Depo-Provera is a long-term contraceptive injection for women that contains the hormone progestin (medroxyprogesterone acetate).
Indications for use
Uses in gynecology:
- prevention of pregnancy;
- treatment of endometriosis;
- treatment of vasomotor manifestations in menopause
Uses in oncology:
- with relapses and/or metastases of breast cancer;
- with relapses and/or metastases of endometrial cancer;
- with relapses and/or kidney cancer;
- with metastases of prostate cancer
Mechanism of action
Medroxyprogesterone acetate is a gestagen with a long-term effect. The substance does not have androgenic and estrogenic activity, suppresses the secretion of pituitary gonadotropins (especially LH), resulting in the prevention of follicular maturation in women and prolonged anovulation. It also reduces vasomotor symptoms in menopause, inhibits secretory changes in the endometrium, increases the viscosity of cervical mucus, increases the number of intermediate cells in the index of maturation of the vaginal epithelium.
When taken for contraception, medroxyprogesterone acetate reduces the risk of inflammatory diseases of the genitals, candidiasis vulvovaginitis. In most women with hyperplastic processes of the endometrium, partial or complete regression is observed.
When administered in high doses, the drug has an antitumor effect on hormone-sensitive neoplasms. The antitumor effect is determined by a complex effect on the pituitary gland, estrogen receptors and the metabolism of steroid hormones at the tissue level. In large doses, the substance has GCS-activity.
Mode of application and dosage
The recommended dose of Depo-Provera is 150 mg (in the gluteus or deltoid muscle) every 3 months. The first injection is performed during the first 5 days of the normal menstrual period, or 5 days after childbirth if the woman does not breastfeed, or after cessation of breastfeeding period; or 6 weeks after childbirth if it is impossible to refuse to breastfeed. To ensure reliable contraception, the following injections should be made at intervals of 12 weeks (but not more than 89 days).
Before use, the disposable syringe should be shaken until a uniform suspension is obtained. Remove the protective cap from the syringe. Observing the requirements of asepsis, put the needle on the syringe. Remove the protective cap from the needle. The syringe is ready for use.
Depo-Provera cannot be used in the following conditions:
- hypersensitivity to medroxyprogesterone acetate or other components;
- severe violations in the work of the liver;
- malignant neoplasms of the breast (if used as a contraceptive drug);
- pregnancy and bleeding from the vagina of unknown etiology.
In addition, this medication should not be used until the onset of the menstrual period. It is used with caution in epilepsy, chronic renal and heart failure, bronchial asthma, depressive states, diabetes, migraine.
Depo-Provera can cause the following adverse reactions:
- nervous system: headache, dizziness, irritability, insomnia, drowsiness, fatigue, depression.
- digestive system: nausea, pain and discomfort in the abdomen;
- hematopoiesis and hemostasis system: thromboembolic disorders (thrombophlebitis, cerebrovascular disorders, thromboembolism of small branches of the pulmonary artery, renal thrombosis);
- allergic reactions: urticaria, pruritus, rash, anaphylactoid reactions;
- endocrine system: increased sensitivity of the nipples of the mammary glands, galactorrhea, erosion of the cervix, dysmenorrhea, “smearing” secretions, a decrease in glucose tolerance. When applied at a dose of more than 500 mg/day – “vulgar” acne, hirsutism, weight change, moonlike face;
- other: hyperthermia, alopecia;
- local reactions: at the injection site – pain, residual compaction, discoloration of the skin
- Aminoglutethimide can decrease the concentration of medroxyprogesterone in the blood plasma;
- Drugs that cause the induction of microsomal liver enzymes may reduce the contraceptive effect of medroxyprogesterone;
- Carbamazepine, griseofulvin, phenobarbital, phenytoin, rifampicin can increase the clearance of gestagens. Depo-Provera can change the effectiveness of hypoglycemic drugs and inhibit the metabolism of cyclosporine, which leads to an increase in its concentration in the blood plasma and an increased risk of toxicity.
Depo-Provera and pregnancy
When planning to conceive a child, it is necessary to stop using Depo-Provera several months before the conception.
The drug is contraindicated in pregnant women.
Infants born as a result of an unplanned pregnancy that occurred 1-2 months after the injection of medroxyprogesterone suspension may have an increased risk of low birth weight, which in turn is associated with an increased risk of neonatal death. The attributed risk is low since pregnancy rarely occurs during the use of this drug.
If a woman becomes pregnant during the use of the drug, she should be informed of the potential hazard to the fetus.
Medroxyprogesterone acetate and its metabolites are excreted in breast milk. There is no evidence that this represents any danger to the child being breastfed. It’s not recommended prescribing the drug to breastfeeding women prior to establishing its safety for an infant.