Management of Irregular Vaginal Bleeding with Provera

Dosing Recommendations

The American College of Obstetricians and Gynecologists recommends medroxyprogesterone acetate 10 mg orally daily for 12-14 days per month for endometrial protection and bleeding control in young women with irregular vaginal bleeding 1, 3
Alternative dosing of 2.5-5 mg daily continuously can be used if avoidance of withdrawal bleeding is desired, as recommended by the American College of Obstetricians and Gynecologists 1, 2

The Centers for Disease Control and Prevention recommends depot medroxyprogesterone acetate (DMPA) 150 mg intramuscularly every 12 weeks for contraceptive purposes, which is highly effective 4, 5
The American Academy of Pediatrics recommends DMPA 104 mg subcutaneously every 13 weeks as an alternative formulation 4, 5

The FDA specifies absolute contraindications to Provera, including known or suspected pregnancy, undiagnosed vaginal bleeding, known or suspected breast malignancy, active thrombophlebitis, and liver dysfunction or disease 6, 7

The American Academy of Pediatrics recommends screening for cardiac abnormalities before prescribing hormonal therapy in patients with Cornelia de Lange syndrome 5
The American College of Obstetricians and Gynecologists recommends assessing liver function before initiating therapy, as liver dysfunction is an absolute contraindication 3

The Centers for Disease Control and Prevention recommends counseling patients on expected side effects, including menstrual irregularities and weight gain 5, 6, 8
The American College of Obstetricians and Gynecologists recommends continuing the regimen for at least 3 months before considering it ineffective, and assessing endometrial thickness by ultrasound if clinically indicated 8
The American Academy of Pediatrics recommends recommending 1300 mg calcium daily plus 600 IU vitamin D and weight-bearing exercise to maintain bone health 5, 9

The American College of Obstetricians and Gynecologists recommends considering alternative progestogen options, such as norethisterone acetate, levonorgestrel intrauterine system, or micronized progesterone, if MPA is not tolerated or contraindicated 1, 2, 5, 7