medroxyprogesterone acetate + oestrogens, conjugated: clinical use

Prescribing considerations

• Confirm postmenopausal status, intact uterus and symptoms affecting quality of life.
• Assess cancer, thromboembolism, cardiovascular and liver-disease history.
• Consider individual thromboembolic risk, including age, obesity, immobility, surgery and thrombophilia.
• Reassess benefit and risk at least annually.
• Use caution with previous meningioma; discontinue medroxyprogesterone if meningioma is diagnosed.
• Tablets contain lactose and sucrose.

Contraindications and cautions

• Known, past or suspected breast cancer
• Known or suspected oestrogen-dependent malignancy
• Undiagnosed genital bleeding or untreated endometrial hyperplasia
• Previous or current venous thromboembolism or known thrombophilia
• Active or recent arterial thromboembolic disease
• Acute liver disease, or previous liver disease with abnormal liver function
• Porphyria
• Hypersensitivity to an active substance or excipient
• Pregnancy

Monitoring

• Investigate persistent, heavy or newly developing unscheduled bleeding.
• Review breast symptoms and appropriate screening participation.
• Monitor blood pressure, liver function, glucose control and triglycerides where relevant.
• Review treatment around planned surgery or prolonged immobilisation.
• Stop and assess jaundice, deteriorating liver function, significant blood-pressure increase or new migraine-type headache.

Clinical pharmacology

Conjugated oestrogens replace diminished menopausal oestrogen activity. Medroxyprogesterone acetate opposes oestrogen-driven endometrial proliferation. Medroxyprogesterone acetate is released immediately; conjugated oestrogens are released over several hours.

Formulation and product differences

• Oral modified-release, sugar-coated tablet.
• The coating and tablet must remain intact to preserve modified release.
• Contains lactose monohydrate and sucrose.