Dydrogesterone for Endometriosis: Efficacy and Side Effects

Dosing Recommendations

The standard dosing of dydrogesterone is 5-10 mg daily for 12-14 days per month in sequential regimens, or 5 mg daily for continuous regimens, as recommended by the American Society for Reproductive Medicine 1, 2, 3
Sequential regimens are preferred when used with estrogen replacement therapy in women with premature ovarian insufficiency who have endometriosis, according to the European Society of Human Reproduction and Embryology 1, 2
Continuous regimens at 5 mg daily can be used to avoid withdrawal bleeding when combined with estradiol, as suggested by the International Menopause Society 2, 3

Dydrogesterone has a favorable safety profile compared to other hormonal treatments for endometriosis, with minimal side effects, as reported by the American College of Obstetricians and Gynecologists 1
Dydrogesterone has less negative effects on lipid metabolism and fewer androgenic effects compared to other progestins, making it preferred for prolonged treatment, according to the Endocrine Society 1
Unlike progestins with anti-androgenic properties, dydrogesterone does not worsen hypoandrogenism or sexual dysfunction, as stated by the European Menopause and Andropause Society 2, 3

The first-line approach for treating endometriosis is to start with NSAIDs for immediate pain relief, then add dydrogesterone 10 mg daily, as recommended by the American Academy of Family Physicians 4, 5
GnRH agonists should be reserved for refractory cases, as they require add-back therapy and have more significant side effects, according to the Society of Obstetricians and Gynaecologists of Canada 4, 5

Dydrogesterone is not curative, and like all medical therapies for endometriosis, it suppresses but does not eradicate endometriotic lesions, as reported by the American Society for Reproductive Medicine 5
There is a risk of symptom recurrence within one year after treatment, highlighting the need for ongoing management, according to the European Society of Human Reproduction and Embryology 4, 5
Dydrogesterone can be safely combined with estrogen in women who have undergone oophorectomy for endometriosis, as combined estrogen/progestogen therapy may reduce disease reactivation risk, as suggested by the International Menopause Society 1, 5