How should I administer medroxyprogesterone acetate 4 mg (Medro) daily for endometrial protection in a woman on combined estrogen therapy?

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Last updated: February 8, 2026View editorial policy

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Administration of Medroxyprogesterone Acetate 4 mg

I cannot provide specific guidance on administering a "Medro 4 mg pack dose" as this formulation and dosing regimen is not described in standard medical literature or FDA-approved labeling.

Standard Medroxyprogesterone Acetate Dosing Regimens

The evidence-based dosing for medroxyprogesterone acetate (MPA) varies significantly by indication, and no guideline supports a 4 mg daily dose for any standard indication.

For Endometrial Protection in Hormone Therapy

  • MPA 10 mg daily for 12-14 days per month (sequential regimen) is the gold-standard dose for endometrial protection when combined with estrogen therapy 1
  • MPA 2.5-5 mg daily continuously is an alternative regimen for continuous combined hormone therapy 1
  • The American College of Obstetricians and Gynecologists specifically recommends MPA 10 mg daily for 12-14 days every 28 days when using transdermal estradiol patches 1

For Contraception

  • Depot MPA (DMPA) 150 mg intramuscularly every 13 weeks (up to 15 weeks) is the standard contraceptive formulation 2
  • DMPA 104 mg subcutaneously every 13 weeks is an alternative contraceptive formulation 2
  • Oral MPA is not used at 4 mg daily for contraception; studies show 10 mg daily is needed to reliably inhibit ovulation 3

For Endometriosis Treatment

  • MPA 30-50 mg daily orally for 90 days is the evidence-based dose for treating endometriosis 4, 5
  • Lower doses have not been validated for this indication

Critical Considerations

A 4 mg daily dose falls below the therapeutic threshold for all standard indications. The evidence shows:

  • For endometrial protection: 10 mg daily for 12-14 days monthly is required to prevent endometrial hyperplasia 1
  • For ovulation suppression: 10 mg daily is the minimum effective dose, with 5 mg proving insufficient in many women 3
  • For endometriosis: 30-50 mg daily is the established therapeutic range 4, 5

If You Have a 4 mg Formulation

If you are holding a specific "Medro 4 mg pack," this likely represents either:

  • A non-standard compounded formulation requiring clarification from the prescriber
  • A medication intended for a different indication not covered in reproductive endocrinology guidelines
  • A potential prescribing error requiring verification

Contact the prescribing provider or pharmacist to clarify the intended indication and verify the correct dosing regimen before administration.

References

Guideline

Second-Line Progestogen Options

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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