medroxyprogesterone acetate: clinical use

Prescribing considerations

• Confirm indication and formulation: selected oral and depot products are not interchangeable.
• Exclude pregnancy and investigate unexplained vaginal bleeding where relevant.
• Counsel depot users about menstrual disturbance, delayed return to fertility, bone-mineral-density loss and inability to reverse an administered injection.
• Assess meningioma history and prolonged high-dose exposure.
• Higher-strength oral therapy for malignancy should remain under specialist supervision.

Contraindications and cautions

• Hypersensitivity to medroxyprogesterone acetate or product excipients
• Known or suspected pregnancy
• Active liver disease or severe hepatic disease without normalised liver tests
• Unexplained vaginal or uterine bleeding pending diagnosis
• Current or previous meningioma for high-dose non-oncological use

Monitoring

• Bleeding pattern
• Mood, particularly with a history of depression
• Bone-health risk during prolonged depot use
• Symptoms suggesting thromboembolism, visual vascular events or meningioma

Clinical pharmacology

A progesterone-receptor agonist with progestogenic, anti-oestrogenic and antigonadotrophic activity. Depot intramuscular administration produces prolonged exposure through slow absorption from the injection site.

Formulation and product differences

• The selected lower-strength oral tablet is licensed for specified menstrual disorders, secondary amenorrhoea and endometriosis.
• The selected higher-strength oral tablet is licensed for specialist treatment of specified hormone-dependent cancers.
• The selected suspension is a depot intramuscular contraceptive injection administered by a healthcare professional.

Tablet

Route: Oral

Strengths: 2.5 mg, 10 mg, 100 mg, 200 mg, 400 mg