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How is cyclic progesterone (provera or prometrium) given?

Provera is typically prescribed during the second half of the month long cycle or, during the luteal phase. That is why the prescription typically describes taking the medicine days 16 through 25. Upon receiving the medicine at first, you will likely not know where you are in your cycle so you start the medicine immediately. Within 1-3 days of finishing your 10 day course, you should have a menstrual cycle. This cycle can be significantly heavier than your usual cycle. The day you start bleeding after the medicine, is CYCLE DAY #1. From that day forward, count to day 16 and that is when you initiate your next 10 day course and so on... Patients are typically put on at least a 3 month course. Each subsequent cycle should become more manageable.

A couple words of caution:

  1. It is possible to bleed too much. If you are concerned about the volume of blood loss, go to the emergency room, especially if you feel like your heart is racing, you feel dizzy, or appear pale.
  2. Uterine/vaginal bleeding can be the sign of miscarriage, ectopic pregnancy, and different forms of uterine pathology. Further investigation is sometimes warranted.
  3. Pregnant patients should not cycle with provera. If you have any question about potential pregnancy, do a pregnancy test before taking provera.
  4. If you are bleeding when you originally start the provera, it probably won't stop that bleeding. Also, sometimes, patients will get breakthrough bleeding in the middle of their course of progesterone. Most patients will complete the 10 day course with no additional bleeding.

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