Medroxyprogesterone Acetate Recommendations

Pre-Treatment Requirements

Blood pressure measurement is not required before initiating oral medroxyprogesterone acetate, according to the MMWR Recommendations and Reports 1, 2
Pelvic examination is not required before initiating oral medroxyprogesterone acetate, as stated by the MMWR Recommendations and Reports 1, 2
Weight/BMI measurement, glucose testing, lipid testing, and liver enzyme testing are not necessary before initiation of oral medroxyprogesterone acetate, as recommended by the MMWR Recommendations and Reports 3, 4
Clinical breast examination is not required before initiation of oral medroxyprogesterone acetate, according to the MMWR Recommendations and Reports 4, 5

Active arterial thromboembolic disease (stroke, MI) or history of these conditions is a contraindication for oral medroxyprogesterone acetate, as stated by the MMWR Recommendations and Reports 5
Known liver impairment or disease is a contraindication for oral medroxyprogesterone acetate, according to the MMWR Recommendations and Reports 5

The first injection of DMPA can be given at any time if it is reasonably certain that the patient is not pregnant, as recommended by the MMWR Recommendations and Reports 1, 2
Back-up contraception should be used for 7 days if DMPA is started more than 7 days after menses, according to the MMWR Recommendations and Reports 1, 2

Hypertension is not a contraindication to oral medroxyprogesterone use, as stated by the Human Reproduction Update 6
For hormone replacement in premature ovarian insufficiency with hypertension, transdermal estradiol is preferred over oral formulations, according to the Human Reproduction Update 6

Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) can reduce the contraceptive efficacy of DMPA, as reported by the MMWR Recommendations and Reports 2
Rifampin or rifabutin can reduce the contraceptive efficacy of DMPA, according to the MMWR Recommendations and Reports 1
Most antiretroviral medications can be used with DMPA, though some interactions exist, as stated by the MMWR Recommendations and Reports 1

Oral medroxyprogesterone acetate is the appropriate formulation for short-term menstrual cycle planning in women with secondary amenorrhea, as it allows for brief cycle manipulation, according to the American College of Obstetricians and Gynecologists 7

Oral medroxyprogesterone acetate is used to induce menstruation in women with secondary amenorrhea, typically given as a short course, and pregnancy must be ruled out before initiating treatment, as recommended by the American College of Obstetricians and Gynecologists 7
If no withdrawal bleeding occurs after oral medroxyprogesterone acetate treatment, further evaluation for other causes of amenorrhea is warranted, such as thyroid dysfunction, hyperprolactinemia, or polycystic ovary syndrome (PCOS), according to the Endocrine Society 7

Injectable Depo-Provera should only be considered when long-term contraception (≥3 months) is the primary goal, not for menstrual cycle planning, due to its high effectiveness for contraception (failure rate <1% per year with typical use at 3%), as stated by the Centers for Disease Control and Prevention 8, 9