비권장 프로게스틴 (MPA)

Not Recommended for HRT

Medroxyprogesterone acetate (MPA) is not recommended by WPATH SOC 8 for transfeminine HRT ^[1] . This page explains why and helps you understand the reasons to choose safer alternatives.

What Is MPA?

Medroxyprogesterone acetate (MPA) is a synthetic progestin, commonly known by brand names:

• Provera (oral, 5-10 mg)
• Depo-Provera (injection, 150 mg/3 months)

MPA was widely used in postmenopausal hormone therapy but large clinical trials (WHI study) revealed significant risks.

Why It Is Not Recommended

1. Significantly Increases VTE Risk

Compared to natural progesterone, MPA significantly increases venous thromboembolism (VTE) risk ^{[2] [3]} :

• MPA + estrogen VTE risk: RR approximately 2.0-2.5
• Natural progesterone + estrogen VTE risk: RR approximately 1.0 (no significant increase)

2. Adverse Metabolic Effects

• May reduce HDL (“good” cholesterol)
• Unfavorable effects on insulin resistance
• Weight gain

3. Safer Alternatives Exist

• Micronized progesterone: Natural/bioidentical, VTE risk neutral
• Dydrogesterone: Better oral bioavailability, superior safety data
• Hydroxyprogesterone caproate: Injectable option

If You Are Currently Using MPA

Do Not Stop Abruptly

If you are currently using MPA (oral or injection), do not discontinue abruptly on your own. Discuss a gradual transition to a safer progestogen alternative with your healthcare provider. Sudden discontinuation of hormonal medications can cause hormonal fluctuations and discomfort.

Exception Circumstances

In resource-limited settings where MPA may be the only available progestogen:

• Use the lowest possible dose
• Intensify VTE risk factor monitoring
• Prioritize not smoking and weight management
• Switch to natural progesterone or dydrogesterone as soon as available