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Medroxyprogesterone Acetate (MPA)
Medroxyprogesterone Acetate (MPA) is a synthetic progestogen, a form of progesterone, widely used in medicine. It is available in various formulations, including oral tablets and intramuscular injections.
Composition and Forms
- Active Ingredient: Medroxyprogesterone Acetate
- Forms: Oral tablets (e.g., 2.5 mg, 5 mg, 10 mg) and intramuscular injection (e.g., 150 mg/mL suspension).
Indications
MPA is prescribed for a range of conditions, including:
- Abnormal uterine bleeding (dysfunctional uterine bleeding)
- Endometriosis
- Amenorrhea (absence of menstruation)
- Contraception (as a long-acting injectable or in combination pills)
- Hormone replacement therapy (HRT) to counter estrogen effects in women with a uterus
- Management of symptoms associated with menopause
- Palliation of advanced, recurrent, or metastatic endometrial carcinoma (uterine cancer)
- Palliation of advanced, hormone-dependent breast cancer in postmenopausal women
- Treatment of precocious puberty
Mechanism of Action
Medroxyprogesterone Acetate acts by mimicking the effects of endogenous progesterone. It exerts its effects through binding to the progesterone receptor, influencing gene expression and cellular activity. Its actions include:
- Endometrial Effects: Induces secretory changes in the endometrium, leading to decidualization and shedding, which helps control uterine bleeding. It also inhibits endometrial proliferation induced by estrogen.
- Hypothalamic-Pituitary Axis Suppression: Suppresses the release of gonadotropins (LH and FSH) from the pituitary gland, which can inhibit ovulation and reduce estrogen production.
- Anti-androgenic and Anti-estrogenic Effects: May exhibit some anti-androgenic and anti-estrogenic properties, contributing to its efficacy in certain hormone-sensitive conditions.
Safety Profile
Potential Benefits: Effective in managing various gynecological conditions, providing contraception, and alleviating menopausal symptoms.
Common Side Effects: May include menstrual irregularities (spotting, changes in cycle length), weight changes (gain or loss), headache, dizziness, breast tenderness, mood changes, hot flashes, and acne. Injectable forms can cause injection site pain or reactions.
Serious Side Effects: Rarely, can include thromboembolic events (blood clots), cardiovascular issues, lier dysfunction, depression, and allergic reactions. Long-term use, especially at high doses, may increase the risk of osteoporosis.
Contraindications: Known or suspected pregnancy, history of thromboembolic disease, severe liver dysfunction, undiagnosed vaginal bleeding, known hypersensitivity to MPA, breast cancer (except for palliative treatment), missed abortion.
Warnings: Use with caution in patients with cardiovascular disease, diabetes, epilepsy, migraine, asthma, or renal impairment. Regular monitoring is advised, especially for bone mineral density with long-term injectable use.
Dosage Table
| Disease/Condition | Recommended Dosage | Treatment Duration |
|---|---|---|
| Abnormal Uterine Bleeding | 10 mg daily for 10 days, starting on day 16 of the menstrual cycle. | Repeat for 2-3 cycles. |
| Endometriosis | 10 mg daily for 10-14 days starting on day 5 of the cycle, then 10 mg twice daily continuously. Or 150 mg IM injection every 3 months. | Continuous for 6-12 months. |
| Amenorrhea | 10 mg dail yfor 10 days, preceded by estrogen therapy. | Repeat for 3 cycles. |
| Contraception (Injectable) | 150 mg intramuscular injection. | Every 3 months (13 weeks). |
| Uterine Cancer Palliation | 400 mg daily orally, or 400 mg IM every 2 weeks for 3 months, then 400 mg IM every 4 weeks. | As indicated. |
| Breast Cancer Palliation | 150 mg orally daily or 400-800 mg IM weekly. | As indicated. |
Frequently Asked Questions
1. How long does it take for Medroxyprogesterone Acetate to work?
The onset of action can vary depending on the condition being treated and the formulation used. For abnormal uterine bleeding, improvements may be noticeable within a few treatment cycles. For contraception, effectiveness is achieved quickly after the first injection or starting oral pills. For cancer palliation, it may take longer to see symptom relief.
2. Can Medroxyprogesterone Acetate be used during menopause?
Yes, Medroxyprogesterone Acetate is often used as part of hormone replacement therapy (HRT) during menopause, particularly in women who still have their uterus. It is typically prescribed along with estrogen to prevent endometrial hyperplasia and reduce the risk of uterine cancer caused by unopposed estrogen.
3. What are the long-term effects of using injectable Medroxyprogesterone Acetate for contraception?
The most significant long-term concern associated with the injectable form (Depo-Provera) is a potential decrease in bone mineral density, which may not be completely reversible in all women. Other long-term effects can include persistent menstrual irregularities and weight gain. Patients are typically advised to use this method for no longer than two years unless other methods are unsuitable.
4. Is Medroxyprogesterone Acetate a birth control pill?
Medroxyprogesterone Acetate can be used for birth control, most commonly as a long-acting injectable contraceptive. While it can be a component in some combined oral contraceptives, it is also available as a progestin-only medication for contraception.