Talk:Medroxyprogesterone

Half life
The half-life seems completely bogus. E.g. http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2943134&dopt=Abstract mentions 40-60 hours. —Preceding unsigned comment added by 82.130.46.87 (talk • contribs) 15:45, June 2, 2007

Wyeth acted with reckless disregard to the risk of injury to women in marketing dangerous PremPro
Evidence shows that Wyeth knew the dangers of Medroxyprogesterone Acetate (the "Pro" in Prempro) but marketed it in reckless disregard for the risks to the women who received it.

Another Loss for Pfizer in Drug Suits

http://www.nytimes.com/2009/11/24/business/24wyeth.html?fta=y

By DUFF WILSON

Published: November 23, 2009


 * "... On Monday a jury in Philadelphia Common Pleas Court awarded $28 million in punitive damages to Donna Kendall of Decatur, Ill., whose breast cancer was found after she had taken hormone drugs for 11 years. The jury had already given her $6.3 million in compensatory damages.


 * Punitive damages in Pennsylvania require a finding of “wanton and reckless” conduct. The jurors heard testimony that Wyeth paid consultants and ghostwriters of medical journal articles to play down concerns about breast cancer, as well as testimony that Pharmacia did not study known risks. The punitive award was split $16 million for Wyeth and $12 million for Pharmacia.


 * After that ruling was made public, Sandra M. Moss, the judge who leads the complex litigation program at the Philadelphia court, unsealed a $75 million punitive damage award from last month in a case brought against Wyeth by Connie Barton of Peoria, Ill. She was also awarded $3.7 million in compensatory damages previously made public."


 * "... Esther E. Berezofsky, a lawyer for one of the women who won the awards in Philadelphia said Monday, 'This is just the tip of the iceberg.'


 * She said that in cases that had reached jury judgments, women with breast cancer had won damages in 10 of the 12 hormone drug cases, although many are on appeal. Ms. Berezofsky also said a federal appeals court decision in St. Louis this month had significantly improved plaintiffs’ chances of receiving punitive damages and winning appeals.


 * In that decision, a three-judge panel of the United States Court of Appeals for the Eighth Circuit overturned an award of $27 million for an Arkansas woman, citing improper testimony by an expert witness. But the court ordered a new trial on punitive damages. The judges’ ruling said 'there was sufficient evidence upon which a jury could conclude that Wyeth acted with reckless disregard to the risk of injury.'" —Preceding unsigned comment added by 66.167.61.214 (talk) 17:15, 18 April 2010 (UTC)

Bioidentical progesterone shown to be more efficacious than synthetic MPA
Bioidentical progesterone shown to be more efficacious than synthetic MPA medroxy progesterone in peer reviewed clinical study in mainstream literature.

"The effect of progesterone compared with MPA included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 30% reduction in somatic symptoms, a 25% reduction in menstrual bleeding, a 40% reduction in cognitive difficulties, and a 30% improvement in sexual function. Overall, 65% of women felt that HRT combined with progesterone was better than the HRT combined with MPA." Quoted from Holtorf

Reference: Fitzpatrick LA, Pace C, Witta B. Comparison of regimens containing oral micronized progesterone of medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey. J Womens Health Gend Based Med. 2000;9(4):381–387. UGAcodon (talk) 23:58, 1 July 2010 (UTC)
 * Wikipedia prefers secondary sources. This, being the reporting of a single experimental trial, is considered a primary source.  See WP:MEDRS.  WLU (t) (c) Wikipedia's rules: simple/complex 18:46, 2 July 2010 (UTC)


 * In that case the secondary source, as you know, is the Holtorf review article. http://www.postgradmed.com/index.php?article=1949 Postgraduate Medicine: Volume 121: No.1 January 2009. The Bioidentical Hormone Debate:Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?Kent Holtorf, MD Conclusion: Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animalderived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly. I assume you would have no problem with this as a reference, since it has been accepted on the Bioidentical Hormone Page. UGAcodon (talk) 22:58, 2 July 2010 (UTC)

This is what the edit will look like:

"Bioidentical progesterone shown to be more efficacious than synthetic MPA medroxy progesterone. (Holtorf Reference Here)"


 * Assuming there are no objections I will go ahead with the edit.UGAcodon (talk) 22:18, 2 July 2010 (UTC)
 * Please stop creating new headings unnecessarily. That should probably be attributed to Holtorf, since he's writing in defence of a principle rather than a neutral summary of the literature.  I looked for a recent review article on progesterone and couldn't find one on pubmed, the newest one was from 1999 and that wouldn't incorporate the WHI results.  I'd also like to review the article itself, a quick look seemed to conflate MP and MPA.  But still, it is a secondary source about progesterone and medroxyprogesterone.  Be sure to differentiate medroxyprgesterone and medroxyprogesterone acetate.  WLU (t) (c) Wikipedia's rules: simple/complex 23:19, 2 July 2010 (UTC)


 * OK, Will go ahead since we all have agreement.UGAcodon (talk) 23:47, 2 July 2010 (UTC)

"more efficacious" doesn't say much in itself: I'd suspect that a higher dose of MPA would be more effective than a lower dose, so the real question is the comparison of therapeutic widths. Holtorf seems to support that progesterone is better in that respect than MPA, but unfortunately I can't access the complete article. However, the phrasing "has been shown to be..." is a bit too matter-of-fact for my taste given that HRT is a rather controversial topic and Holtorf might not be completely NPOV as far as I can tell. Given the WHI results, I think that phrasing should be done with great caution – this shouldn't look like "bioidentical = effective and harmless". --ἀνυπόδητος (talk) 09:23, 3 July 2010 (UTC)

Regarding the statement that Holtorf has been accepted on Bioidentical hormone replacement therapy: A quick glance at the page suggests that this is as part of the discussion on the controversy surrounding bioidentical hormones. Quote: "Bioidentical hormone proponents Erika Schwartz and Kent Holtorf criticized a 2008 review of literature on bioidentical hormones..." and that's how it should be: Explain that there are proponents and opponents. If a source is from people who have certain stance, say so, and preferably mention alternative views as well. See WP:WEIGHT. --ἀνυπόδητος (talk) 09:40, 3 July 2010 (UTC)
 * The full article can be found here and I would agree that caution is warranted given the source. WLU (t) (c) Wikipedia's rules: simple/complex 13:47, 3 July 2010 (UTC)
 * Also, given Cirigliano's statements about MPA versus progesterone, "more efficacious" is, if not wrong, then certainly misleading. MPA is more absorbable, has a longer half-life, and leads to more stable blood levels.  The statement would have to be clearer about what "more efficacious" means.  And the word "bioidentical" shouldn't appear, it should simply say progesterone, assuming a coherent statement about specifically how it is better than MPA can be found.  WLU (t) (c) Wikipedia's rules: simple/complex 10:28, 5 July 2010 (UTC)


 * There is a huge undue weight problem here, - slow down, stop edit warring, and try to summarize the literature as a whole, please. - 2/0 (cont.) 07:06, 6 July 2010 (UTC)

MPA
The difference between MP and MPA is apparently equivocal. See here. Someone mentioned merging the two, I'm not sure yet, but if not then clarifying the difference would be helpful. WLU (t) (c) Wikipedia's rules: simple/complex 13:47, 3 July 2010 (UTC)

Clinical profile
The section Clinical profile is getting a bit off-topic, I'm afraid. This article is about MPA, not progesterone. Any ideas? Is this necessary at all at this place? --ἀνυπόδητος (talk) 07:18, 5 July 2010 (UTC)
 * Shit, my bad - I was editing progesterone at the same time and apparently got confused. Edit away - the only germ of relevance in it is that MPA has a longer half life and accordingly leads to longer blood levels, but I'm still not sure if MP and MPA are the same or not.  WLU (t) (c) Wikipedia's rules: simple/complex 10:25, 5 July 2010 (UTC)
 * but the evidence for this view has been questioned and the Food and Drug Administration considers the risks and benefits of different types of hormone replacement therapy regimens to be the same until research demonstrates otherwise. undone because it is too general a statement for the medroxyprogesterone page. Willing to discuss it further if the FDA reference page link can be supplied. UGAcodon (talk) 11:25, 5 July 2010 (UTC)

—Preceding unsigned comment added by UGAcodon (talk • contribs) 10:48, 5 July 2010 (UTC)
 * "the evidence has been questioned" is sourced, so please leave it there for balancing out Holtorf's view. Thanks.--ἀνυπόδητος (talk) 10:54, 5 July 2010 (UTC)
 * this looks better.UGAcodon (talk) 11:25, 5 July 2010 (UTC)
 * I'm sorry, why was the statement about the FDA removed? It's not too general a statement, it was sourced to Cirigliano, and the FDA page is actually more specific, mentioning progesterone specifically; used that page instead but Cirigliano would have been perfectly suitable.  WLU (t) (c) Wikipedia's rules: simple/complex 13:04, 5 July 2010 (UTC)
 * Dear WLU, the FDA guidance statement does not mention progesterone, rather it discusses progestins, a very different subset of chemical substances which does not include progesterone. Therefore, these are not valid references for this section. Do you have any other references that could be used instead?

Here are the links: MICHAEL CIRIGLIANO http://www.solaltech.com/doctors/3/Bioidentical%20Hormone%20Therapy--%20Cirigliano.pdf

FDA Guidance http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM135336.pdf

"Other doses of oral conjugated estrogens with medroxyprogesterone acetate, and other combinations and dosage forms of estrogens and progestins were not studied in the WHI clinical trials and, in the absence of comparable data, these risks should be assumed to be similar. Because of these risks, estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman."

The FDA guidance is referring to comparing the MPA used in the WHI to other combinations of progestins. Progesterone, which is not a progestin, is not mentioned anywhere in the guidance. The phrase, " assumed to be similar" is not refernced properly by the FDA guidance. UGAcodon (talk) 14:12, 5 July 2010 (UTC)


 * from http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm183088.htm

"2) Why is FDA concerned about compounded “BHRT” drugs?

FDA is aware that a growing number of pharmacies compound hormone drugs for treatment of the symptoms of menopause. These pharmacies often promote their compounded drugs as “bio-identical” to the hormones produced by a woman’s body, and the phrase “bio-identical hormone replacement therapy” has been used to describe these drugs.

Some pharmacy compounders claim that their compounded “BHRT” drugs are a “natural” alternative to FDA-approved drugs, because the compounded hormones are purportedly identical to the hormones produced in the body. These pharmacies may also claim that their “natural” compounded drugs are safer and more effective than FDA-approved menopausal hormone therapy drugs. FDA is not aware of any credible scientific evidence supporting these claims. Nor is FDA aware of sound evidence showing that the side effects and risks of compounded "BHRT" drugs that use estrogen and progesterone as active ingredients are different than those of similarly formulated FDA-approved menopausal hormone therapy drugs. Because many claims regarding the safety, efficacy, and superiority of compounded “BHRT” drugs have not been proven, FDA is concerned that these claims mislead patients and practitioners. Compounded products that have identical chemical structures to synthetic hormones can be expected to have the same benefits—and risks— associated with FDA-approved hormone therapy."


 * We can use a quote if you'd like. WLU (t) (c) Wikipedia's rules: simple/complex 14:15, 5 July 2010 (UTC)


 * Quote from FDA reference: Nor is FDA aware of sound evidence showing that the side effects and risks of compounded "BHRT" drugs that use estrogen and progesterone as active ingredients are different than those of similarly formulated FDA-approved menopausal hormone therapy drugs Here the FDA is saying that compounded progesterone has the same benefits and risks as FDA approved progesterone (Prometrium and Prochieve).


 * Compounded products that have identical chemical structures to synthetic hormones can be expected to have the same benefits—and risks— associated with FDA-approved hormone therapy Here the FDA is referring to FDA approved synthetic producs like MPA. They are saying that compounded MPA has similar benefits and risks as FDA approved MPA (as in Provera).


 * This reference does not say what we need. Do you have another one?UGAcodon (talk) 14:35, 5 July 2010 (UTC)
 * Dear WLU, in the absence of a valid reference verifying the statement, I assume you agree to remove it. Will give it until tomorrow.UGAcodon (talk) 14:48, 5 July 2010 (UTC)
 * It's somewhat equivocal and muddied by the use of the word "synthetic" but that does seem the most reasonable interpretation. I'll remove it.  WLU (t) (c) Wikipedia's rules: simple/complex 16:04, 5 July 2010 (UTC)

Comparison with progesterone
This section (which isn't about "clinical profile" since all it talks about is how it compares with progesterone) is already quite lengthy considering the length of the article, and shouldn't get any longer. This is particularly relevant considering just how damning the general consensus is of BHRT. I've tried to contextualize as much as I could, particularly with Panay & Fenton's editorial (available by e-mail) but I really don't want a lengthy set of primary sources detailing how much greater progesterone is than MPA (Holtorf's research, from what I can tell of a quick review, is still fairly biased and oversells a couple papers). The expansion of the page should come from the other sections which are sorely missing. WLU (t) (c) Wikipedia's rules: simple/complex 16:58, 5 July 2010 (UTC)
 * Dear WLU, 1) the section was intended to specifically compare the clinical profile of medroxyprogesterone with progesterone. Other comparisons such as chemical structure, manufacturer, product names,  etc can come under separate sections. 2) the use of the word bioidentical is ill advised since, as you know, the meaning of the word bioidentical is ill-defined.  In addition, using the word bioidentical introduces controversy. and as previous editors have said elsewhere, this is best kept on the Bioidentical Hormone Therapy page.         3) A problem with using Cirigliano to provide an opposing view is that his review does not specifically cite studies that compares progesterone with medroxyprogesterone, while Holtorf's review does.  In addition. Cirigliano does not specifically state anywhere in his article that the benefits and side effects of progesterone are the same as medroxyprogesterone.  In fact, they are quite different as any student of pharmacology knows.  So if you want to state they are the same, you need a reference that specifically states this. 4) In terms of efficacy of medroxyprogesterone over progesterone, many secondary sources state that MPA is more effective than progesterone in treatment of DUB, and most sources state that both progesterone and MPA are equally effective at preventing endometrial hyperplasia and endometrial cancer.  These are the types of statements that should go in this section. 5) In terms of adverse effects, many secondary sources are concerned about fetal teratogeneiss of MPA taken during pregnancy, while progesterone is safe for use during pregnancy.  Many secondary sources state the two substances have quite different effects on breast tissue, with MPA affecting breast tissue adversely, while progesterone beneficially.UGAcodon (talk) 00:06, 6 July 2010 (UTC)
 * This page is about medroxyprogesterone. Putting in a comparison is a POV coatrack that places undue weight on an advocacy source.  The source is partisan, it's a lone voice in the wilderness, and there is much opposition to it.  The compounds haven't been directly compared in specific tests in the many combinations that exist for hormone replacement therapy - something even Holtorf is explicit on.  We therefore can't say progesterone is better than MP because no fair tests have been done and there is no consensus.  Panay and Fenton is about the best we can use because it grants the possibility while calling for more research.  We shouldn't be be comparing them in any greater depth, in structure, function, clinical profile, smell, colour, name, shoe size, etc.  We use this page to describe medroxyprogesterone.  It's possible this information is better suited to the main hormone replacement therapy page, but it certainly shouldn't be spammed to every single progesterone, progestin and pregnane page on wikipedia.
 * The section shouldn't be expanded. The properties of medroxyprogesterone should be explained and expanded on based on their own merits, not in relation to another compound.  WLU (t) (c) Wikipedia's rules: simple/complex 00:47, 6 July 2010 (UTC)
 * I would disagree with this. Medroxyprogesterone was synthesized and patented as a replacement for progesterone, so comparison of clinical profile is very appropriate. In fact numerous studies have been done comparing the two, and these were referenced in the Holtorf article (a secondary source).  If you can provide another secondary source referencing these same primary articles, with a different conclusion, please do so.  I would be happy to see that on the page.  Otherwise, please respect the editing work of others and refrain from adding spaghetti. UGAcodon (talk) 01:14, 6 July 2010 (UTC)
 * Medroxyprogesterone was synthesized because progesterone had a short half-life and was poorly absorbed. It was synthesized, then extensively used, because it was convenient and served its purpose of preventing pregnancy and endometrial hyperplasia very effectively using a single pill per day rather than the dozens (or a large and dangerous single pill) you'd need with something that has a 20 minute half-life.  It's also heavily researched with a known side-effects and safety profile - so safe they were very surprised to find out it possibly has side effects that they were not aware of.  The WHI results were a huge surprise to nearly everyone.  Cirigliano and Panay and Fenton are both secondary sources, and not purveyors of bioidentical or nonbioidentical hormones, and do not have to look at exactly the same papers.  The compounds are not considered to have been adequately compared in head-to-head.  We convey the majority opinion - and the majority opinion is not yet that progesterone is better.  And even if it is, we should still cite the properties, uses, side effects and other information about medroxyprogesterone here, those of progesterone on that article, and when the results and consensus is clear, probably include the therapeutic recommendations on the HRT (menopause) page.  We should not be making advocacy statements on every single page.  We are not a crystal ball, we are not a place to promote, and we must convey the weight of the scholarly opinion - not that of a single person or tiny minority.  WLU (t) (c) Wikipedia's rules: simple/complex 01:30, 6 July 2010 (UTC)


 * I agree that medropxyprogesterone has been used successfully as a more absorbable and "potent" form of progesterone, and quite successfuly for DUB, and BCP's. Usage for treatment of DUB, may represent its highest volume use presently.  However, there are significant differences, as you mentioned, in use profile, benefits and adverse effects when compared to progesterone which have been studied and reported in the medical literature for decades.  The majority opinion is that medroxyprogesterone is better in some ways, and that progesterone is better in other ways, depending on the condition and intended treatment, and depending on the adverse effect profile.  For example, progesterone is used extensively in fertility treatment, while medroxyprogersterone is contraindicated.  These, among others, are the comparisons that should be mentioned on this page along with valid secondary sources that review the pertinent medical studies in a neutral, non-biased way.  I think we can work together on this, and make a real contribution to Wikipedia.


 * Hardly Neutral POV Sources,see below (intentionally unindented)....

Cirigliano The Cirigliano article can hardly be considered neutral or non-biased, since it was ghostwritten by PharmaWrite, as acknowledged by Cirigliano at the end of the article under editorial assistance. Pharmawrite was paid by Wyeth to write pro-Prempro articles in the medical literature and "recruit" doctors to be the authors. http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aHBqo8_f_lLA

Cirigliano is an internist at U Penn in active clinical practice. Medline lists 8 articles to his name, with only one dealing with women's hormone therapy.

The Cirigliano article was published in Journal of Women's health, whose editor has disclosed numerous financial ties to the synthetic hormone industry, and runs Wyeth funded ghost-written pro-synthetic hormone industry articles. see: http://www.nytimes.com/2008/12/12/business/13wyeth.html?scp=2&sq=wyeth&st=cse

Panay and Fenton see: http://www.imsociety.org/editorial_board.php Financial Disclosure for Climacteric Editors-in-Chief Anna Fenton (New Zealand) Nick Panay (UK). Dr Anna Fenton, (New Zealand)Endocrinologist Dr Fenton has disclosed that she is or has been a recipient of research/grant funding from, a consultant/advisor to, and a member of the speakers’ bureaux for: Pfizer/Wyeth, Merck Sharpe and Dohme, Bayer Schering, Eli-Lilly, GlaxoSmithKline, Sanofi-Aventis and Novartis.

Mr Nick Panay Queen Charlotte’s & Chelsea Hospital, London, UK Mr Panay has disclosed that he has acted in an advisory capacity, performed research and/or lectured on behalf of the following companies: Baxter, Bayer Schering, Eli Lilly, Galen, Janssen Cilag, Merck, Novo Nordisk, Novogen, Organon, Orion, Procter & Gamble, Se-cure, Servier, Shire, Solvay, Storz, and Wyeth.

With these financial disclosures, these are clearly Non-Neutral POV secondary sources. I would be interested to see any other Non-Biased, Non-Ghostwritten secondary sources that actually review the medical studies comparing clinical profile of medroxyprogesterone to other progestins, and progesterone. This would be quite helpful here.

By the way, do you have a pdf of the Panay Fenton article? UGAcodon (talk) 12:04, 6 July 2010 (UTC)
 * That is not, and never will be convincing. It wasn't convincing on talk:bioidentical hormone replacement therapy, it's not convincing here.  It's a stupid ad hominem argument that utterly fails to deal with not only the specific research cited by any of these sources, and applies equally, if not even more so to Schwartz, Holtorf and Moskowitz, all of whom sell bioidentical molecules, consultations or books that are just shy of propaganda - the criticism you apply here is tremendously one-sided and is a blatant example of your ideological bias.  Why is Cirigliano a tool of Big Pharma, when Holtorf is not?  On top of getting $400 per consultation, he has published news articles, advocates against vaccination (and is he an endocrinologist, an infectious disease specialist, or just trying to drum up some buzz?), treats "hard to treat, poorly understood conditions" (the ones without effective treatment where anything can be said because there is no firmly established standard of care - fibromyalgia, chronic fatigue syndrome, "complex endocrine dysfunction"), oh, and gives lectures - but I'm sure those are for free.  The same companies make bioidentical and synthetic hormones and make money off of both.  Further, Cirigliano is in agreement with a multitude of other sources that converge on a specific viewpoint - bioidentical hormones are oversold and at best, micronized progesterone might offer some advantages - a fact that is noted in the page using a source I put in.   Your fallacious argument still doesn't address both the multitude of policy objections that I've raised (and since you're playing the conspiracy card again, I will again point to WP:REDFLAG - claiming a conspiracy means it is almost certain that you're advocating for a fringe claim).  This is still undue weight as now three editors have said - see 2/0's comment above.  WLU (t) (c) Wikipedia's rules: simple/complex 13:12, 6 July 2010 (UTC)

Requesting Mediation
I am requesting mediation and dispute resolution on Medroxyprogesterone regarding WLU placing statements without a valid reference. See the changes regarding section Comparison with progesterone. UGAcodon (talk) 01:23, 6 July 2010 (UTC)
 * There have now been four editors saying your recent changes have been problematic, for the same reasons I have - the sources are inadequate to support the weight given to a single opinion. Mediation is not needed.  What is needed is for you to accept consensus is that it is undue weight to give the "progesterone is inherently better" opinion anything but a limited, attributed context.  The molecules have not been adequately tested head-to-head, and there is an appropriately contextualized, properly weighted statement saying progesterone might have health advantages, but that's the limit that should be explored.  This is not the progesterone, or hormone replacement therapy page.  It should not discuss progesterone at length, and no page should give excessive weight to progesterone being better unless that is the appropriate, majority opinion.  Right now it's not there.  No-one, no-one has supported your version and you have been cautioned several times about problematic edits.  Stop it.  WLU (t) (c) Wikipedia's rules: simple/complex 00:56, 9 July 2010 (UTC)

Progestins and the Risk of Breast Cancer
Two secondary reviews state, " When combined estrogen/progestin therapy is used, the risk of breast cancer is consistently higher than that of estrogen alone use." see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1974841/ Review - Progestins and progesterone in hormone replacement therapy and the risk of breast cancer by Carlo Campagnolia

Also see second review: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670363/ Expert Opin Pharmacother. 2006 December; 7(18): 2455–2463. Current breast cancer risks of hormone replacement therapy in postmenopausal women by Nirav R Shah

These two reviews indicate the weight of the medical evidence supports the claim that progestins added to HRT increase breast cancer risk in women. This increased breast cancer risk was also demonstrated in the women's health initiative study which used medroxyprogesterone added to premarin. The study was halted early due to increased breast cancer in the drug group compared to placebo. see http://jama.ama-assn.org/cgi/content/full/288/3/321 UGAcodon (talk) 11:27, 12 July 2010 (UTC)
 * And that's noted in the adverse effects section. WLU (t) (c) Wikipedia's rules: simple/complex 12:52, 12 July 2010 (UTC)
 * Regarding the inclusion of extra sources for breast cancer being a risk. Yes, it is known.  It is in fact noted in the article, and I was the one who placed it there. Breast cancer is one risk of several faced by women taking medroxyprogesterone.  By placing extra references on that single point, and particularly by including quotations (utterly unnecessary quotations by the way - the statement isn't controversial and the quotations are bare statements of fact without nuance; no-one is arguing that breast cancer is not a risk of HRT) the reader's attention is drawn to that fact in such a way as to give undue weight to it.  First, there are multiple side effects to MP supplementation, so why highlight just one?  Second, the WHI used estrogen plus medroxyprogesterone acetate, not MP making it technically incorrect.  Third, they just aren't necessary and interrupt the citation - to be truly clear about the attribution of text to sources, it would require Russouw to be cited at least five times rather than once, due to Shah/Campagnoli interrupting the citation making the paragraph less clear and considerably uglier.  Citations interrupt reading.  Fourth, Shah & Wong only mentions medroxyprogesterone once, and it is in reference to medroxyprogesterone acetate making this arguably the wrong article to use it in - in addition to the risk being greatest for MPA plus estrogens.  There is too much emphasis being placed on a single finding, to no end.  MPA + CEE has been demonstrated to increase breast cancer.  It's in the article, there's no need to add emphasis.  I frankly don't see the value.  The single WHI source verifies all risks, while the two extra sources place undue weight on the risk of breast cancer, without regard for context or relative risk for other possible conditions, and focus solely on breast cancer relative to many different combinations of progestins. The problem isn't that the sources aren't neutral (sources must be reliable, neutrality is generally not a concern and specifically not a concern in this case).  The issue is that the number of sources focussing on one page is undue weight.   WLU (t) (c) Wikipedia's rules: simple/complex 14:32, 14 July 2010 (UTC)

Merge from to MPA
Per Talk:Medroxyprogesterone 17-acetate, the compounds appear to be discussed substantially as if they were identical. Are there sufficiently few differences between the two that unique aspects of MP A can't be dealt with in the body text of medroxyprogesterone acetate ? WLU (t) (c) Wikipedia's rules: simple/complex 16:40, 12 July 2010 (UTC)


 * Unless someone can find an unambiguous source where medroxyprogesterone (MP) and not medroxyprogesterone acetate (MPA) is used clinically, I support the merger. However since it appears that only MPA has been used clinically, I think the direction of the merger should be reversed (i.e., merge MP into MPA).  Boghog (talk) 20:27, 12 July 2010 (UTC)
 * Agree with BogHog.-- Literature geek |  T@1k?  01:02, 13 July 2010 (UTC)
 * Agreed also, corrected direction of merge on this and other pages. WLU (t) (c) Wikipedia's rules: simple/complex 03:56, 13 July 2010 (UTC)