Provera (medroxyprogesterone) is a hormonal progestin-only pill, used to treat irregular menstrual periods or a lack of menstrual periods in women.
Indications for use
- Contraception, especially in women of late reproductive age, endometriosis, differential diagnosis of primary and secondary amenorrhea, correction of side effects from the endometrium with estrogen therapy in menopause, anovulatory metrorrhagia, secondary amenorrhea, premenstrual syndrome, vasomotor symptoms during menopause, prevention and treatment of osteoporosis in postmenopausal period (in combination with estrogen and Ca2 + preparations);
- Additional and palliative treatment: cancer of the kidney (recurrent and metastatic), breast cancer (hormone-dependent, recurrent, postmenopausal period), endometrial cancer (including metastatic), prostate cancer, prostatic hypertrophy (some forms), cancerous cachexia in advanced tumors of different locations.
Mechanism of action
Medroxyprogesterone is a gestagen, which has a long-term effect and does not have androgenic and estrogenic activity. The drug 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, does not affect lactation.
In men, gestagens inhibit the production of testosterone.
When taken for contraception, reduces the risk of inflammatory diseases of the genitals, candidiasis vulvovaginitis.
With a parenteral administration 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 breast cancer, there is a correlation between the effectiveness of therapy and the concentration of estrogen and progesterone receptors in the tumor tissue.
In large doses, the medicine has GCS-activity.
Dosage and mode of application
- Suppression of ovulation (contraception): the recommended dose is 150 mg every 3 months (deep intramuscular injection). To ensure that the patient is not pregnant at the time of the initial use of the drug, it is recommended to do the first injection within the first 5 days after the start of another menstrual period or at least 6 weeks after the delivery;
- Dysfunctional (anovulatory) uterine bleeding: orally, 5-10 mg / day for 10 days. During this time, the bleeding gradually stops. After 3-7 days after the cancellation of Provera, the bleeding of “progestin cancellation” begins. After this, the therapy can be repeated starting from the 16th day of the cycle for 2-3 cycles;
- Endometriosis: intramuscular injections, the recommended dose is 50 mg once a week or 100 mg once every 2 weeks for at least 6 months. Due to prolonged action, the recovery of the menstrual period after such therapy may occur after a while;
- Differential diagnosis of primary and secondary amenorrhea: the drug is prescribed in the dose of 5-10 mg/day for 10 days. For the prevention of endometrial hyperplasia in the treatment of estrogen in menopause: 5-10 mg/day for at least 10 days, starting from the 16th day of the 25-day course of treatment with estrogens;
- Additional and palliative treatment of recurrent and metastatic endometrial cancer or kidney cancer: 200-600 mg/day, orally;
- Breast cancer: orally, 400-1200 mg/day. The results of treatment may be observed in 8-10 weeks;
- Prevention and treatment of osteoporosis in postmenopause: 5-10 mg once a day from 12-15 to 25 day of the month.
Do not use Provera 500 mg if you have any of the following conditions
- hypersensitivity to medroxyprogesterone;
- hypersensitivity to auxiliary components;
- tumors of genital organs of incomprehensible origin;
- bleeding of an unclear genesis from the vagina;
- breastfeeding period;
Use the drug with caution:
- renal insufficiency;
- propensity to stroke;
- heart failure;
- diabetes mellitus;
- bronchial asthma.
- Hematopoiesis system: an increase in the number of leukocytes and platelets in the blood plasma;
- Endocrine system: the Kunshng syndrome (obesity, lunar face, osteoporosis, menstrual cycle disorder, different color streaks, hirsutism, swelling of the lower extremities, decreased sexual function, hyperpigmentation of the skin in places of friction, hypokalemia), decompensation of diabetes mellitus, glucosuria, galactorrhea, a decrease in glucose tolerance, a change in body weight;
- Genitourinary system: a change in libido, dysfunctional uterine bleeding (irregular, abundant, meager), amenorrhea, changes in vaginal discharge, erosion of the cervix, prolonged anovulation, mastodynia, soreness of the breast or mammary glands, abdominal pain, vaginitis, hypersensitivity of the nipples of the breast or mammary glands, erectile dysfunction;
- Nervous system: confusion, euphoria, insomnia, drowsiness, depression, dizziness, headache, decreased ability to concentrate, increased nervous excitability, increased fatigue, reactions like adrenergic (such as hand tremor, sweating, muscle cramps but at night), tonic or clinical cramps;
- Cardiovascular system: stroke, myocardial infarction, chronic heart failure, palpitations. tachycardia, thromboembolism of the pulmonary artery, thromboembolic disorders, thrombophlebitis, increased blood pressure, “hot flashes”;
- Vision: diabetic cataract, visual disturbances, thrombosis of retinal vessels;
- Digestive system: constipation, diarrhea, dryness of the oral mucosa, nausea, vomiting, impaired liver function, jaundice, changes in appetite, pain and discomfort in the abdomen, flatulence;
- Skin: acne, alopecia, hirsutism, itching, rash, urticaria;
- Immune system: hypersensitivity reactions (anaphylaxis and anaphylactoid reactions, angioedema);
- Other: reactions at the injection site (compaction at the injection site, skin discoloration at the injection site, sterile abscess), swelling/fluid retention, malaise, hyperthermia, hypercalcemia. pain in the back and joints.
In rare cases, Provera medication caused osteoporosis, including osteoporotic fractures of bones.
- Aminoglutethimide may reduce the concentration of medroxyprogesterone in the blood plasma;
- When used simultaneously with drugs that induce the induction of microsomal liver enzymes, the contraceptive effect of medroxyprogesterone administered parenterally may decrease;
- Carbamazepine, griseofulvin, phenobarbital, phenytoin, rifampicin can increase the clearance of medroxyprogesterone;
- Provera can change the effectiveness of hypoglycemic drugs;
- The hormonal medication can inhibit the metabolism of cyclosporine, which leads to an increase in its concentration in the blood plasma and an increased risk of toxicity.
What if I miss a dose?
If you miss a dose of Provera, take the medicine as soon as you remember. If the time is close to taking the next pill, skip the dose and take the medicine as before. Do not take a double dose of the drug.
Pregnancy and breastfeeding period
- Pregnancy: Provera is contraindicated to pregnant women. Some reports mention a connection between using gestagen medications in the first trimester of pregnancy and the anomalies of the genitals in the fetuses. If the patient becomes pregnant during the use of the drug, she should be informed of the potential hazard to the fetus;
- Breastfeeding period: Medroxyprogesterone is excreted in breast milk. There is no evidence that this represents any danger to the child being breastfed.
- In the case of suspected hypercoagulable development, stop using the drug;
- When taking tests for pathogistology, it is necessary to warn a specialist-histologist about the therapy with Provera (current or in the past);
- The drug can alter the levels of gonadotropin, cortisol, testosterone, gestagen, estrogens. Provera affects the results of determining the concentration of pregnanediol, the test for glucose tolerance, the test with metapyron;
- There is no data about the influence of the drug on the ability to drive a car and work with mechanical equipment.