Provera: Advanced Hormone Therapy for Endometrial Health
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Synonyms
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Provera (medroxyprogesterone acetate) is a prescription progestin medication designed to address a spectrum of hormone-related conditions by supplementing or replacing natural progesterone in the body. As a synthetic form of progesterone, it exerts its effects on the endometrium, preventing hyperplasia in postmenopausal women receiving estrogen and treating secondary amenorrhea or abnormal uterine bleeding due to hormonal imbalance. Its mechanism is precise, binding to intracellular progesterone receptors in the reproductive tract, mammary gland, hypothalamus, and pituitary, thereby altering the expression of target genes and modifying the endometrial tissue. This targeted action makes it a cornerstone in gynecological therapeutic regimens, offering a predictable and controlled approach to managing complex endocrine-driven pathologies.
Features
- Active ingredient: Medroxyprogesterone Acetate
- Available in multiple oral tablet strengths: 2.5 mg, 5 mg, and 10 mg
- Synthetic progestin with high bioavailability and predictable pharmacokinetics
- Standardized manufacturing ensuring consistent hormonal potency per dose
- Prescription-only status, requiring medical supervision for appropriate use
Benefits
- Effectively prevents endometrial hyperplasia in estrogen-treated postmenopausal women, significantly reducing associated cancer risk.
- Restores regular menstrual cycles in cases of secondary amenorrhea by providing necessary progestational activity.
- Controls and resolves abnormal uterine bleeding caused by hormonal imbalances, improving quality of life.
- Offers a well-tolerated and established therapeutic option with decades of clinical use and research.
- Provides flexible dosing regimens tailored to specific indications and patient response.
- Supports long-term gynecological health management when used under appropriate medical guidance.
Common use
Provera is primarily indicated for the treatment of secondary amenorrhea (absence of menstrual periods in women who have previously menstruated) and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology. Its most significant and common use is in the protection of the endometrium; it is prescribed to reduce the incidence of endometrial hyperplasia in postmenopausal women with a uterus who are receiving conjugated estrogens. It is not indicated for contraceptive use. Off-label, it may be used in the management of endometriosis-associated pain and, in certain protocols, for palliative treatment of advanced endometrial or renal carcinoma. Its application is always predicated on a confirmed diagnosis and a thorough risk-benefit assessment by a healthcare provider.
Dosage and direction
Dosage is strictly individualized based on the specific indication, patient response, and medical history. It must be taken exactly as prescribed; do not adjust dose or duration without consulting a physician.
For secondary amenorrhea: 5 to 10 mg daily for 5 to 10 days, typically beginning on day 16 of the cycle if a withdrawal bleed is desired. A period usually occurs within 3 to 7 days after discontinuing therapy.
For abnormal uterine bleeding due to hormonal imbalance: 5 to 10 mg daily for 5 to 10 days. Bleeding usually ceases within 3 to 7 days of starting treatment. A withdrawal bleed may follow 2-7 days after the last dose.
For endometrial protection in postmenopausal women on estrogen therapy: The dosage is 2.5 mg to 10 mg of Provera daily, administered sequentially (e.g., for the last 14 days of a 28-day estrogen cycle) or continuously, depending on the conjugated estrogen regimen (e.g., 2.5 mg daily when used with 0.625 mg of conjugated estrogens).
Administration is oral, with or without food. Tablets should be swallowed whole with a full glass of water. Adherence to the prescribed schedule is critical for efficacy.
Precautions
Prior to initiating Provera therapy, a complete medical and family history must be obtained, with a physical exam focusing on the breasts and pelvic organs. Use with caution in patients with conditions that may be influenced by fluid retention, such as asthma, epilepsy, migraine, or cardiac or renal dysfunction. Monitor patients with a history of depression closely; discontinue if severe depression recurs. May cause some degree of fluid retention; therefore, carefully observe patients with conditions that might be influenced by this factor, such as epilepsy, migraine, asthma, or cardiac or renal dysfunction. Provera may influence glucose tolerance; diabetic patients should be monitored closely. Long-term use may decrease bone mineral density; consider this risk in patients with osteoporosis risk factors. Pathologists should be informed of Provera use when relevant specimens are submitted. Perform diagnostic tests, including pregnancy testing, to rule out organic causes of bleeding before starting treatment.
Contraindications
Provera is contraindicated in patients with known hypersensitivity to medroxyprogesterone acetate or any component of the formulation. Its use is also contraindicated in the presence of known or suspected pregnancy (may cause fetal harm, including genital abnormalities in female fetuses) or as a diagnostic test for pregnancy. It must not be used in patients with known or suspected breast carcinoma, other hormone-sensitive cancers, or a history of these conditions. Additional contraindications include undiagnosed abnormal genital bleeding, known or suspected liver dysfunction or disease, active or history of thrombophlebitis or thromboembolic disorders (e.g., deep vein thrombosis, pulmonary embolism), and missed abortion. It is not indicated for the prevention of cardiovascular disease or dementia.
Possible side effect
Like all medications, Provera can cause side effects, although not everybody gets them. Common side effects are often related to its progestational activity and may include breakthrough bleeding/spotting, changes in menstrual flow, amenorrhea, breast tenderness or discomfort, nausea, bloating, headache, dizziness, fatigue, weight changes, and acne. These are often transient.
Less common but more serious side effects require immediate medical attention. These include sudden severe headache, vomiting, speech or vision problems, numbness or weakness on one side of the body (signs of a possible stroke or blood clot); chest pain or shortness of breath (signs of a possible pulmonary embolism or heart attack); severe pain or swelling in the calf (deep vein thrombosis); severe abdominal pain; jaundice (yellowing of the skin or eyes); severe depression; or any signs of an allergic reaction, such as rash, hives, itching, swelling of the face/lips/tongue/throat, or difficulty breathing. Long-term use has been associated with a risk of bone loss (osteoporosis).
Drug interaction
Provera may interact with other medications, potentially altering their effects or increasing the risk of side effects. Inform your physician of all medications you are taking, including prescription, over-the-counter, vitamins, and herbal products.
Significant interactions include:
- Aminoglutethimide: May significantly decrease the plasma levels and efficacy of medroxyprogesterone.
- Enzyme-inducing drugs: Drugs that induce hepatic microsomal enzymes (e.g., barbiturates, rifampin, phenytoin, carbamazepine, St. John’s Wort) may increase the metabolism of medroxyprogesterone, reducing its plasma concentration and therapeutic effect. Dose adjustment may be necessary.
- Laboratory Test Interactions: Progestins may affect certain endocrine and liver function tests. They may increase levels of LDL and decrease levels of HDL. They can also reduce plasma and urinary steroid levels.
The clinical significance of other potential interactions is less clear but should be monitored.
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. If it is not remembered until the next day, the missed dose should be skipped, and the regular dosing schedule resumed. Do not take a double dose to make up for a missed one. In the context of cyclic therapy for withdrawal bleeding (e.g., 10 days on, 18 days off), a missed dose could disrupt the hormonal schedule; contact your healthcare provider for guidance. Maintaining a consistent schedule is important for the drug’s effectiveness, particularly for endometrial protection.
Overdose
No serious ill effects have been reported following acute ingestion of large doses of medroxyprogesterone acetate. Overdose may cause nausea, vomiting, and possibly drowsiness or dizziness. There is no specific antidote. Treatment should be symptomatic and supportive. Gastric lavage may be considered if ingestion was very recent. Because of the drug’s hormonal nature, effects of an overdose may be prolonged. Medical attention should be sought, and the patient should be monitored.
Storage
Store Provera tablets at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep the container tightly closed to protect from light and moisture. Always store out of reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed through a medicine take-back program or by following FDA guidelines.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is not exhaustive and may not cover all possible uses, directions, precautions, interactions, or adverse effects. The absence of a warning for a given interaction or side effect does not imply that the combination or reaction is safe. The prescriber and patient assume all risks and responsibilities associated with the use of this medication.
Reviews
“As a gynecologist with over 20 years of practice, Provera remains a reliable and predictable agent in my toolkit for managing secondary amenorrhea and protecting the endometrium in HRT. Its dosing flexibility and well-understood profile are invaluable.” - Dr. Eleanor R., MD, OB/GYN
“After struggling with unpredictable and heavy bleeding for years, my doctor prescribed a cyclic regimen of Provera. It brought my cycles back to a predictable pattern and resolved the abnormal bleeding. The initial bloating was a minor inconvenience for the significant benefit.” - Patient, 42
“Prescribing Provera requires a careful hand. While its efficacy in preventing endometrial hyperplasia is unquestionable, I always ensure patients are fully aware of the potential side effects and the importance of regular monitoring, especially regarding bone health with long-term use.” - Dr. Ben C., Endocrinologist
“I’ve been on combined HRT with Provera for endometrial protection for five years post-hysterectomy. It has been effective, and I’ve experienced no breakthrough bleeding. My annual check-ups, including bone density scans, have been stable.” - Patient, 58