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medroxyprogesterone acetate

Brand: Provera, Depo-Provera, Depo-SubQ Provera 104

⚠ BBW Prototype Drug
Drug Class: progestogen
Drug Family: hormone
Subclass: synthetic progestogen (19-nor-testosterone derivative)
Organ Systems: endocrinereproductive

Mechanism of Action

Binds progesterone receptors to produce progestogenic effects: secretory transformation of estrogen-primed endometrium, inhibition of gonadotropin release (LH surge inhibition = contraception), and cervical mucus thickening. Also has some androgenic and glucocorticoid activity.

progesterone receptor (PR)

Indications

  • secondary amenorrhea
  • abnormal uterine bleeding
  • endometrial protection with estrogen replacement
  • contraception (Depo-Provera IM injection)
  • endometrial cancer palliative treatment
  • endometriosis

Contraindications

  • known or suspected pregnancy
  • undiagnosed vaginal bleeding
  • breast cancer
  • thromboembolic disease
  • liver disease

Adverse Effects

Common

  • irregular menstrual bleeding
  • weight gain
  • mood changes
  • breast tenderness
  • hot flashes

Serious

  • bone density loss (Depo-Provera — significant; up to 10% at spine with 2 years use)
  • VTE (higher risk than low-dose progestogens)
  • depression (possible)
  • delayed return of fertility after Depo-Provera

Pharmacokinetics (ADME)

Absorption oral (Provera) or IM depot (Depo-Provera 3-month injection)
Distribution 90% protein bound
Metabolism hepatic via CYP3A4; extensive first-pass effect
Excretion renal (primarily as glucuronide conjugates)
Half-life 50 days (Depo-Provera depot)
Onset oral: days; Depo: weeks
Peak oral: 2–4 hours; Depo: ~3 weeks
Duration 3 months (Depo-Provera)
Protein Binding 90%
Vd moderate

Drug Interactions

Drug / Agent Mechanism Severity
CYP3A4 inducers may reduce contraceptive efficacy; additional contraception may be needed moderate

Nursing Considerations

  1. For Depo-Provera: administer IM injection in the first 5 days of menstrual cycle to ensure non-pregnancy; next injection due every 12–13 weeks.
  2. Counsel patients about bone density loss with long-term Depo-Provera use (>2 years); recommend adequate calcium (1000 mg/day) and vitamin D (600 IU/day).
  3. Irregular bleeding is common for first 6–12 months of Depo-Provera; most women have amenorrhea by 12 months, which is normal.
  4. Fertility may not return for 9–12 months (mean) after stopping Depo-Provera; counsel patients accordingly.

Clinical Pearls

  • Depo-Provera is the most effective long-acting reversible contraceptive method short of IUDs, with a failure rate of <1% with perfect use — however its delayed return of fertility after discontinuation must be communicated.
  • Bone density loss with Depo-Provera is reversible after discontinuation but may not completely return to baseline in adolescents who start and continue during peak bone mass accumulation years.

Safety Profile

Pregnancy contraindicated
Lactation safe
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Abnormal Uterine Bleeding Contraception (Depo-Provera IM Injection) Endometrial Cancer Palliative Treatment Endometrial Protection With Estrogen Replacement Endometriosis Progestogen Secondary Amenorrhea
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