Medroxyprogesterone Acetate (MPA) (medroxyprogesterone acetate)
Also sold as: Provera, Meprate, Depo-Provera (injectable), Medroxygest, Cyclo-Provera
Pregnancy
Cat X
Lactation
Caution
Schedule
H
Forms
Tablets 5 mg +3
Indications
- Dysfunctional uterine bleeding (DUB)
- Secondary amenorrhea
- Contraception (Depo-Provera injectable)
- Hormone replacement therapy (combined with estrogen, as progestogen component)
- Endometriosis (high dose)
- Endometrial cancer (palliative, high dose)
- Renal cell carcinoma (palliative, high dose — off-label)
Adult Dosing
Dysfunctional uterine bleeding
10 mg orally once daily
For 5–10 days, starting Day 15–26 of cycle
Withdrawal bleed expected 3–7 days after completing the course.
Secondary amenorrhea
10 mg orally once daily
For 10 days to induce withdrawal bleed
If no withdrawal bleed occurs, investigate further (pregnancy, hypothalamic amenorrhea, outflow obstruction).
Contraception (Depo-Provera injectable)
150 mg intramuscular injection
Every 3 months (12–13 weeks)
First injection ideally within 5 days of onset of menses. Deltoid or gluteal injection. Do not rub injection site. Fertility may be delayed 12–18 months after last injection — counsel patients thoroughly.
Hormone replacement therapy (progestogen component)
2.5 mg orally once daily (continuous) OR 5–10 mg OD for 12–14 days/month (sequential)
As directed; long-term use
Micronised progesterone preferred for HRT due to better cardiovascular and metabolic profile, but MPA is still widely used.
Endometrial carcinoma (palliative)
400–1000 mg intramuscular injection per week
Oncologist-directed; 1–3 months, then maintenance if response seen
High-dose oncology use. Specialist prescription only.
Hepatic Adjustment
Avoid in active liver disease or severe hepatic impairment. MPA is extensively hepatically metabolized.
Pregnancy & Lactation
Pregnancy: Category X
Contraindicated in pregnancy. Depo-Provera: once injected, fertility suppression is irreversible for 12–18 months. Oral MPA in 1st trimester for HRT/DUB: classified X due to reports of virilization of female fetuses with high-dose progestogens (historical data with older synthetic progestogens; risk with MPA at standard doses is low but the classification remains X).
Lactation: Caution
Depo-Provera: small amounts excreted in breast milk. Most guidelines consider it acceptable after 6 weeks postpartum when breastfeeding is established. Not recommended in the immediate postpartum period if exclusively breastfeeding (first 6 weeks).
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Rifampicin (rifampin) | Potent CYP3A4 inducer — significantly reduces MPA plasma levels, reducing contraceptive efficacy. Depo-Provera contraceptive failure has been reported. | Major |
| Aminoglutethimide | Markedly increases MPA clearance — reduces efficacy significantly | Major |
| Anticonvulsants (phenytoin, carbamazepine, phenobarbital, topiramate) | Reduce MPA plasma levels by CYP3A4 induction — may reduce contraceptive reliability of Depo-Provera | Moderate |
| Anticoagulants (warfarin) | MPA may increase or decrease anticoagulant effect — monitor INR closely | Moderate |
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Side Effects
Common
- Irregular menstrual bleeding / spotting (especially first 3–6 months of Depo-Provera)
- Amenorrhea (after 12 months of Depo-Provera — in ~50% of users)
- Weight gain (common complaint with Depo-Provera)
- Breast tenderness
- Headache
- Mood changes / depression
- Reduced libido
- Acne
- Nausea
- Bloating
Serious / Discontinue If
- Bone mineral density loss (with long-term Depo-Provera — FDA black box warning; usually reversible after discontinuation)
- Delayed return to fertility — 12–18 months after last Depo-Provera injection
- Depression / mood disorders
- Venous thromboembolism (lower risk than combined OCP, but not zero)
- Ectopic pregnancy (if contraceptive failure occurs, higher risk of ectopic)
- Allergic reactions including anaphylaxis (rare)
- Cervical cancer (controversial — confounded by HPV exposure; WHO states acceptable risk)
Contraindications
- Known or suspected pregnancy
- Undiagnosed vaginal bleeding
- Known or suspected breast cancer
- Active thromboembolic disorder or history of DVT/PE
- Severe hepatic impairment or active liver disease
- History of cerebrovascular accident
- Hypersensitivity to medroxyprogesterone acetate
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Provera 10 mg Tablets | Pfizer India | ₹52/10 tablets |
| Meprate 10 mg Tablets | Sun Pharma | ₹42/10 tablets |
| Depo-Provera 150 mg/mL Injection | Pfizer India | ₹185/vial |
| Medroxygest 10 mg Tablets | Shreya Life Sciences | ₹35/10 tablets |
Monitoring Required
- Menstrual pattern — document bleeding diary for first 6 months on Depo-Provera
- Blood pressure — at each injection visit
- Weight — monitor for significant weight gain
- Bone mineral density (DEXA scan) — consider if Depo-Provera used for >2 years, especially in adolescents and young women
- Mood assessment — screen for depression at each visit
- Pregnancy test — if >13 weeks since last injection before next dose
- Breast examination — periodic in long-term users
- Liver function tests — if hepatic disease suspected
- INR — in patients on concurrent warfarin
Patient Counseling Points
- Irregular bleeding is very common in the first few months of Depo-Provera — this is expected and usually improves over time.
- After 1 year on Depo-Provera, about half of women will have no periods at all — this is safe and normal.
- Once you stop the Depo injection, it may take 12–18 months before your fertility returns to normal. Plan ahead if you want to conceive soon.
- Depo-Provera does NOT protect against sexually transmitted infections — use condoms if STI risk.
- Your next injection must be given within 12–13 weeks (3 months) — do not miss or delay your appointment.
- If taking rifampicin (tuberculosis treatment) or anti-epileptic medicines, inform your doctor — they may reduce the effectiveness of Depo-Provera.
- Weight gain is common — maintaining a healthy diet and exercise routine is recommended.
- For oral Provera/Meprate: take at the same time daily for the prescribed number of days (usually 5–10 days). Expect a withdrawal bleed 3–7 days after the last tablet.
- Long-term Depo-Provera use can reduce bone density — adequate calcium and vitamin D intake is important.
- Report any unusual vaginal bleeding, severe abdominal pain, chest pain, shortness of breath, or leg swelling immediately.
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Clinically reviewed by: Dr. Priya Menon, MD (Obstetrics & Gynaecology), Family Planning Specialist
Last reviewed: 2026-04-01
References
- WHO Medical Eligibility Criteria for Contraceptive Use. 5th edition. 2015.
- Pfizer India. Depo-Provera (medroxyprogesterone acetate) prescribing information. 2023.
- RCOG. Injectable Contraceptives and Bone Mineral Density. Scientific Impact Paper No. 7. 2020.
- FOGSI. Progestogen-only contraception guidelines. 2022.