Medroxyprogesterone Acetate Dosing for Anovulatory Dysfunctional Uterine Bleeding
For anovulatory dysfunctional uterine bleeding, administer medroxyprogesterone acetate 10 mg orally once daily for 10 days each month for at least 3 months, with close monitoring thereafter. 1
Standard Chronic Management Regimen
The recommended dose is medroxyprogesterone acetate 10 mg orally daily for 10 days per month for women with anovulatory dysfunctional uterine bleeding who require cycle regulation without contraception 1, 2
This regimen should be continued for a minimum of 6 months in reproductive-age women to establish regular withdrawal bleeding patterns 1
For adolescents with anovulatory bleeding, use the same 10 mg daily for 10 days monthly protocol for at least 3 months, followed by close observation 1
Alternative Dosing Protocols Based on Treatment Duration
A 10-day protocol (days 16-25 of the cycle) is superior to a 15-day protocol (days 11-25) for achieving menstrual cycle regulation and stopping abnormal bleeding, with 3 cycles typically sufficient 3
The shorter 10-day duration in the predicted luteal phase more effectively regulates cycles compared to longer administration periods 3
Higher doses of 5-10 mg three times daily (15-30 mg total daily) administered from day 12-25 can be used for more severe anovulatory bleeding, though this exceeds standard dosing 4
Acute Bleeding Episode Management
For acute, heavy anovulatory bleeding requiring urgent outpatient management, combine depot medroxyprogesterone acetate 150 mg intramuscularly with oral medroxyprogesterone acetate 20 mg every 8 hours for 3 days (9 doses total) 5
This acute regimen stops bleeding within a mean of 2.6 days in nearly all patients, with minimal side effects 5
High-dose estrogen, not progestin alone, remains the preferred initial treatment for acute bleeding episodes causing hypovolemia 1
Important Clinical Considerations
Curettage is indicated for patients with acute bleeding resulting in hypovolemia or for women with endometrial cancer risk factors who have persistent bleeding 1
Oral contraceptives should be used instead of medroxyprogesterone acetate alone when contraception is also needed 1, 2
Clomiphene citrate, not medroxyprogesterone acetate, is the appropriate choice for women with anovulatory bleeding who desire pregnancy 1
For perimenopausal women, cyclic medroxyprogesterone acetate can be administered on days 18-25 of a 25-day cycle when combined with conjugated equine estrogens 1
Common Pitfalls to Avoid
Do not use medroxyprogesterone acetate as monotherapy for ovulatory dysfunctional uterine bleeding—this condition requires different management strategies including NSAIDs, antifibrinolytics, or cycle suppression 1, 2
Avoid prescribing medroxyprogesterone acetate without first excluding organic pathology, particularly in women with risk factors for endometrial cancer 1
Do not continue indefinitely without reassessment—after 3-6 months of treatment, evaluate whether ongoing therapy is necessary or if the patient has resumed regular ovulatory cycles 1