Provera is a synthetic progesterone (female sex hormone) which converts the proliferative phase of the endometrium into secretory phase. It has some adrenergic and anabolic activities but no estrogenic effects.
This drug is widely indicated in menorrhagia, endometriosis, menopausal hormone replacement therapy (HRT), breast cancer, endometrial or renal carcinoma, prostatic carcinoma, secondary amenorrhoea, and contraception.
Moreover, abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathologies, such as fibroids or uterine cancer may warrant use of the drug to reduce the incidence of endometrial hyperplasia in non-hysterectomized postmenopausal women receiving daily oral conjugated estrogens 0.625 mg tablets.
High dose of medroxyprogesterone is palliative in about 50% cases of advanced/metastatic endometrial carcinoma.
2 What to Know Before Using
Your doctor will inform you of what you need to know before using Provera. Provera is commonly used as contraceptive leading to inhibition of pituitary gonadotropins, thus preventing follicular maturation and ovulation.
In non-hysterectomised postmenopausal women, estrogen therapy is supplemented with a progestin like medroxyprogesterone for 10-12 days each month to counteract the risk of inducing endometrial carcinoma.
Dysfunctional uterine bleeding is often associated with anovulatory cycles.
Continued estrogenic action on endometrium may cause endometrial hyperplasia without progesterone induction and withdrawal resulting in incomplete sloughing leads to irregular, often profuse bleeding.
Medroxyprogesterone in relatively large doses promptly stops bleeding and keeps it in abeyance as long as given.
Endometriosis is this condition resulting from the presence of endometrium at ectopic sites. Here, manifestations are dysmenorrhea, painful pelvic swellings, and infertility.
Continuous administration of progestin like medroxyprogesterone is recommended here which induces an anovulatory and hypoestrogenic state.
The direct action on endometrium prevents bleeding in the ectopic sites by suppressing menstruation. Treatment for a few months causes atrophy and regression of the ectopic masses.
Therapy can be withdrawn in many cases after 6 months without reactivation. Such treatment is cheap and generally well tolerated.
Some women develop a headache, irritability, fluid retention, distension and breast tenderness a few days preceding menstruation which are suggestive of premenstrual syndrome.
When depression predominates, it has been labeled as a premenstrual dysphoric disorder. Premenstrual syndrome may demand suppression of ovulation by combined estrogen-progesterone treatment given cyclically.
Relatively higher dose of progestin (e.g. medroxyprogesterone) is generally used in such conditions. Progestins are added to estrogen when it is used for severe dysmenorrhea.
In the case of threatened or habitual abortion, most of the patients show no progesterone deficiency but progestin therapy may be considered in those patients who have established deficiency.
However, medroxyprogesterone is briskly promoted and almost routinely prescribed. There is some recent evidence of its efficacy in preventing premature delivery in high-risk pregnancy.
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3 Proper Usage
To use Provera properly, you must follow all instructions given by your doctor. Each and every time the risks of taking a drug should be kept in mind. Here, both the doctor and the physician take part to make a decision for choosing a drug.
The risk and benefit ratio should be considered before starting a drug therapy. If you have had any allergic reactions to any medicine then you must inform your doctor about that.
Always be free to tell your physician if you have had any heart diseases or respiratory problems like bronchial asthma. Moreover, serious reactions may take place when it is used with another.
Concurrent use of aminoglutethimide and enzyme-inducing drugs (e.g. carbamazepine, griseofulvin, phenobarbital, rifampicin, phenytoin) may reduce the plasma concentration of medroxyprogesterone leading to reduced efficacy.
Additional measures are also required when it is used for contraception during co-administration with these drugs.
The use of medroxyprogesterone is contraindicated in thromboembolic disorders, hormone-dependent carcinoma, cerebral apoplexy, severe hepatic dysfunction, incomplete abortion and known or suspected pregnancy.
Additionally, this drug should not be used in undiagnosed vaginal bleeding, undiagnosed urinary tract infection, and undiagnosed breast pathology. In such circumstances, the use of medroxyprogesterone may hamper the diagnosis of actual pathology.
Studies in animals or humans have demonstrated severe fetal abnormalities and/or there are positive evidence of human fetal risk based on adverse reaction data from investigational experiences.
Hence, the risks involved in the use of the drug in pregnant women clearly outweigh the potential benefits you may have using this drug.
4 Precautions to Take
In using Provera, you must be careful and take some precautions as advised by your doctor. Breakthrough bleeding is likely to occur in patients being treated for endometriosis. Use of such medicine may also cause some degree of fluid retention.
Conditions which might be influenced by this factor, such as epilepsy, migraine, asthma, or cardiac or renal dysfunction require careful observation. A decrease in glucose tolerance has been observed in some patients.
Monitoring a patient closely by a doctor for loss of vision, proptosis, diplopia, and thromboembolic disorders are highly recommended to avoid further complications.
5 Potential Side Effects
Make sure you meet with your doctor in using Provera to avoid unwanted potential side effects. Although each drug comes with little or more side effects, but most of the time remain subtle.
Sometimes you may need to consult with the doctor if you feel depression, fatigue, insomnia, dizziness, breast tenderness, weight gain/loss, anorexia, or jaundice.
Usual side effects need no medical attention but in some conditions may demand emergency. However, toxicity is influenced by the relative rates of absorption and metabolism.
You should seek medical help when the following problems become significant:
Breast engorgement, headache, the rise in body temperature, edema, esophageal reflux, acne and mood swings may occur with higher doses.
Irregular bleeding or amenorrhoea can occur if it is taken continuously.
Long-term use of progestin in hormone replacement therapy (HRT) may increase the risk of breast cancer.
Blood sugar may rise and diabetes may be precipitated by long-term use.
Given in early pregnancy can cause masculization of the female fetus and other congenital abnormalities.
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