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Hormonal drugs for endometriosis treatment: provera HORMONAL DRUGS FOR ENDOMETRIOSIS TREATMENT: PROVERA
Provera is one of the hormonal drugs that is used to treat women with endometriosis. In the past, Provera was used infrequently in Australia for the treatment of endometriosis but its use has increased markedly over the last four or five years. It has also been used for over 25 years to treat a number of other conditions including endometrial cancer (cancer of the uterus), abnormal uterine bleeding, amenorrhea (absence of periods) and menopausal symptoms in some women.
Provera is a strong progestogen (a synthetic progesterone) which is sometimes also known by its chemical name, medroxyprogesterone acetate.
Provera tablets, manufactured by Upjohn, come in several strengths. Those most commonly used in the treatment of endometriosis are small, white 10 milligram tablets.
Provera should not be confused with its controversial close relative Depo-Provera. Although both have the same chemical composition, Provera is in the form of a short-acting tablet whereas Depo-Provera is in the form of a long-acting injection. The long-term side effects that may be associated with the use of Depo-Provera do not occur with the use of Provera. If side effects occur when using Provera they can be rapidly reversed by stopping the treatment because the drug does not remain in the body for a significant length of time. The delay in the return of ovulation that sometimes occurs following the use of Depo-Provera is not a problem with Provera.
How Provera works
It is not known precisely how Provera eradicates endometrial implants but it probably works by suppressing ovulation and inhibiting the growth of the misplaced endometrial cells in some way, causing them to gradually waste away.
At the dosages usually recommended for endometriosis most women will stop ovulating and menstruating.
Dosages of Provera generally used
Most gynecologists recommend dosages of Provera in the range of 20 to 60 milligrams a day (two to six 10 milligram tablets a day). Generally, gynecologists recommend that Provera be taken daily for three to nine months.
Although the usual length of treatment is three to nine months there is no evidence that prolonged or repeated courses of Provera cause long-term side effects.
You should visit your gynecologist about six to eight weeks after starting your course of Provera so that you can discuss how me treatment is progressing. Thereafter, you should visit every two to three months for the remainder of your course of treatment.
Side effects of Provera
Most women using Provera will experience one or more side effects which are usually mild to moderate in severity and generally quite manageable. A few women will find them intolerable.
The more common side effects are weight gain, bloating, spotting, irregular vaginal bleeding, decreased libido, lethargy and tiredness, depression, headaches, acne, nausea and tender breasts.
The amount of weight gain on Provera varies widely and although most women will gain only one or two kilograms some women will experience greater gains.
Vaginal bleeding is a significant problem for some women on Provera. Usually it can be controlled by increasing the dosage but some women will continue to suffer vaginal bleeding even if they take relatively high dosages in the order of 60 to 80 milligrams per day.
Ovulation and menstruation usually occur within four to six weeks of completing therapy.
The side effects of Provera are reversible and they usually disappear within a few weeks of completing treatment.
There are no known long-term side effects of Provera.
How effective is Provera
Although very little research has been carried out into the effectiveness of Provera the results so far indicate that it is as effective as Danazol.
Studies have shown that about 60% to 80% of women had partial or complete relief from their symptoms and that about 50% of the women who wished to conceive became pregnant following treatment. There is no information available on how frequently endometriosis recurs following treatment.
Provera, pregnancy and breastfeeding
The manufacturers of Provera state that it should not be used during pregnancy as progestogens may cause abnormalities in the developing foetus.
The use of Provera while breastfeeding is also not recommended by the manufacturers. Small amounts of progestogens have been found in the milk of mothers taking them and the effect on the child is not known. However, some gynecologists believe that Provera can be safely used during pregnancy and breastfeeding.
Interaction with other drugs, alcohol or foods
There are no known interactions of Provera with any foods, alcohol or other drugs.
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