What to Know About Provera (medroxyprogesterone acetate)

Provera (medroxyprogesterone acetate) is a prescription medication used to treat some causes of female hormone imbalance that lead to menstrual cycle disruptions or heavy bleeding. Provera will bring on a period between three and seven days after you finish taking a five- to 10-day course of treatment.

Provera is a progestin, a synthetic form of the hormone progesterone that's naturally produced in the body after ovulation. It works by correcting hormonal balance and regulating ovulation, which may help with irregular, missing, or unusually heavy periods.

This article explains Provera's uses and includes information about drug dosages and side effects, as well as reasons why some people should not take Provera.

Uses for Provera

Provera helps correct hormonal imbalances in your body. This drug is approved by the Food and Drug Administration (FDA) to treat:

• An abnormal absence of menstrual periods due to another condition (secondary amenorrhea)
• Abnormal uterine bleeding such as PCOS due to hormonal imbalance and not associated with conditions such as fibroid tumors or uterine cancer
• Endometrial hyperplasia (overgrowth of the uterine lining) after menopause, which can increase the risk of uterine cancer

Off-Label Uses

Provera is also used for conditions it hasn't received FDA approval for, including:

• Heavy menstrual bleeding
• Irregular menstrual periods
• Endometriosis
• Endometrial cancer
• Menopause-related symptoms such as hot flashes, night sweats, and vaginal dryness (used along with estrogen)

Before Taking Provera

Provera may be a treatment option for certain conditions, especially if you can't take estrogen.

As part of the diagnosis and treatment process, your healthcare provider will likely perform a pelvic exam and may order numerous tests.

You might have tests for hormone levels, including:

• Progesterone
• Estrogens (estradiol, estriol, and estrone)
• Follicle-stimulating hormone, which stimulates the growth of eggs in the ovary
• The male hormones testosterone and DHEA
• Thyroid hormones (thyroid-stimulating hormone, thyroxine, triiodothyronine)
• The pregnancy hormone human chorionic gonadotropin (HCG)

Imaging studies used in the diagnostic process may include:

• Ultrasound
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Hysteroscopy, an examination of the uterus via a small camera inserted through the vagina

The specific tests your healthcare provider orders depend on your symptoms and stage of life (e.g., premenopausal or postmenopausal).

If you've never taken estrogens, your healthcare provider may prescribe it first for certain conditions. If you don't tolerate estrogen or it's not effective enough, you may be switched to Provera or have Provera added to your estrogen regimen.

Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate Provera use or should be used with caution.

Precautions and Contraindications

Provera isn't safe for everyone. You shouldn't start taking it if you have:

• Vaginal bleeding with an undiagnosed cause
• Hormone-sensitive cancers, like breast or uterine cancer (or a history of them)
• Had a stroke in the past year
• Had a heart attack in the past year
• Blood clots or a history of them
• A bleeding disorder
• Liver problems or a history of them
• A possible or confirmed pregnancy
• A known allergy to medroxyprogesterone or any ingredients in Provera

Before taking Provera, be sure to tell your healthcare provider:

• If you're planning to become pregnant
• If you're breastfeeding
• If you're planning to have surgery
• If you have any other medical problems

These issues may affect whether you can take Provera or if a break from the medication may be necessary, such as before surgery.

Conditions that may require close monitoring while you're taking Provera include:

• Asthma
• Diabetes
• Endometriosis
• Epilepsy
• Heart problems
• High blood calcium levels
• Kidney problems
• Liver problems
• Lupus
• Migraines
• Thyroid disease

Other Progestins

Other progestin drugs on the market include:

• Prometrium (micronized progesterone), which is approved for treating amenorrhea and, along with estrogens, for reducing menopause symptoms
• Oral contraceptives called the "minipill" that contain norethindrone, including brand names Camila, Errin, Heather, Incassia, and Jencycla

Provera Dosage

Your healthcare provider will instruct you to take Provera on certain days during your menstrual cycle. When used to treat amenorrhea (missing periods), Provera is taken for up to 10 days during the second half of the planned menstrual cycle. You should take Provera at the same time every day. Do not take more or less of this medication than instructed.

Provera is available in three dosages:

• 2.5 milligrams (mg)
• 5 mg
• 10 mg

Healthcare providers typically prescribe the lowest effective dose and for the shortest amount of time possible. The dosage used varies by the condition being treated.

Dosages may not be established for off-label uses. Always follow your healthcare provider's instructions for prescription medications.

Modifications

If you have significant liver impairment from alcoholic cirrhosis, Provera is discouraged. If it is prescribed, your dosage may be lower than the standard dose.

If you take thyroid replacement hormone, your dosage of that medication may need to be adjusted after you start Provera. Also, your healthcare provider may want you to get more frequent lab work to check your thyroid hormone levels.

How to Take and Store

Provera has to be taken at certain times, so be sure to follow your healthcare provider's instructions for taking it.

If you forget to start Provera when you're supposed to, if you miss a dose, or if you have any questions about dosage or timing, talk to your healthcare provider or pharmacist for guidance.

Provera should be stored at room temperature (between 68 degrees and 77 degrees Fahrenheit).

Signs Provera Is Working

After taking Provera, your period will become more regular. Some people experience lighter periods than usual when taking this medication. Taking Provera may also significantly reduce or stop bleeding. 

Provera is used to regulate periods and can also be used to delay periods. You will not have a period while taking Provera, however, your period should start three to seven days after your last dose of Provera.

Provera Side Effects

Provera can cause side effects in some people. Some of these are common and not considered dangerous, while others are cause for calling your healthcare provider right away.

Common

Provera use may lead to common side effects that don't require immediate medical care, but you should contact your healthcare provider if any of them become severe, don't go away after you've been on the drug for a while, or are a significant problem for you.

These side effects include:

• Headaches
• Tender breasts
• Breast milk secretion
• Irregular vaginal bleeding or spotting
• Acne
• Facial hair growth
• Hair loss
• Insomnia
• Tiredness
• Nausea
• PMS symptoms

Severe

Other, less common side effects may be more serious. Call your healthcare provider immediately or seek emergency medical attention if you experience:

• Pain, swelling, redness, and warmth in one leg
• Difficulty speaking or slow speech
• Dizziness or feeling faint
• Weakness or numbness in a limb
• Shortness of breath
• Coughing up blood
• Sudden sharp or crushing chest pain
• Fast or pounding heartbeat
• Sudden vision changes or blindness
• Double or blurred vision
• Bulging eyes
• Skipped periods
• Depression
• Jaundice (yellow eyes and skin)
• Fever
• Skin rash
• Hives
• Itching
• Difficulty swallowing
• Swollen face, mouth, tongue, or neck
• Swollen hands, feet, or lower legs

If you take Provera with estrogen, be sure you're aware of the estrogen side effects, as well.

Warnings and Interactions

Provera by itself is not a contraceptive and won't prevent pregnancy. Use another form of birth control, such as a condom, while you're taking this drug. You may not be able to take Provera while also using hormonal birth control.

When Provera is combined with estrogens, the FDA has required that the following serious warnings be included with packaging information:

• Estrogen and progestin should not be used to prevent heart disease or dementia.
• After menopause, estrogen plus progestin may increase your risk of heart attack, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis.
• After age 65, estrogen plus progestin may increase the risk of dementia. (It's unknown whether this risk applies to those under 65.)

Provera may interfere with the results of certain lab tests, including:

• Thyroid hormone levels
• Glucose tolerance
• Cholesterol and triglyceride levels
• Hormone concentrations
• Binding proteins

Drug Interactions

Provera shouldn't be taken with CYP3A4 inducers/inhibitors, as they may alter the way your body responds to progestins.

Other drugs may pose problems as well. Be sure your healthcare provider knows everything you're taking, including over-the-counter drugs and nutritional supplements. Using the same pharmacy for all of your prescription medications can help you avoid negative drug interactions.

Summary

Provera is a prescription medication that can help regulate your menstrual cycle. It is typically taken for five to 10 days at a specific time during your menstrual cycle. Most people will have a period between three and seven days after they finish a course of treatment.

Provera is prescribed to treat irregular menstruation and conditions like PCOS and endometrial hyperplasia. It also may be used to treat other diseases, such as endometrial cancer.

If taking Provera, do so as directed and watch for any symptoms or side effects.