Medoxyprogesterone acetate (Provera)

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Your doctor has recommended a medication called Provera as treatment for your illness. This page provides extra information about your medicine, summarises possible side effects and methods to alleviate them.

What is in Provera tablets? Provera belongs to group of medicines called "progestogens" and is related to the naturally occurring hormone called progesterone.  The active ingredient in Provera is called medoxyprogesterone acetate.  Provera  tablets are available in a number of strengths 2.5mg, 5mg, 10 mg, 100mg, 200mg & 400mg. The lower doses tend to be used for non-malignant conditions and the higher ones for cancers such as Breast, Uterus or Kidney.

How do they work? Some tumours such as breast cancer are stimulated by the bodies own female hormone (Oestrogen). Stopping the bodies hormones reaching the tumour can cause the cancer cells to stop growing and in some cases shrivel up and die completely (self destruct - apoptosis).   Provera  works in two main ways. Firstly it  fools the signal pathway between the brain (pituitary) and the Ovaries  by increasing the blood levels of another hormone produced in the ovaries called progesterone so in turn the brain thinks the ovaries are producing too many hormones including oestrogen. As a consequence the body switches off the driving signal from the brain by itself - this results in reducing the blood level of oestrogen.  Secondly Provera has a direct effect on the tumour via its own receptors called progesterone receptors. Stimulation of these receptors causes the cell to slow its uncontrolled growth and become less aggressive.

How will I & the doctor know they are working? In most cases there is something the doctor can measure. This may be how you feel, a symptom related to you cancer, something which can be felt on examination (e.g. a lump) are something seen on a scan or xray. After 2-3 months a formal assessment of response is usually performed before continuing the tablets indefinitely - This may well involve repeating the xrays or scans.

Possible side effects. All tablets have side effects. These can effect some people more than others. It its hard to predict the level and type of side effect for each individual. Listed below are an overview of the more common side effects you may encounter, however, you may experience none, all, or only a few of these. You may also have a rare side effect not listed here - If you become aware of any other side effects, please report them to your clinic.

If side effects are severe, you may have to stop taking the drug and a different hormonal drug may be prescribed. Side effects are more common in pre-menopausal women who may develop menopausal side effects as a result of a reduced level of oestrogen. The commonest side effects, apart from nausea, are hot flushes and sweats, particularly at night.

• Flushes and sweats. These are not usually prominent. Sometimes the flushes will gradually lessen over the first few months but some women continue to have them for as long as they take megace. There are a number of ways to help reduce or control hot flushes and sweats. Some women find it helpful to avoid or cut down on tea, coffee, nicotine and alcohol. Evening primrose oil has been reported to be helpful in reducing sweats but it does not work for all women and it is  expensive. There are a lot of calories in Evening Primrose Oil so it may be fattening in some women. Some women have found complementary therapies have helped, and your GP may be able to give you details about obtaining these on the NHS. If you find your own therapist makes sure he or she is properly qualified and registered.   If you are having very troublesome hot flushes do not hesitate to discuss some of these treatments with your doctor.

• Nausea and indigestion.  Feelings of sickness (nausea) and indigestion are fairly common but can often be relieved by taking your tablet(s) with foods or milk or at night. Although mild nausea is quite common initially it usually wears off after a few weeks. see diet and indigestion

• Weight gain. Weight gain can be a side effect of provera and this is sometimes due to water retention but at other times a consequence of a eating more either due to a increased appetite or mild nausea - "to settle the stomach" . See coping with weight gain.
  
• Ankle swelling. - If women are prone to ankle swelling this may be worse, it is caused by fluid retention. If one leg gets swollen tender and hot this may be a thrombosis and should be reported to your doctor immediately.

• Change in periods. Women who have not yet reached the menopause may notice their monthly periods change – they may become irregular, lighter or sometimes stop altogether. Some women also notice an increase in vaginal discharge and vulval itching.

Less common side effects include depression, tiredness and dizziness.

 Very rare side effect of Provera include:

• Allergic reactions – this may include skin rashes
• Temporary thinning of the hair
• Headaches – some people affected by migraine have noticed a change in the pattern of their headaches
• Flaking finger nails – after several years of treatment
• Thrombosis (blood clots) – pain, warmth, swelling or tenderness in an arm or leg or any chest pain must be reported to your doctor immediately

Before you take provera - tell your doctor: 

• If you have had an allergic reaction to provera in the past.

• What other medications you are taking

• If you plan to become pregnant

• If you have a history of blood clots (thrombophlebitis).

Other issues. There is no interaction between Provera tablets and moderate amounts of alcohol. Provera tablets do not usually affect your ability to drive.   Provera  tablets may raise your blood sugar if you are diabetic. If you notice that your blood sugar is higher than normal consult your doctor.  

Remember! This medicine is for you. Only a doctor can prescribe if for you never give this medicine to any one else, even if they have the same symptoms as you, as it may harm them.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.