Medroxyprogesterone

What is Medroxyprogesterone?

Medroxyprogesterone is the generic tablet version of Provera, and is named after its active ingredient, medroxyprogesterone acetate. It’s a type of prescription medication called progestins, which are man-made forms of the naturally occurring female hormone progesterone.

What is Medroxyprogesterone used for?

Medroxyprogesterone tablets are used for a few different medical issues, like:

• hormone replacement therapy (HRT) although this use is off-label, meaning that while there’s plenty of evidence showing that the medication is effective, its use in this way hasn’t been officially approved;
• menstrual problems like irregular or heavy periods;
• secondary amenorrhoea (when someone who’s had periods before stops having them for three months or more);
• period delay; and:
• endometriosis.

The active ingredient, medroxyprogesterone acetate, is also used in birth control injections like Depo-Provera or Sayana Press.

How does Medroxyprogesterone work?

Medroxyprogesterone is a type of medicine called a progestin, which is a lab-made version of the female hormone progesterone and works by mimicking its effects in the body.

When you take oestrogen as part of HRT, it can thicken your womb lining, which may slightly increase your risk of endometrial cancer. Medroxyprogesterone helps balance this by keeping the lining under control. It either encourages regular shedding, like a period, or keeps the lining thin, depending on the stage of menopause you’re in. This helps lower the risk of endometrial cancer.^[1]

And by replacing the hormone levels that fall during and after menopause, medroxyprogesterone, in combination with oestrogen, helps to relieve menopause symptoms. In the large Women’s Health Initiative (WHI) trial, which included 8,506 women taking 0.625 mg conjugated oestrogen + 2.5 mg medroxyprogesterone versus a placebo, women on the combined HRT reported greater relief of:^[2]

• Hot flushes: 86% (combined HRT) vs 58% (placebo)
• Night sweats: 78% (combined HRT) vs 57% (placebo)
• Vaginal/genital dryness: 74% (combined HRT) vs 54% (placebo)

What doses are available for Medroxyprogesterone?

For menopause and menstrual issues, Medroxyprogesterone is available in 2.5mg, 5mg, and 10mg tablets. Higher strengths of 100 mg, 200 mg, and 400 mg are also available, but these are usually only prescribed for certain types of cancer.

How to use Medroxyprogesterone

Take medroxyprogesterone exactly as your doctor has prescribed it. Depending on what stage of menopause you’re at, your clinician may suggest one of two ways to take it:

Sequentially (if you still have your period, even if it’s irregular):

• Take the prescribed dose for 12 days each month, usually from day 15 to day 26 of your cycle.
• Take it at the same time as your oestrogen tablet (if you’re using an oestrogen patch, then you can take your Medroxyprogesterone tablet when it suits you).
• Swallow your tablet whole with a glass of water.

Continually (if you still have a womb but haven’t had a period in 12 months or more):

• Usually, the prescribed dose is 5mg every day
• Take it at the same time as your oestrogen tablet every day (if you’re using an oestrogen patch, then you can take your Medroxyprogesterone tablet when it suits you).
• Swallow the tablet whole with water.

How long does Medroxyprogesterone take to work?

The time it takes Medroxyprogesterone to work for menopause symptoms, when taken in combination with oestrogen, will vary from person to person. One study found that some women began to notice relief within 4 to 7 days of starting Medroxyprogesterone, with improvements continuing over the following 8 to 20 weeks.^[1]

Why am I still bleeding while taking Medroxyprogesterone?

It’s pretty common to have some irregular bleeding when you start Medroxyprogesterone with HRT. Up to 4 in 10 women on sequential HRT and 8 in 10 on continuous HRT notice bleeding in the first few months. Most women see this settle within 6 to 12 months. But if the bleeding continues past the six-month threshold, it’s a good idea to check in with your clinician.^[2]

Does Medroxyprogesterone cause any side effects?

Medroxyprogesterone, like any other medication, can cause some side effects, although many people don’t experience any, or if they do, they’re very mild.

Common side effects include:

• Headaches
• Nausea
• Unexpected or unusual vaginal bleeding or spotting
• Mood changes like depression
• Trouble sleeping
• Feeling anxious or nervous
• Acne
• Dizziness
• Hair loss
• Skin reactions, including rash, hives, or itching
• Vaginal discharge
• Breast tenderness or pain
• Fever
• Fatigue
• Weight gain
• A severe allergic reaction (wheezing or difficulty breathing)

Serious symptoms to watch for include:

• Blood clot in the lungs (pulmonary embolism), which can give you some or all of these symptoms: sudden, sharp chest pain, coughing up blood, shortness of breath, and a fast heartbeat;
• Blood clot in the brain (stroke), when you may experience: a very severe or long-lasting headache, changes in your vision, trouble speaking, fainting or collapsing, weakness or numbness in any part of your body.

Seek emergency medical help immediately if you experience any of these serious symptoms.

And if you’re looking for a full list of possible side effects, take a look at the patient information leaflet that comes with your medication.