Side effects of medroxyprogesterone
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Side Effects of Medroxyprogesterone: A Comprehensive Review
Introduction to Medroxyprogesterone Side Effects
Medroxyprogesterone acetate (MPA) is a synthetic progestin commonly used in various medical treatments, including hormone replacement therapy, contraception, and cancer management. While effective, MPA is associated with several side effects that can impact patient compliance and overall health.
Weight Gain and Appetite Changes
One of the most frequently reported side effects of MPA is weight gain. Studies have shown that MPA can lead to increased body fat mass and overall weight gain in users1. In patients with advanced-stage non-hormone-sensitive cancer, MPA was found to improve appetite and prevent further weight loss, although it did not significantly enhance overall quality of life2.
Menstrual Irregularities
MPA is also known to cause menstrual irregularities, including unpredictable bleeding patterns and amenorrhea (absence of menstruation)1 5. These side effects are significant contributors to the high discontinuation rates of depot medroxyprogesterone acetate (DMPA) as a contraceptive method.
Mood and Psychological Effects
The impact of MPA on mood and psychological well-being is inconsistent. Some studies suggest that MPA may cause mood changes, including negative mood symptoms, particularly in women with a history of premenstrual syndrome (PMS)6. However, other research indicates that MPA does not produce consistent adverse psychological effects when used in conjunction with estrogen therapy3 9.
Cardiovascular Side Effects
Cardiovascular toxicity is another concern with MPA use. Fluid retention, hypertension, and thromboembolic events have been reported, particularly in older patients or those with pre-existing cardiovascular conditions4. However, the risk of severe cardiovascular complications is generally lower with MPA compared to other hormonal treatments like diethylstilbestrol4.
Metabolic Effects
MPA can also affect metabolic parameters. In undernourished lactating women, MPA use was not associated with significant alterations in glucose tolerance or serum triglyceride levels. However, a decrease in cholesterol levels and alkaline phosphatase activity was observed, which might be attributed to waning lactation8.
Bone Health and Hypoestrogenic Effects
In the treatment of endometriosis, combining MPA with a gonadotropin-releasing hormone agonist (GnRH-A) has been shown to reduce some hypoestrogenic side effects, such as hot flushes and sweating, and may have a bone-sparing effect7. This combination therapy helps mitigate the antiestrogenic effects of GnRH-A while maintaining its efficacy in reducing endometriotic implants and pelvic symptoms.
Conclusion
Medroxyprogesterone acetate is a versatile medication with a range of applications, but its use is accompanied by several side effects. Weight gain, menstrual irregularities, mood changes, cardiovascular toxicity, and metabolic effects are among the most notable. While some side effects can be managed or mitigated through combination therapies, patient-centered counseling and higher-quality research are essential to better understand and address these issues.
Sources and full results
Most relevant research papers on this topic
Side Effects and Health Benefits of Depot Medroxyprogesterone Acetate: A Systematic Review.
DMPA use may cause weight gain, increased body fat mass, irregular bleeding, and amenorrhea, with limited evidence supporting decreased cancer risk and tubal infertility.
Systematic Review
Rigorous JournalEffects of medroxyprogesterone acetate on appetite, weight, and quality of life in advanced-stage non-hormone-sensitive cancer: a placebo-controlled multicenter study.
Medroxyprogesterone acetate improves appetite and may prevent further weight loss in advanced-stage non-hormone-sensitive cancer patients, but does not significantly impact overall quality of life.
RCT
Highly CitedA Randomized, Double-Blind, Placebo- Controlled, Cross-Over Trial to Assess the Side Effects of Medroxyprogesterone Acetate in Hormone Replacement Therapy
Medroxyprogesterone acetate 10 mg/day for 14 days combined with transdermal estrogen therapy does not cause consistent adverse physical or psychological effects on women for one cycle of treatment.
RCTCardiovascular side effects of diethylstilbestrol, cyproterone acetate, medroxyprogesterone acetate and estramustine phosphate used for the treatment of advanced prostatic cancer: results from European Organization for Research on Treatment of Cancer trials 30761 and 30762.
Diethylstilbestrol has higher cardiovascular toxicity than estramustine phosphate or medroxyprogesterone acetate, and cyproterone acetate, with the risk of severe complications increasing during the first 6 months of treatment.
RCT
Large Human TrialHighly CitedEffects of depo-medroxyprogesterone acetate as a contraceptive agent.
Depot medroxyprogesterone acetate is a highly effective contraceptive agent with unpredictable bleeding patterns and no deleterious effect on pregnancy outcome.
Observational StudyNegative mood changes during hormone replacement therapy: a comparison between two progestogens.
Medroxyprogesterone to estrogen is preferable for mood symptoms during hormone replacement therapy in women without a history of premenstrual syndrome.
RCTHighly CitedMedroxyprogesterone acetate supplementation diminishes the hypoestrogenic side effects of gonadotropin-releasing hormone agonist without changing its efficacy in endometriosis.
High-dose medroxyprogesterone acetate combined with a GnRH agonist reduces hypoestrogenic side effects and may have a bone-sparing effect in endometriosis treatment without changing its efficacy.
RCTMetabolic side-effects of injectable depot-medroxyprogesterone acetate, 150 mg three-monthly, in undernourished lactating women. WHO Task Force on Long-acting Agents for Fertility Regulation.
Depot-medroxyprogesterone acetate (DMPA) use in undernourished lactating women does not cause metabolic side-effects, but may affect cholesterol levels and alkaline phosphatase activity.
Observational StudyComparison of physical and emotional side effects of progesterone or medroxyprogesterone in early postmenopausal women
Progesterone and medroxyprogesterone do not affect mood in early postmenopausal women, and micronized progesterone may have lesser side effects than MPA.
RCTNo Adverse Effects of Medroxyprogesterone Treatment Without Estrogen in Postmenopausal Women: Double-Blind, Placebo-Controlled, Crossover Trial
Medroxyprogesterone treatment alone does not cause adverse symptoms in postmenopausal women, and it cannot explain the side effects reported by women taking combined hormones.
RCT