Medroxyprogesterone

Generic/proprietary names
- Medroxyprogesterone acetate: Adgyn Medro, Depo-Provera, Farlutal, Provera.

Action
- Medroxyprogesterone prevents follicular maturation and ovulation.

- Stimulates growth of mammary tissue.

- Antineoplastic action against endometrial cancer.

Classification
- Antineoplastic hormone contraceptive.

- Progesterone derivative.

Indications
- Contraception following appropriate counselling.

- Malignant disease.

- Dysfunctional uterine bleeding.

- Secondary amenorrhoea.

- Opposition of oestrogen in HRT.

- Mild to moderate endometriosis.

Contraindications
- Cancer of the breast or reproductive organs.

- Hypersensitivity.

- Severe liver impairment.

- Undiagnosed vaginal bleeding.

- Known or suspected pregnancy.

Cautions
- Breastfeeding.

- Hypertension.

- Asthma.

- Diabetes.

- Epilepsy.

- Cardiac or renal dysfunction.

- A history of blood clots.

Side-effects
- Change to the menstrual cycle.

- Premenstrual-like syndrome.

- Weight gain.

- Nausea and vomiting.

- Headache.

- Dizziness.

- Insomnia.

- Depression.

- Skin reactions.

Interactions
- Increases plasma ciclosporin concentration.

- Hormone antagonists reduce plasma concentration of medroxyprogesterone.

Administration
- For contraception the first injection should be given within five days after the beginning of a normal menstrual period, and repeated every 12 weeks.

- Oral preparations are tolerated better when taken with milk or food to reduce gastrointestinal side-effects.

- Confusion can arise with drugs of similar name - methylprednisolone and Premarin.

Nursing considerations
- Medroxyprogesterone should not be given for contraception without full counselling backed by the manufacturer's approved leaflet.

- It can take 9-10 months to become pregnant after stopping medroxyprogesterone as a contraceptive.

- Heavy bleeding has been reported in women who start this contraceptive in the immediate puerperium. It is therefore better to delay giving the first injection until six weeks postnatally.

- Blood pressure should be recorded at the beginning of treatment and then periodically.

- The prescribing health care professional should be informed if weight gain is a problem.

- Monitor mental status.

- Evaluate therapeutic response.

Patient teaching
- When used for contraception lack of periods does not mean pregnancy when regular injections have been administered.

- If a contraceptive injection is late or missed, pregnancy can occur.

- Any unusual vaginal bleeding or breast lumps should be reported to the prescribing health care professional.

- Medroxyprogesterone does not provide protection against sexually transmitted diseases.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines.

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