Whether it’s a cat you are fostering or a new stray who has wandered into your neighborhood, many of us are finding ourselves in the uncomfortable position of having an unspayed female cat in our lives at time when access to surgical spay is limited.

Fortunately, veterinarians who specialize in cats are now recommending a non-surgical means of preventing female cats from going into heat and becoming pregnant. With spay and neuter halted in many communities due to the COVID-19 crisis, this contraceptive could be critical.

The drug is called megestrol acetate (MA). It’s used to control female cat fertility in other countries as well as for other purposes.  MA has long been prescribed by American veterinarians to treat various conditions in both male and female cats, but before now, it has not been widely used in the United States as a contraceptive.

The use of MA for other purposes, and its use as a contraceptive overseas, have given veterinarians an increased and now solid level of comfort in recommending the use of MA as a contraceptive during the COVID-19 pandemic.

How Much & How to Give Megestrol Acetate:

  • Experts recommend that one 2.5 mg dose of MA be given orally to each unspayed female cat once a week. The simple guideline is “one cat – one dose – once a week.” For female cats already showing signs of heat, the dose should be given at 5 mg per cat per day for three days only. After that, it should be given in a 2.5 mg dose once a week.
  • MA is best given in liquid form added to food that is served on a plastic plate. If served on a paper plate, some or all of the MA might be absorbed by the paper.
  • It is recommended that cats be given MA for no more than 30 weeks.
  • MA requires a commitment on the part of the caregiver to give the medicine each week in the right amount to each cat. This is most easily accomplished in a household with only one cat, and more difficult in scenarios in which there are multiple cats. If you are giving MA to more than one cat, each cat must be watched to ensure she doesn’t eat her own food with its dose and then wander over to eat another cat’s dose as well.

Cost and Availability: 

  • Cost and availability of MA will vary, but back-of-the-envelope calculations based on discussions with compounders put the cost of an eight-week course of MA in the range of $3.00 – $5.00 per cat.
  • A veterinarian prescription is required for MA. MA has a shelf life of 180 days.
  • MA must be compounded, meaning tailored to the needs of a particular patient by a compounding pharmacy. You can obtain a prescription for MA suspended in a liquid compound and flavored in a way that is appealing to a cat (tuna/chicken) from your veterinarian.
  • In turn, your veterinarian must obtain MA from a compounding pharmacy. Please speak with your veterinarian about availability of medicines from compounders, as rules vary from state to state.

More Details:

  • MA should be given in such a way as to prevent cats from accidentally consuming all or part of another cat’s dose. This ensures appropriate contraceptive protection for the target cat, and it ensures that other cats do not receive unintended doses. MA provides no contraceptive benefit to male cats.
  • As a result of the COVID-19 outbreak, the federal government and many states have relaxed requirements for in-person veterinarian consultations. In some states, telemedicine is now available for a veterinarian’s existing patients. In other states, even new patients qualify for telemedicine consultations. You should check to see what is allowed in your state.
  • The use of MA for fertility control in female cats is “off-label” in the US. This means that the FDA has yet to approve MA specifically for the use of fertility control in female cats. Many drugs are used off-label in veterinary medicine, usually—as is the case here,* – after experts have weighed in and made recommendations on safe and effective dosage.
  • Some veterinarians are reticent about the use of MA for community cats due to concerns about getting the right dose to the right cat.  However, there are veterinarians who are comfortable with – and enthusiastic about – the use of MA for community cats. These veterinary professionals see MA as a good way to reduce the number of kittens born until clinics are open again to spaying cats as part of a Trap-Neuter-Return (TNR) program.
  • Because of COVID-19 and reduced availability of surgical spaying and neutering, there will be an increase in unspayed females in our neighborhoods. For that reason, MA is a potentially appealing option.

Conclusion

The COVID-19 pandemic is a humbling reminder that nothing in life is entirely risk-free. We each make the best decisions we can with the information we have, and we must recognize that both action and inaction carry risks. Pregnancy and birth carry risks, surgical spaying carries risks, and oral contraception carries risks. Only you and your veterinarian can assess your comfort level with the course of action you choose regarding the health of your cats.

At the doses being recommended, experts indicate that the health risks of MA as a contraceptive are low. Experts feel the health risks to non-target cats who accidentally ingest some MA are also low. That said, it is worth discussing the potential risks and benefits of MA with your veterinarian.

*In this case, the Alliance for Contraception in Cats and Dogs (ACC&D) is one of several organizations with an expertise in veterinary reproductive health to have recently studied MA. ACC&D’s mission is to advance non-surgical sterilants and contraceptives for cats and dogs and to promote their global accessibility. In response to COVID-19, which has caused many communities to defer sterilization surgeries for dogs and cats, ACC&D believes the progestin megestrol acetate (MA) may be an option for short-term contraception of some female cats. Visit their website for more information about the use of M.A. for U.S. Practitioners and Non-U.S. practitioners. Alley Cat Allies is a member of the ACC&D’s Council of Stakeholders.