Praxis Medical Insights

Est. 2024 • Clinical Guidelines Distilled

Made possible by volunteer editors from the University of Calgary & University of Alberta

Last Updated: 9/29/2025

Progestin-Only Pills for Menstruation Suppression in Endometriosis

  • Medroxyprogesterone acetate (MPA) is available in Canada, but its depot formulation (DMPA) is not recommended due to thrombogenicity concerns in certain populations, as noted by the Arthritis Care & Research and Arthritis and Rheumatology journals 1, 2
  • Dienogest has become one of the most widely used progestins for all endometriosis phenotypes for long-term treatment, according to Arthritis care & research 1

Contraindications

  • The Arthritis care & research, Arthritis and Rheumatology, and other journals recommend avoiding progestin-only pills in patients with active thromboembolism or history of VTE, though progestin-only pills have lower risk than combined contraceptives 1, 2, 5
  • Pregnancy is a contraindication for progestin-only pills, as stated by the MMWR Recommendations and Reports 4

Prescribing Instructions

  • The MMWR Recommendations and Reports suggest that norethindrone can be initiated anytime if reasonably certain the patient is not pregnant, and back-up contraception should be used for 2 days if started >5 days after menses began 4

Important Counseling Points

  • The Arthritis care & research journal notes that patients with certain conditions, such as thrombogenicity concerns, should avoid using medroxyprogesterone acetate (MPA) depot formulation (DMPA) 1, 2

REFERENCES

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