuracy 5
• Consider starting 1-2 days earlier if cycle regularity is uncertain 1

Alternative Consideration

While not Provera, combined oral contraceptives used continuously (skipping placebo pills) are an alternative approach with potentially better cycle control, but this requires ensuring no contraindications to estrogen-containing products 3