I am taking oral medroxyprogesterone acetate (Provera) for abnormal uterine bleeding and want to switch to an intrauterine device; should I taper the medication, when should I stop it, which IUD is preferred, and what timing and backup contraception are required?

Switching from Oral Medroxyprogesterone to an IUD for Abnormal Uterine Bleeding

You do not need to taper oral medroxyprogesterone acetate (Provera) when switching to an IUD—simply stop the medication and insert the levonorgestrel-releasing IUD (LNG-IUD) as your preferred device, which can be placed at any time during your menstrual cycle without backup contraception if inserted within 7 days of bleeding onset. 1

Preferred IUD Selection

• The levonorgestrel-releasing IUD (LNG-IUD) is the optimal choice for abnormal uterine bleeding, as it reduces menstrual blood loss by 71-95%, which is comparable to endometrial ablation and far superior to copper IUDs for this indication. 2
• The copper IUD is not recommended for your situation since you are treating heavy bleeding, not seeking contraception alone—copper IUDs do not reduce menstrual blood loss and may worsen bleeding patterns. 1

Timing of Medication Discontinuation and IUD Insertion

• Stop oral medroxyprogesterone acetate on the day of IUD insertion—no tapering is required or recommended by CDC guidelines. 1
• The LNG-IUD can be inserted at any time during your menstrual cycle if it is reasonably certain you are not pregnant. 1
• If the IUD is inserted within the first 7 days after menstrual bleeding starts, no backup contraception is needed. 2
• If insertion occurs more than 7 days after your period started, use backup contraception (condoms or abstinence) for 7 days following insertion. 2

Practical Implementation Algorithm

Step 1: Confirm you are not pregnant using clinical criteria (negative pregnancy test if indicated, no unprotected intercourse since last normal menses). 1

Step 2: Schedule IUD insertion ideally within the first 7 days of your menstrual cycle to avoid the need for backup contraception. 1

Step 3: Take your last dose of oral medroxyprogesterone on the morning of your IUD insertion appointment—there is no withdrawal bleeding risk or need for overlap. 1

Step 4: Proceed with LNG-IUD insertion on the same day, which requires a bimanual exam and cervical inspection but no other systematic examinations. 3

Step 5: Use backup contraception for 7 days only if the IUD was inserted more than 7 days after your last period started. 2

Important Clinical Considerations

• No routine follow-up visit is required after IUD insertion, though you should return if you experience concerning symptoms, want to discuss side effects, or wish to change methods. 1
• Expect irregular spotting or light bleeding during the first 3-6 months after LNG-IUD insertion, which typically decreases with continued use and does not require treatment. 1, 2
• If heavy or prolonged bleeding persists with the LNG-IUD, NSAIDs for 5-7 days are the first-line treatment; hormonal therapy with combined oral contraceptives or estrogen for 10-20 days can be considered if NSAIDs are ineffective. 1
• Before treating any persistent breakthrough bleeding, rule out pregnancy, sexually transmitted infections, new uterine pathology (polyps or fibroids), and medication interactions. 2

Common Pitfalls to Avoid

• Do not delay IUD insertion to taper oral progestins—this is unnecessary and prolongs your time without optimal treatment for abnormal uterine bleeding. 1
• Do not choose a copper IUD for heavy menstrual bleeding—it will not improve and may worsen your bleeding patterns, as it lacks the endometrial-suppressing effects of the LNG-IUD. 1
• Do not assume you need backup contraception if the IUD is inserted during the first week of your cycle—this is only required if insertion occurs more than 7 days after bleeding onset. 2
• Do not request IUD string checks at every visit—routine follow-up is unnecessary, and you should only return for specific concerns or when the device needs removal (typically after 5-8 years depending on the specific LNG-IUD model). 1