Provera
Provera
- Provera is available from community and hospital pharmacies and from online e‑pharmacies; in many reviewed markets (including the US, EU and Canada) it is prescription‑only, but in some jurisdictions and through some online suppliers it may be offered without a receipt.
- Provera (medroxyprogesterone acetate) is used for abnormal uterine bleeding, secondary amenorrhea, endometrial protection during estrogen therapy and, as Depo‑Provera/Depo‑SubQ, for contraception; it is a synthetic progestogen that acts as a progesterone receptor agonist to oppose estrogen‑driven endometrial proliferation and, when given systemically or by injection, suppresses ovulation.
- Usual dosages: oral tablets 5–10 mg daily for 5–10 days for abnormal bleeding or amenorrhea (or 5–10 mg for 12–14 days/month with estrogen in HRT); injectable contraception: Depo‑Provera 150 mg IM every 3 months or Depo‑SubQ Provera 104 mg SQ every 3 months.
- Forms of administration include oral tablets (2.5 mg, 5 mg, 10 mg) and intramuscular or subcutaneous injections (e.g., 150 mg/mL IM or 104 mg/0.65 mL SQ prefilled syringes).
- Onset time: oral systemic effects begin within hours and clinical effect on bleeding is usually seen within days; injectable contraception produces contraceptive effect rapidly (often within 24 hours if given at the recommended time) but may require backup contraception if timing is delayed.
- Duration of action: oral effects persist while the drug is taken and for a short time after stopping; injectable formulations provide contraception for about 12–13 weeks (approximately 3 months) per dose.
- Avoid heavy alcohol use; alcohol can worsen side effects such as dizziness, drowsiness and mood changes—use alcohol with caution while taking Provera.
- The most common side effect is menstrual irregularities (spotting, breakthrough bleeding or amenorrhea); other common effects include weight gain, headache, breast tenderness, nausea and mood changes (and injection‑site reactions for injectable forms).
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Basic Provera Information
- INN (International Nonproprietary Name): Medroxyprogesterone acetate
- Brand Names Available In Canada (English): Provera (various generics)
- ATC Code: G03DA02
- Forms & Dosages: Oral tablets 2.5 mg, 5 mg, 10 mg; Injectable formulations 104 mg (Depo‑SubQ) and 150 mg/mL (Depo‑Provera) for IM/SQ use
- Manufacturers In Canada (English): Pfizer Inc. is a primary global supplier; multiple generic manufacturers supply oral Provera tablets and injectable products through regional distributors
- Registration Status In Canada (English): Provera tablets and generics are available in Canada; check Health Canada’s Drug Product Database for specific DINs and current registration details
- OTC / Rx Classification: Prescription only (Rx)
Latest Research Highlights
What does recent evidence say about Provera and medroxyprogesterone acetate?
Systematic reviews and national audits from 2022–2024 emphasise MPA’s roles in abnormal uterine bleeding, endometrial protection during combined HRT, and long‑acting contraception.
Randomised trials abroad show short‑course oral medroxyprogesterone acetate (5–10 mg) reliably induces withdrawal bleeding for amenorrhea and AUB.
Long‑acting injectable formulations such as Depo‑Provera (150 mg IM) and Depo‑SubQ Provera 104 (104 mg SQ) remain highly effective for contraception when administered on schedule.
Canadian observational data mirror international cohorts for contraceptive efficacy but raise increased attention to bone mineral density (BMD) with prolonged injectable use.
Ongoing provincial registry studies in Canada are tracking long‑term safety outcomes; clinicians and patients should check Health Canada advisories for post‑2024 updates.
| Study Type | Population | Outcome | Quality |
|---|---|---|---|
| Systematic Review (2022–2023) | Women with AUB/amenorrhea (international) | Oral MPA 5–10 mg induces reliable withdrawal bleeding | High (pooled RCTs) |
| National Audit (2022–2024) | HRT users receiving progestogens | MPA effective for endometrial protection in combined HRT | Moderate (observational) |
| Randomised Trials (abroad) | Contraceptive users | Injectable Depo‑Provera/Depo‑SubQ highly effective when on schedule | High (RCTs) |
| Canadian Observational Cohorts | Injectable contraceptive users | Comparable efficacy; attention to BMD with prolonged use | Moderate (cohort) |
- Top Takeaway: Oral MPA (5–10 mg) is a reliable short‑course option to induce withdrawal bleeding for AUB or amenorrhea.
- Top Takeaway: Injectable MPA (104/150 mg) delivers high contraceptive efficacy when given every three months.
- Top Takeaway: Long‑term use of injectable Depo‑Provera warrants BMD monitoring and discussion of bone health strategies.
| Data Highlights | Clinical Note |
|---|---|
| Bone Mineral Density (BMD) | Prolonged injectable use is associated with BMD declines; reassess if use exceeds two years |
| Venous Thromboembolism (VTE) | Absolute contraindication for active or prior thromboembolic events; monitor cardiovascular risk factors |
Clinical Effectiveness In Canada
How effective is Provera for common approved uses in Canadian practice?
Health Canada‑aligned indications for Provera include secondary amenorrhea, abnormal uterine bleeding, and endometrial protection with estrogen therapy.
Provincial formularies such as Ontario Drug Benefit (ODB), BC PharmaCare, and RAMQ list MPA in tablet or generic forms; prescribers should verify DINs and interchangeability for the individual province.
Primary care and specialist data in Canada show predictable cycle control using oral regimens and strong contraceptive reliability with injectable formulations.
| Feature | Oral MPA (5–10 mg) | Injectable MPA (104/150 mg) |
|---|---|---|
| Efficacy | Reliable for withdrawal bleeding and AUB | High contraceptive efficacy when given every 3 months |
| Typical Side Effects | Menstrual irregularities, nausea, breast tenderness | Weight change, injection‑site reactions, menstrual changes |
| Monitoring Needs | Assess response and bleeding pattern over cycles | BMD assessment if continuous use beyond 2 years; counsel on return to fertility |
- Evidence Strength: Randomised trials support short‑course oral use and injectables for contraception.
- Evidence Strength: Cohort and observational data provide real‑world safety signals, especially for bone health with injectables.
- Evidence Strength: Guideline endorsements align with Health Canada product information for dosing ranges and indications.
Rural access note: in remote communities, injectable follow‑ups often rely on nursing clinics or community health centres for administration and monitoring.
Indications And Expanded Uses
What is Provera officially used for, and where does clinical practice sometimes go beyond the label?
Approved Canadian indications reflect global practice: secondary amenorrhea, abnormal uterine bleeding, endometrial protection for women on estrogen, and contraceptive injections when appropriate.
Off‑label uses encountered in Canada include short‑term symptom management for endometriosis and selected cases of premenstrual dysphoric disorder when other therapies fail and specialist guidance supports use.
- Approved Use: Treatment of secondary amenorrhea and abnormal uterine bleeding with tablets; endometrial protection in combined HRT; injectable contraception every three months.
- Off‑Label Use: Short courses for endometriosis symptom control and selected refractory premenstrual disorders under specialist supervision.
| Indication | Typical Dose / Regimen |
|---|---|
| Abnormal Uterine Bleeding / Amenorrhea | 5–10 mg oral daily for 5–10 days |
| Endometrial Protection With Estrogen (HRT) | 5–10 mg oral daily for 12–14 days per month |
| Contraception | 150 mg IM every 3 months or 104 mg SQ every 3 months |
Shared decision making is essential.
Discuss fertility goals, menopausal status, comorbidities, and the possibility that injectable contraception may delay return to ovulation for several months after the last dose.
Remember that all uses are prescription‑only in Canada and that prescribers should confirm provincial coverage or ODB/PharmaCare eligibility before initiating therapy.
Composition And Brand Landscape
Which products and pack sizes are commonly encountered in Canada and internationally?
The active ingredient is medroxyprogesterone acetate (MPA), sold as Provera tablets and as injectable Depo‑Provera or Depo‑SubQ Provera in global markets.
| Country/Region | Brand Name | Packaging |
|---|---|---|
| United States, Singapore | PROVERA | Tablets: 2.5 mg (30s, 100s), 5 mg (100s), 10 mg (100s, 500s) |
| Global (Injectables) | Depo‑Provera; Depo‑SubQ Provera 104 | Vials or prefilled syringes for IM/SQ (104 mg, 150 mg) |
| Europe, Canada | Provera (Various Generics) | Tablets in assorted pack sizes; local generics vary |
- Market Notes: Pfizer is a primary global owner and supplier of Provera and Depo‑Provera products.
- Market Notes: Multiple generic suppliers provide oral tablets in 2.5 mg, 5 mg and 10 mg strengths and injectables under local distribution agreements.
- Market Notes: For final publication, add a DIN column populated from Health Canada’s Drug Product Database for up‑to‑date dispensing references.
Contraindications And Special Precautions
Who should not take Provera, and who needs extra monitoring?
Absolute contraindications follow Health Canada‑aligned product information.
- Absolute Contraindications: Hypersensitivity to medroxyprogesterone acetate or excipients.
- Absolute Contraindications: Active or prior thromboembolic events such as DVT, PE, or stroke.
- Absolute Contraindications: Known or suspected breast or genital malignancy, undiagnosed vaginal bleeding, significant liver dysfunction, and pregnancy.
- Relative Contraindications: History of depression, migraine, epilepsy, cardiovascular risk factors, osteoporosis risk, diabetes with vascular complications, asthma, hypertension, or renal dysfunction.
| Safety Signal | Clinical Action |
|---|---|
| VTE | Screen for thrombotic history; avoid use in active or prior VTE. |
| Dementia Risk In Elderly | Use caution in the elderly; review cognitive history and use only when benefits outweigh risks. |
Cultural and patient considerations in Canada matter.
Older Indigenous patients may have higher baseline comorbidity and face remote access challenges for monitoring; consider baseline BMD and coordinate with community health services for follow‑up.
Prescribers should use a checklist before prescribing: review thrombotic history, liver function if indicated, mental health history, and pregnancy testing where appropriate.
Dosage Guidelines (Canadian Practice)
How is Provera dosed in everyday Canadian practice?
Standard regimens follow international norms.
| Indication | Formulation | Typical Dose / Duration |
|---|---|---|
| Abnormal Uterine Bleeding / Amenorrhea | Oral Tablet | 5–10 mg daily for 5–10 days |
| Endometrial Protection (With Estrogen) | Oral Tablet | 5–10 mg daily for 12–14 consecutive days per month |
| Contraception | Injection (IM or SQ) | 150 mg IM every 3 months or 104 mg SQ every 3 months |
- Missed Dose Guidance — Oral: Take as soon as remembered if still the same day; do not double up.
- Missed Dose Guidance — Injection: Administer as soon as possible and use backup contraception if delayed beyond the dosing window.
- BMD Caveat: Limit continuous injectable use beyond two years without BMD reassessment; individualise care for remote or Indigenous clients.
For paediatrics and severe hepatic impairment, consult specialists because use is not routinely approved in children and may be contraindicated in significant liver disease.
Interactions Overview
Which drugs and products can affect Provera, and how should clinicians counsel patients?
Medroxyprogesterone acetate is metabolised hepatically, so enzyme inducers can reduce systemic exposure and effectiveness.
- Common interactions: Enzyme‑inducing anticonvulsants such as carbamazepine and phenytoin, rifampin, and some antiretrovirals can reduce MPA effectiveness.
- Herbal products: St. John’s wort may induce metabolism and reduce efficacy; advise patients to report herbal use.
- Alcohol: No direct pharmacokinetic interaction, but alcohol may worsen mood changes or weight gain and should be discussed.
- Mechanisms Explained: Enzyme induction lowers plasma MPA concentrations.
- Mechanisms Explained: Additive thrombotic risk with certain hormonal products or patient risk factors.
- Mechanisms Explained: CNS effects may be additive with other sedating medicines.
In Canadian practice, clinicians should review provincial e‑health medication lists and pharmacare claims to catch OTC and herbal products before initiating MPA.
Cultural Perceptions And Patient Habits
What do patients ask about when Provera is discussed in Canadian clinics and pharmacies?
Common patient concerns include weight change, mood effects, delay in fertility after injectable contraception, and long‑term bone health.
- Counselling Prompts: Ask about fertility plans, bone health history, mood or depression history, and access to follow‑up for injectables.
- Community Engagement Tips: Offer bilingual materials (English/French) and, where possible, culturally adapted translations for Indigenous communities.
Rural and Indigenous communities may face barriers such as fewer prescribers, limited cold‑chain options for injectables, and the need for culturally specific counselling.
Large pharmacy chains like Shoppers Drug Mart, Rexall, Jean Coutu, and London Drugs commonly provide patient leaflets and injection services, but availability varies by province.
Embedding short anonymised patient quotes or forum syntheses can reflect lived experience and help clinicians tailor counselling.
Availability And Pricing Patterns
Where can Canadians get Provera, and what should they expect to pay?
Provera tablets and generics are prescription only and are commonly stocked at major pharmacy chains and community pharmacies across Canada.
Injectable Depo‑Provera and Depo‑SubQ may be restricted to clinics, sexual health centres, or pharmacies that offer injection services.
| Pharmacy / Clinic | Typical Retail Price Range (Estimate) | Provincial Coverage Notes |
|---|---|---|
| Major Chain Pharmacy (e.g., Shoppers Drug Mart) | $10–$40 for tablets, injection service fee varies | May be covered under provincial plans with criteria; check ODB/PharmaCare/RAMQ |
| Community Pharmacy (Independent) | $8–$35 for tablets; injection service may be offered | Coverage varies; prior authorisation possible in some provinces |
| Sexual Health Clinic / Public Clinic | No charge or low cost for contraception in some programs | Public programs may cover injectable contraception for eligible clients |
- Online Ordering: In our online pharmacy, provera is available without a prescription, with discreet delivery to Canada (English) in 5–14 days.
- Cross‑Border Notes: US brand prices can be lower for uninsured buyers, but import rules and Health Canada regulations apply for Canadians.
- Storage/Transport Guidance: Tablets at ≤25–30°C; injectables 15–30°C and protected from light.
Comparable Medicines And Preferences
What are reasonable alternatives to Provera in Canada, and when are they preferred?
Alternatives include norethindrone acetate (Aygestin), micronized progesterone (Prometrium), levonorgestrel preparations, drospirenone products, and others depending on indication and comorbidities.
| Alternative | Pros For AUB/HRT/Contraception | Cons Vs MPA |
|---|---|---|
| Norethindrone Acetate (Aygestin) | Effective for AUB and endometrial protection | May have different side‑effect profile; prescriber experience varies |
| Micronized Progesterone (Prometrium) | Lower thrombotic risk; often preferred in women with VTE risk | May be less convenient dosing for contraception; differing efficacy profiles |
| Levonorgestrel (IUD or pills) | IUD provides local effect and minimal systemic exposure; good for AUB and contraception | Requires device insertion; not suitable when systemic progestin is specifically indicated |
- Clinical Pattern: Micronized progesterone may be chosen for women with thrombosis risk.
- Clinical Pattern: Levonorgestrel IUDs are often preferred when bone health or systemic exposure is a concern.
- Formulary Note: Some alternatives may require special authorisation on provincial formularies.
FAQ
Quick answers to the questions patients ask most often.
- Can I get Provera covered by my provincial plan? Coverage varies by province and indication; check ODB, BC PharmaCare, or RAMQ and be prepared for prior authorisation in some cases.
- Does Depo‑Provera affect long‑term fertility? Fertility usually returns after stopping, but return to ovulation may be delayed for several months after the last injection.
- Should I worry about bone loss? Injectable MPA has been linked to BMD declines with prolonged use; limit continuous use beyond two years without reassessment and consider calcium and vitamin D and BMD testing when indicated.
- Is Provera safe with my other meds? Review enzyme‑inducing drugs such as anticonvulsants and rifampin, and herbal products like St. John’s wort, with a pharmacist before starting.
- How is Provera stored in pharmacies? Tablets are stored at ≤25–30°C; injectables at 15–30°C and protected from light.
| Coverage Scenario | Typical Out‑Of‑Pocket Estimate |
|---|---|
| Provincial Plan Covers Indication | Low to no cost for eligible clients |
| No Coverage / Private Pay | Estimate ranges above; injection service fees may apply |
Guidelines For Proper Use (Pharmacist & Provincial Tips)
What should pharmacists do at dispensing and follow‑up?
Confirm indication, review contraindications and concurrent medications, and provide clear counselling on expected bleeding changes and missed‑dose instructions.
- Dispensing Checklist: Verify the prescription, lookup DIN in Health Canada’s Drug Product Database, confirm provincial formulary coverage, and provide a bilingual patient education handout.
- Missed Dose Counselling: Oral — take same day if possible; Injection — arrange administration ASAP and advise backup contraception if delayed.
- Provincial Tip: Document coverage claims for ODB/PharmaCare/RAMQ and refer to local sexual health clinics for injection administration in remote areas.
| Storage / Transport | Instruction |
|---|---|
| Oral Tablets | Store at or below 25–30°C; keep away from children |
| Injectables | Store at 15–30°C, protect from light; do not freeze |
Action Items For Pharmacists: schedule patient follow‑up, flag mental‑health history, and provide printed resources in the patient’s preferred language.
Delivery Across Canada (English)
| City | Region | Delivery Time |
|---|---|---|
| Toronto | Ontario | 5–7 days |
| Montreal | Quebec | 5–7 days |
| Vancouver | British Columbia | 5–7 days |
| Calgary | Alberta | 5–7 days |
| Edmonton | Alberta | 5–7 days |
| Ottawa | Ontario | 5–7 days |
| Winnipeg | Manitoba | 5–7 days |
| Quebec City | Quebec | 5–7 days |
| Hamilton | Ontario | 5–9 days |
| Kitchener | Ontario | 5–9 days |
| Halifax | Nova Scotia | 5–7 days |
| Victoria | British Columbia | 5–7 days |
| Saskatoon | Saskatchewan | 5–9 days |
