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Dydrogesterone: Uses, Mechanism & Side Effects

Dydrogesterone is a synthetic progestogen used in gynaecology and hormone therapy. It closely mimics the action of the naturally occurring hormone progesterone.

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Things worth knowing about "Dydrogesterone"

Dydrogesterone is a synthetic progestogen used in gynaecology and hormone therapy. It closely mimics the action of the naturally occurring hormone progesterone.

What is Dydrogesterone?

Dydrogesterone is a synthetic progestogen (an artificially produced progestins) that is structurally very similar to the naturally occurring hormone progesterone. It belongs to the class of progestogens and has been used in medicine since the 1960s. Unlike many other synthetic progestogens, dydrogesterone has virtually no androgenic, oestrogenic, or corticosteroid side effects, making it generally well tolerated.

Indications (Uses)

Dydrogesterone is used for a range of gynaecological conditions and hormonal disorders:

Endometriosis: Treatment of uterine lining tissue growing outside the uterus
Dysmenorrhoea: Relief of painful menstrual periods
Irregular menstrual cycles: Normalisation of cycles in cases of progesterone deficiency
Premenstrual syndrome (PMS): Relief of symptoms in the second phase of the cycle
Hormone replacement therapy (HRT): Combined with oestrogens to protect the uterine lining
Threatened miscarriage: Supporting early pregnancy in cases of luteal insufficiency
Assisted reproduction: Luteal phase support during fertility treatments

Mechanism of Action

Dydrogesterone selectively binds to the progesterone receptor in target tissues, particularly in the uterine lining (endometrium). This binding promotes the transformation of the endometrium from the proliferative to the secretory phase, which is necessary for the implantation of a fertilised egg. When used in combination with oestrogens, it also protects the endometrium from excessive cell growth (hyperplasia).

At therapeutic doses, dydrogesterone does not inhibit ovulation and is therefore not a contraceptive. It also does not significantly affect lipid metabolism or blood coagulation.

Dosage and Administration

Dydrogesterone is available as an oral tablet. The dosage depends on the specific indication:

For endometriosis and dysmenorrhoea: typically 5–10 mg daily during the second half of the cycle
For hormone replacement therapy: usually 10 mg daily in combination with oestrogen
For threatened miscarriage: 40 mg as a single initial dose, followed by 10 mg every 8 hours until symptoms resolve

The exact dosage and duration of treatment should always be determined by a qualified healthcare professional.

Side Effects

Dydrogesterone is generally well tolerated. Possible side effects may include:

Headache or migraine
Breast tenderness or pain
Nausea
Irregular spotting or breakthrough bleeding (especially at the start of treatment)
Depressive mood (rare)
Mild oedema (fluid retention)

Serious side effects are rare. If signs of thrombosis (swelling or pain in the legs) or allergic reactions occur, medical attention should be sought immediately.

Contraindications

Dydrogesterone should not be used in cases of:

Known hypersensitivity to the active substance
Unexplained vaginal bleeding
Diagnosed or suspected progesterone-dependent tumours
Severe liver impairment
Porphyria (a rare metabolic disorder)

Drug Interactions

Dydrogesterone may interact with certain medications. Enzyme-inducing drugs such as some antiepileptics (e.g., phenytoin, carbamazepine) or rifampicin can accelerate the breakdown of dydrogesterone and thereby reduce its effectiveness. Patients should inform their doctor about all medications they are taking.

References

European Medicines Agency (EMA): Assessment Report on Dydrogesterone-containing medicinal products. EMA/CHMP/580082/2020.
Schindler A.E. et al. - Classification and pharmacology of progestins. Maturitas, 2003; 46(Suppl 1): S7–S16.
Wahabi H.A. et al. - Progestogen for treating threatened miscarriage. Cochrane Database of Systematic Reviews, 2018, Issue 8.

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