Provera (Medroxyprogesterone Acetate) 2.5 mg / 5 mg / 10 mg Tablets: Prescription Synthetic Progestin for Secondary Amenorrhea, Abnormal Uterine Bleeding, and Endometrial Protection in HRT

Reviewed by the Lucas Clinic Medical Team | Updated May 2026

Provera (medroxyprogesterone acetate, MPA) is a synthetic derivative of the natural hormone progesterone, classified as a progestin. It is one of the most extensively studied progestins in clinical medicine, with approvals and uses spanning several decades. Provera tablets are prescribed for conditions driven by lack of adequate progestogen activity: secondary amenorrhea (absent menstruation not due to pregnancy), abnormal uterine bleeding due to hormonal imbalance, and endometrial hyperplasia prevention in women receiving estrogen replacement therapy. When combined with conjugated estrogens (as Prempro), MPA was the progestin component investigated in the Women's Health Initiative trials — providing substantial long-term safety data, both reassuring and cautionary.

Beyond oral Provera tablets, medroxyprogesterone acetate is also prescribed in its depot injectable form — Depo-Provera (150 mg/mL IM injection given every 3 months) — as a highly effective contraceptive. The injectable form provides sustained contraceptive coverage and is used in women for whom daily oral contraception is not feasible. Depo-Provera is associated with menstrual irregularity and, with long-term use, reduced bone mineral density which is reversible on stopping. MPA is a prescription medicine in all markets — no OTC routes exist.

What Is Provera (Medroxyprogesterone Acetate)?

Medroxyprogesterone acetate is a synthetic 17-alpha-hydroxyprogesterone derivative with potent progestational activity at progesterone receptors. Unlike natural micronised progesterone (which can also be used in HRT and amenorrhea management), MPA is orally active in low doses, is not quickly inactivated in the gut and liver, and delivers consistent progestogen bioavailability. Its progestational activity converts a proliferative estrogen-primed endometrium to a secretory state, opposing the mitogenic effects of estrogen on the uterine lining — this endometrial protection mechanism is why progestogen must always accompany estrogen in women with an intact uterus during HRT.

When used for secondary amenorrhea or abnormal bleeding, MPA is typically given for 5–10 days in a specific menstrual cycle phase to induce withdrawal bleeding on cessation — a so-called "progesterone challenge test" that confirms intact estrogen priming of the endometrium. A withdrawal bleed on stopping MPA confirms that the endometrium is responsive and that estrogen levels are adequate — the amenorrhea in such patients is typically due to a progesterone deficit (anovulation) rather than estrogen deficiency.

Prescription vs. Over-the-Counter Status

Provera tablets and Depo-Provera injection are prescription-only in the US, UK, and all comparable markets. No OTC progestin hormonal product is approved. Hormone replacement therapy components, including progestins for endometrial protection, require individual medical assessment — particularly given the risk-benefit profile discussed in the WHI trials regarding combined continuous HRT exposure and breast cancer risk. Patients seeking HRT should consult an obstetrician-gynaecologist, women's health specialist, or GP who can individually tailor the estrogen preparation, progestin type, dose, and route of administration to minimise risk and maximise symptomatic benefit.

Available Strengths and Forms

Provera tablets are available in three oral strengths: 2.5 mg, 5 mg, and 10 mg. For secondary amenorrhea: 5–10 mg daily for 5–10 days in the second half of the cycle. For abnormal uterine bleeding: 5–10 mg daily for 5–10 days starting on the 16th or 21st day of the menstrual cycle. For endometrial protection in HRT: 2.5 mg daily continuously (in combined continuous regimens) or 5–10 mg for 12–14 days per cycle (sequential regimens). Depo-Provera injectable suspension (150 mg/mL) is given as a deep IM injection every 13 weeks (3 months) for contraception. A lower-dose Depo-subQ Provera 104 mg formulation is available for subcutaneous injection. Generic medroxyprogesterone acetate tablets are widely available.

Price of Provera

Generic medroxyprogesterone acetate tablets are among the lowest-cost prescription medicines. A 30-tablet supply of 10 mg medroxyprogesterone (generic) typically costs $10–$25 at US pharmacies, with GoodRx coupons sometimes reducing this further. Brand Provera is higher in cost. The Depo-Provera injection is priced at approximately $80–$150 per 3-month injection at retail, but most insurance plans cover it under contraceptive or hormonal therapy benefits. Pfizer (manufacturer of Provera) and generic manufacturers have patient assistance and discount programmes for eligible patients.

Frequently Asked Questions

Does medroxyprogesterone acetate cause depression?

Mood disturbance, including depressive symptoms, has been reported in some patients using MPA-containing preparations — both in HRT and as Depo-Provera. In the WHI trials, combined HRT (CEE + MPA) was associated with slightly increased rates of depression-related symptoms. Some women notice mood effects that resolve with a switch to natural micronised progesterone (which is metabolised to neuroactive steroids including allopregnanolone with anxiolytic/sedative properties) or a different progestin. Not all women are affected. Patients who notice persistent mood changes on MPA-containing HRT should discuss switching progestin preparations or changing HRT formulation with their prescriber.

Why must progestogen be added when taking estrogen?

Estrogen stimulates proliferation of the uterine endometrial lining. Without a progestogen to oppose this stimulation and promote secretory conversion and shedding, the endometrium continues to proliferate under persistent estrogen exposure — leading to endometrial hyperplasia, which is a precursor to endometrial carcinoma. The principle "no estrogen without a progestogen in women with a uterus" is foundational to all modern HRT prescribing. Women who have had a hysterectomy have no endometrium to protect and do not need progestogen. This distinction is clinically crucial and reinforces why HRT should always be managed by a prescriber aware of the patient's full reproductive surgical history.

What is the difference between Provera and natural progesterone (Prometrium/Utrogestan)?

Provera (MPA) is a synthetic progestin — a progesterone derivative with structural modifications that confer oral bioavailability. Natural micronised progesterone (brand names include Prometrium in the US, Utrogestan in the UK) is bioidentical progesterone — the same molecular structure as the body's own progesterone, formulated in a microparticle capsule for oral absorption. Some evidence and clinical experience suggests micronised progesterone has a more favourable tolerability profile (less mood disruption, potentially lower breast cancer risk contribution based on some observational data) compared to synthetic progestins like MPA. NICE guidelines in the UK now favour body-identical progesterone where possible. The clinical choice between progestin types should be individualised with the prescribing clinician.

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