Depot medroxyprogesterone acetate

What it is

Medroxyprogesterone acetate is also known as depot medroxyprogesterone acetate in injectable form, and the same agent is written as DMPA and sold as Depo Provera. It is one of the two progesterone only types, the other being the mini pills taken by mouth. Progestins act by causing atrophy and decidualization of endometrial tissues; progesterone thickens the cervical mucosa so that migration is inhibited, and thins the endometrial lining so that implantation is inhibited. The dose is given as once every 3 months, and in the endometriosis table as 150 mg IM/13 wk or 104 mg SC/12-14 wk. Unlike the combined pill it does not depend on gut flora for absorption, so it is not affected by Abs.

How it is treated

DMPA is used when estrogen is contraindicated, and it carries no DVT risk because it holds no estrogen. It is safe in breast feed and improves milk quality. Outside contraception it is listed for menorrhagia, dysmenorrhea, endometriosis, endometrial ca and acute SCD crisis. In primary dysmenorrhea it sits with the other hormonal options: COCP 3 weeks on and 1 week off, progestin only pills, Mirena, depot medroxyprogesterone acetate injections every 3 months, and the progestin releasing implanted rods Implanon and Nexplanon. Among the first-line agents for endometriosis-associated pain it is grouped with the other progestins, the LNG-IUS and norethindrone 5-20 mg po daily, all of which cause atrophy and decidualization of endometrial tissues. The injectable dose is set out as 150 mg IM 3 monthly, with the injection taken within 5 days of the cycle, and a back up method used for 7 days if it is not given in the first 5 days of the period. Its mechanism there is to thicken the cervical mucous, inhibit ovulation, slow tubal motility and thin the endometrium. It is indicated in breastfeeding from 6 wks postpartum, in epilepsy, in sickle cell, and in the obese patient and the patient on anticoagulant, and its advantages are a lower risk of ectopic pregnancy, of functional ovarian cysts and of endometrial cancer.

Depot medroxyprogesterone also appears among the drugs for the medical management of chronic abnormal uterine bleeding, at 150 mg intramuscularly or 104 mg subcutaneously every 13 weeks.