Medroxyprogesterone

What is Medroxyprogesterone Acetate?

Medroxyprogesterone Acetate (MPA) is a supplement for the hormone progesterone. MPA is used in hormone replacement therapy (HRT) to help treat the symptoms of menopause in women.

Other uses of MPA include treatment of abnormal uterine bleeding, amenorrhea (the absence of menstruation) in women who are not menopausal, and some types of cancer. MPA may also be injected as a form of birth control.

How does MPA work?

When women approach menopause, the level of estrogen produced by the ovaries declines, resulting in symptoms such as hot flashes and night sweats, irregular periods, mood swings and vaginal dryness. HRT works by subsidising the body’s natural hormones, restoring the hormonal balance and relieving symptoms. HRT may also be used to prevent the onset of osteoporosis (weakening of the bones) in post-menopausal women.

What is MPA also known as?

In the United States, MPA is also sold under the brand name Provera. Both contain Methoxyprogesterone Acetate as the active ingredient and work in the same way.

How long does MPA take to work?

MPA begins to work as soon as you start taking it, although you may not notice the effects immediately. Patients generally see a reduction in menopause symptoms within a few weeks of starting treatment.

Active ingredients

The active ingredient in MPA is medroxyprogesterone acetate.

Inactive ingredients

The inactive ingredients in MPA are lactose monohydrate, sucrose, maize starch, liquid paraffin, calcium stearate, talc, and purified water. The 2.5 mg tablets also include the coloring sunset yellow (E110), and the 5 mg tablets also include the color FD & C Blue No. 2 Aluminium Lake.

Different brands of MPA may include slightly different ingredients. Always check the ingredients listed on the pack before taking your medication.

Which ingredients can cause an allergic reaction?

There are 2 inactive ingredients in this medication that can cause a hypersensitivity reaction. If you are severely lactose intolerant, this medication might cause you some uncomfortable tummy problems as lactose monohydrate is one of the ingredients. Another inactive ingredient in sunset yellow (E110) has been found to cause hypersensitivity/intolerant reactions in people, especially in those with an aspirin allergy. Ensure you tell your doctor about any food or drug allergies you have during your consultation. 

Dosage

The usual dose of MPA is 5 to 10 mg taken once daily for the first 12 to 14 days of the menstrual cycle. Your doctor will be able to decide which dose is best for you.

How to take MPA

Always take MPA as instructed by your doctor. For pre-menopausal women, MPA should be taken once daily for 14 days, beginning 7 days after the first day of bleeding. For post-menopausal women who no longer experience natural periods, MPA can be taken for any 14 consecutive days in a 28 day cycle. MPA should be taken in combination with an oestrogen supplement, which you should continue to take daily for the whole 28 day cycle. During the break from your MPA pills, you will experience what is known as a withdrawal bleed. Try and remember to take your tablet at around the same time each day, for example, each morning with breakfast.

If you miss a dose of MPA, take it as soon as you remember. However, if you remember when it is nearly time for your next dose, skip the missed one and carry on as normal. Never take a double dose to make up for a missed one.

Side Effects

Like all medications, MPA can cause side effects in some patients. If you experience any of the following rare but severe side effects, stop taking MPA and seek immediate medical assistance:

• Signs of a severe allergic reaction, including wheezing, difficulty breathing, swelling of the face, tongue, hands or feet, or itchy skin rash.
• Symptoms of a blood clot in the lung, including severe pain in your chest, coughing up blood, sudden shortness of breath, and rapid or irregular heartbeat.
• Symptoms of a blood clot in the brain, including unusually severe or prolonged headache, disturbances to your sight, difficulty speaking, fainting or collapse, and weakness or numbness in any part of the body.
• Symptoms of a deep-vein thrombosis, including severe pain, tenderness or swelling in the calf, ankle or foot, and purple discolouration or patches of red warmth on the skin of the leg.

The following common side effects may affect up to 1 in every 10 patients:

• Headache
• Nausea
• Unexpected or unusual vaginal bleeding
• Depression
• Difficulty sleeping
• Nervousness
• Dizziness
• Hair loss
• Acne
• Nettle rash or hives
• Itchy skin
• Vaginal discharge
• Breast pain
• Breast tenderness
• Fever
• Tiredness
• Weight gain

Uncommon side effects, which may affect up to 1 in 100 patients, include:

• Facial hair growth
• Milky discharge from the breast when not pregnant or breastfeeding
• Edema (fluid retention)

The frequency of the following side effects is too low to be estimated from the available data:

• Severe allergic reaction
• Swelling in the face or throat which may cause difficulty  breathing
• Drowsiness
• Swelling in the veins due to blood clots
• Tenderness or swelling in the calf, ankle or foot
• Rash
• Cervix abnormality
• Decreased sugar tolerance
• Weight loss

Contraindications

Do NOT take MPA if:

• You are allergic to Medroxyprogesterone Acetate, any similar hormone supplements, any of the other ingredients in this medication.
• You are pregnant, think you might be pregnant, or are trying to get pregnant.
• You have or have had breast cancer
• You have or have had a blood clot in your veins
• You have or have had a blood clot in your arteries
• You have liver problems
• You have a rare metabolic disorder known as porphyria

Before taking MPA, tell your doctor and take particular care if you have any of the following medical problems:

• Epilepsy
• Migraine headaches
• Asthma
• Heart problems
• Kidney problems
• Diabetes
• Depression or a history of depression
• High blood pressure
• Liver problems
• Gallstones
• Systemic lupus erythematosus (SLE)
• Hearing problems
• An intolerance to some types of sugars, such as lactose intolerance. This medication contains lactose monohydrate.

Drug Interactions

Tell your doctor if you are taking or have recently taken any other medications, including those purchased without a prescription. In particular, the following medications may alter the effect of MPA if taken at the same time:

• Aminoglutethimide, sometimes used to treat Cushing’s syndrome
• Blood thinners, such as Warfarin
• Medicines used to treat convulsions, such as Phenobarbital, Phenytoin and Carbamazepine
• Ritonavir and Nelfinavir, used to treat HIV and Aids
• Medicines used to treat infections, such as Rifampicin, Rifabutin, Nevirapine and Efavirenz
• St John’s Wort, an herbal treatment used for depression