How long does medroxyprogesterone acetate (Provera) take to suppress menstrual bleeding?

Medroxyprogesterone Timing for Menstrual Suppression

When used for acute abnormal uterine bleeding, medroxyprogesterone acetate stops bleeding within 2-3 days on average, with all patients achieving cessation within 5 days. 1

Acute Bleeding Control

For active menstrual bleeding requiring immediate cessation:

• Mean time to bleeding cessation is 2.6 days when using depot medroxyprogesterone acetate (DMPA) 150 mg intramuscularly combined with oral medroxyprogesterone acetate 20 mg every 8 hours for 3 days 1
• All 48 women in this prospective trial stopped bleeding within 5 days, with only 4 experiencing spotting at the 5-day follow-up 1
• For breakthrough bleeding during contraceptive use, NSAIDs (mefenamic acid or ibuprofen) can stop bleeding within 5-7 days 2, 3

Sequential Regimen for Amenorrhea Induction

When using medroxyprogesterone acetate 10 mg daily for 12-14 days per month to induce withdrawal bleeding:

• Withdrawal bleeding typically occurs within 3-7 days after completing the progestin course 4
• If withdrawal bleeding does not occur within 3 weeks after completing therapy, pregnancy testing is warranted 3
• This sequential approach has an 80-93% success rate for inducing withdrawal bleeding 4

Continuous Regimen for Amenorrhea Achievement

When using continuous combined regimens (daily estrogen plus medroxyprogesterone acetate 2.5-10 mg):

• Initial bleeding occurs in 58% of patients during the first 3 months 5
• Bleeding gradually declines over 6 months, particularly with 5-10 mg doses 5
• Only 10% of patients continue spotting at 12 months with 10 mg daily 5
• Complete amenorrhea is achieved by 24 months in all patients using 5-10 mg doses 5
• With lower doses (2.5 mg), amenorrhea rates reach 40-73% by 6-12 months 4

Depot Medroxyprogesterone Acetate (DMPA) Timeline

For injectable DMPA 150 mg every 12 weeks:

• Amenorrhea becomes common after ≥1 year of continuous use 2
• Unscheduled bleeding or spotting is common initially but decreases with continued use 2, 6
• Relief from climacteric symptoms begins at 4-7 days after injection and extends for 8-20 weeks 7

Critical Monitoring Points

Before initiating therapy, rule out pregnancy if the woman's regular bleeding pattern changes abruptly to amenorrhea 2, 4

If bleeding persists beyond expected timelines:

• Evaluate for underlying gynecologic problems including pregnancy, sexually transmitted infections, and uterine pathology (fibroids, polyps) after 3-6 months of persistent irregular bleeding 2, 3
• Absence of withdrawal bleeding after progestin challenge may indicate insufficient endogenous estrogen or endometrial pathology 4

Common Pitfalls

• Do not assume amenorrhea will occur immediately with continuous regimens—counsel patients that breakthrough bleeding is expected for 3-6 months and generally improves with persistent use 2, 3
• Enhanced counseling about expected bleeding patterns and reassurance that irregularities are generally not harmful reduces discontinuation rates 2
• For patients with iatrogenic premature ovarian insufficiency, micronized progesterone may be preferred over medroxyprogesterone acetate due to potentially lower cardiovascular risk 4