How does it work?
Climanor tablets contain the active ingredient medroxyprogesterone acetate, which is a synthetic form of the naturally occurring female sex hormone, progesterone. It is used to treat various disorders of the menstrual cycle.
A woman's menstrual cycle is a complex process that is controlled by at least four different hormones. The blood levels of these hormones change throughout the menstrual cycle, causing an egg to be released from the ovaries (ovulation), preparation of the womb lining for a possible pregnancy and shedding of the womb lining each month if pregnancy doesn't occur (a menstrual period). There are plenty of places that this complex process can go wrong.
If your periods are irregular or have stopped completely and your doctor can find no obvious cause, it may be that something has upset your natural hormone levels. Medroxyprogesterone can help to restore your natural hormone levels, because it mimics the effects of your natural progesterone.
Normally the level of progesterone in your blood increases about a week before your period. If medroxyprogesterone is taken for 5 to 10 days each month at this time (ie day 16 to 21 of your cycle) it mimics the natural rise in your progesterone levels. This can help your other hormones to behave in a more normal way. To treat irregular periods this medicine is taken in this way for two menstrual cycles. To treat periods that have stopped it is taken for three menstrual cycles. In each case, a few days after you stop taking the tablets you should get your period. At the end of the treatment regular periods should return.
Endometriosis can also be treated by manipulating your hormones with medroxyprogesterone. In this condition, tissue resembling the womb lining grows abnormally around the ovaries, womb and bladder. This tissue is controlled by the same hormones that control your menstrual cycle, and thickens and is shed in the same way as your normal womb lining. Medroxyprogesterone is taken three times a day for 90 days, starting on the first day of your period, to control this. The medroxyprogesterone stops the abnormal tissue from thickening and then bleeding. As a result your menstrual periods are also likely to stop during the treatment as well; alternatively you might get irregular bleeding or spotting. After treatment has finished the patches of endometrial tissue may be smaller, or may have shrunk away altogether.
Climanor tablets can also be used in hormone replacement therapy (HRT) for menopausal women who have not had a hysterectomy. In HRT, oestrogen is used to help reduce the distressing symptoms of the menopause. However oestrogen also stimulates the growth of the womb lining (endometrium), which can lead to endometrial cancer if this growth is unopposed. Medroxyprogesterone can be used to oppose oestrogen's effect on the womb lining and reduce the risk of endometrial cancer, though it does not eliminate this risk entirely. It is taken once a day for the last 14 days of each 28 cycle of oestrogen for this purpose. You will usually have a bleed (similar to your menstrual period) during or after taking the Climanor tablets.
What is it used for?
- Dysfunctional menstrual bleeding, for example heavy, painful, irregular or very frequent periods.
- Menstrual periods that have stopped (secondary amenorrhoea).
- Mild to moderate endometriosis.
- Part of hormone replacement therapy (HRT) for menopausal women who have not had a hysterectomy and are taking an oestrogen hormone supplement.
- This medicine should not be used during pregnancy. It does not provide contraception against pregnancy, because it doesn't stop you releasing an egg (ovulation). You should use a non-hormonal method of contraception such as condoms to avoid getting pregnant while you are taking this medicine. Ask your doctor for advice.
- Stop taking this medicine and inform your doctor immediately if you experience any of the following symptoms while taking this medicine: stabbing pains or swelling in one leg; pain on breathing or coughing; coughing up blood; breathlessness; sudden chest pain; sudden numbness affecting one side or part of the body; fainting; worsening of epilepsy; visual disturbances; severe abdominal complaints; migraine or severe headaches; increased blood pressure; itching of the whole body; yellowing of the skin or eyes (jaundice) or severe depression.
- Women taking any form of HRT to relieve menopausal symptoms should have regular medical and gynaecological check-ups. Your need for continued HRT should be reviewed with your doctor at least once a year.
- It is important to be aware that all women using HRT have an increased risk of being diagnosed with breast cancer compared with women who don't use HRT. This risk needs to be weighed against the personal benefits to you of taking HRT. There is more detailed information about the risks and benefits associated with HRT in the factsheet about the menopause linked above. You should discuss these with your doctor before starting HRT. Women on HRT should have regular breast examinations and mammograms and should examine their own breasts regularly. Report any changes in your breasts to your doctor or nurse.
- It is important to be aware that women using HRT have a slightly increased risk of stroke and of blood clots forming in the veins (eg deep vein thrombosis/pulmonary embolism) compared with women who don't use HRT. The risk is higher if you have existing risk factors (eg personal or family history, smoking, obesity, certain blood disorders) and needs to be weighed against the personal benefits to you of taking HRT. There is more detailed information about the risks and benefits associated with HRT in the factsheet about the menopause linked above. Discuss these with your doctor before starting treatment.
- The risk of blood clots forming in the veins (thromboembolism) while taking HRT may be temporarily increased if you experience major trauma, have surgery, or are immobile for prolonged periods of time (this includes travelling for over five hours). For this reason, your doctor may recommend that you stop taking HRT for a period of time (usually four to six weeks) prior to any planned surgery, particularly abdominal surgery or orthopaedic surgery on the lower limbs, or if you are to be immobile for long periods. The risk of blood clots during long journeys may be reduced by appropriate exercise during the journey and possibly by wearing elastic hosiery. Discuss this with your doctor.
Use with caution in
- Decreased kidney function.
- Women who suffer from migraines.
- High blood pressure.
- Heart failure.
- Women with a history of blood clot in a vein (venous thromboembolism), eg in the leg (deep vein thrombosis) or in the lungs (pulmonary embolism).
- Women with a history of depression.
Not to be used in
- Cancer of the breast or reproductive organs.
- Severe disease of the arteries, eg that has caused angina or a heart attack.
- Decreased liver function.
- Liver disease.
- Abnormal vaginal bleeding of unknown cause.
- If the medicine is being used as part of HRT - untreated overgrowth of the lining of the womb (endometrial hyperplasia).
- Rare hereditary blood disorders known as porphyrias.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used in pregnancy. It does not provide contraception itself. You should use a non-hormonal method of contraception such as condoms to avoid getting pregnant while taking this medicine. Seek medical advice from your doctor. Stop taking this medicine and consult your doctor if you think you could have got pregnant while taking this medicine.
- This medicine passes into breast milk. There is no evidence to suggest that this has any harmful effects on the nursing infant if the medicine is used by breastfeeding mothers. However, the manufacturer recommendeds that it should not be used by breastfeeding women.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Breast tenderness.
- Production of breast milk.
- Fluid retention.
- Weight gain.
- Difficulty sleeping (insomnia).
- Skin reactions such as rash and itch.
- Increased hair growth (hirsutism).
- Hair loss (alopecia).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
The following medicines may increase the breakdown of this medicine in the body, which could make it less effective:
- antiepileptic medicines, eg phenytoin, phenobarbital, primidone, carbamazepine, oxcarbazepine, topiramate
- the herbal remedy St John's wort (Hypericum perforatum).
This medicine may decrease the blood level of the antiepileptic medicine lamotrigine.
Other medicines containing the same active ingredient
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