A 25 year old patient with pcos has irregular periods and has taken me

A 25 year old patient with pcos has irregular periods and has taken mendate 10mg tablet of 5 tablet 5 day course, it’s been 5 days and her periods has still not started , what should she do

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medroxyprogesterone 10mg no withdrawal bleed after 5 days PCOS what to do

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Mendate 10mg (Medroxyprogesterone Acetate) - No Withdrawal Bleed After 5 Days

First: Don't panic. It is completely normal for withdrawal bleeding NOT to have started yet. Withdrawal bleeding typically occurs 2-7 days AFTER the last tablet, not during or immediately at the end of the course. She finished 5 tablets (presumably 5 days), so the bleeding may still be coming - she should wait up to 10 days after stopping the tablets before being concerned.

What She Should Do Right Now

Wait up to 7-10 days after the last tablet. The standard clinical window for withdrawal bleeding is 2-10 days after completing the progestin course. Five days post-course is still within the normal waiting period.
Rule out pregnancy first - even in irregular PCOS cycles, a urine pregnancy test is mandatory before any further hormonal interventions. A progestogen-only course will not harm an early pregnancy, but the clinical plan changes entirely.
Do not repeat the tablets on her own without medical advice.

If No Bleed Occurs After 10 Days - What It Means Clinically

This is called a negative progesterone withdrawal test and is clinically significant. According to the Textbook of Family Medicine:

"If there is no withdrawal bleed, consider repeating the test with progesterone in oil (100-200 mg intramuscular) or with norethindrone or micronized progesterone."

If that also fails, the next step is a 21-day course of conjugated estrogen (1.25 mg/day) or a combined oral contraceptive cycle to build up the endometrium, followed by another progestin course. A negative response after estrogen + progesterone points toward outflow tract obstruction (Asherman syndrome, cervical stenosis).

Causes of a negative withdrawal test include:

Very low estrogen levels (hypothalamic hypoestrogenism - thin endometrium that has nothing to shed)
Outflow tract obstruction (Asherman's syndrome, cervical stenosis)
Premature ovarian insufficiency

In PCOS specifically, the endometrium is usually well-estrogenized, so a bleed is expected. A missing bleed in a known PCOS patient warrants re-evaluation.

Important Note on Dosing

The NHS guidance specifically states that for PCOS with infrequent/absent periods, the standard regimen is 10 mg once daily for 14 days (every 1-3 months) - not just 5 days. A 5-day course at 10 mg is shorter than the typical recommended duration for period induction. This may partly explain why she hasn't bled yet - the endometrial priming may have been insufficient.

The Textbook of Family Medicine also notes that for PCOS-related chronic anovulation, 10 mg/day for 10 days is the preferred approach, with bleeding expected within a few days of stopping.

Summary - Action Steps

Step	Action	Timeframe
1	Wait for withdrawal bleed	Up to Day 7-10 after last tablet
2	Do a urine pregnancy test	Now
3	If no bleed by Day 10	See her gynecologist - do NOT self-medicate
4	Doctor may repeat with longer course or add estrogen	As prescribed

This information is for educational purposes. Please consult a gynecologist before repeating or changing any hormonal medication. The doctor may want to evaluate estrogen levels, thyroid, prolactin, and do a pelvic scan to guide next steps.

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