Can Provera Be Used to Induce Menses?
No, medroxyprogesterone acetate (Provera) should not be used to induce menses in women with secondary amenorrhea or dysfunctional uterine bleeding. The FDA drug label explicitly states that "because of its prolonged action and the resulting difficulty in predicting the time of withdrawal bleeding following injection, medroxyprogesterone acetate is not recommended in secondary amenorrhea or dysfunctional uterine bleeding. In these conditions oral therapy is recommended." 1
Why Injectable Provera (Depo-Provera) Is Inappropriate
- The injectable formulation has unpredictable withdrawal bleeding timing due to its prolonged duration of action (12-15 weeks), making it unsuitable for inducing a predictable menstrual period 1
- Nearly all patients on Depo-Provera experience unpredictable spotting and bleeding initially, with amenorrhea becoming common over time—the opposite of what you're trying to achieve when inducing menses 2
- Menstrual disturbances occur in most Depo-Provera users and are considered the main disadvantage of this method, requiring counseling that these changes are expected 3
Oral Progestins Are the Appropriate Choice
- Oral medroxyprogesterone acetate (not injectable) can successfully induce withdrawal bleeding in 93% of women with secondary amenorrhea when given as 5 mg twice daily for 5 days 4
- The FDA explicitly recommends oral therapy for secondary amenorrhea and dysfunctional uterine bleeding, not the injectable formulation 1
- Oral dydrogesterone 10 mg twice daily for 5 days showed equivalent efficacy (93% withdrawal bleeding rate) with similar side effect profiles 4
Critical Prerequisites Before Administration
- Pregnancy must be definitively ruled out before administering any progestogen to induce withdrawal bleeding 4
- Adequate endogenous estrogen must be present for progestogen withdrawal to successfully trigger menstruation—medroxyprogesterone "transforms proliferative endometrium into secretory endometrium" only in women with adequate estrogen 1
- Endometrial thickness correlates significantly with bleeding response: transvaginal ultrasound showing adequate endometrial development predicts successful withdrawal bleeding better than serum estradiol levels 4
Important Clinical Caveat
- Failure to bleed after progestogen withdrawal does not rule out adequate estrogen status in all cases—some women with polycystic ovarian syndrome and normal estrogen levels may fail to menstruate after progesterone withdrawal despite having adequate estrogen, possibly due to high androgen levels inhibiting endometrial development 5
- Estrogen-progesterone combinations are not more effective than progesterone alone for inducing withdrawal bleeding and showed no significant difference compared to no treatment in one randomized trial 6