What is the recommended dose of dydrogesterone (progestin) for managing abnormal uterine bleeding?

From the Guidelines

The recommended dose of dydrogesterone for managing abnormal uterine bleeding is typically 10 mg twice daily (20 mg total daily dose) for 5-10 days during the luteal phase of the menstrual cycle (days 15-25). When managing abnormal uterine bleeding, it is crucial to first assess the underlying cause, considering factors such as ovulatory dysfunction, as outlined in guidelines like those from the American College of Obstetricians and Gynecologists (ACOG) 1.

Key Considerations

• The dose and duration of dydrogesterone treatment may vary based on the severity of bleeding and the individual's menstrual cycle regularity.
• For women with irregular cycles, treatment can be initiated at any time and continued for the prescribed duration.
• In cases of severe bleeding, the dose may be increased to 10 mg three times daily, although this should be done under the guidance of a healthcare provider.
• Treatment is generally continued for at least three consecutive cycles to establish regular bleeding patterns.

Mechanism and Benefits

Dydrogesterone works by stabilizing the endometrial lining and counteracting the effects of unopposed estrogen, which often contributes to abnormal uterine bleeding 1. This medication is particularly useful for women with anovulatory bleeding or those with relative progesterone deficiency.

Side Effects and Preferences

Side effects of dydrogesterone are typically mild and may include breast tenderness, headaches, and mild nausea. Dydrogesterone is often preferred over other progestins because it has minimal androgenic, estrogenic, and glucocorticoid effects, making it well-tolerated by most patients.

From the Research

Dydrogesterone Dosage for Abnormal Uterine Bleeding

• The recommended dose of dydrogesterone for managing abnormal uterine bleeding is not explicitly stated in the provided studies 2, but other progestins like medroxyprogesterone acetate are administered orally once a day for 10 days each month for ≥ 3 months.
• A study on post-menopausal women taking sequential, combined estradiol and dydrogesterone found that 10 mg of dydrogesterone was used during cycle day 15-28 3.
• Another study assessed the endometrial safety and bleeding patterns of 17 beta-estradiol sequentially combined with dydrogesterone, using doses of 5-20 mg of dydrogesterone for the last 14 days of each 28-day cycle 4.
• A study on dydrogesterone treatment for menstrual-cycle regularization in abnormal uterine bleeding - ovulation dysfunction patients used a dose of 10 mg from day 16 to day 25 of each cycle, consecutively for at least 3 cycles 5.
• A study on bleeding patterns and endometrial histology during administration of low-dose estradiol sequentially combined with dydrogesterone used doses of 5 or 10 mg dydrogesterone during cycle days 15-28 6.

Key Findings

• Dydrogesterone has shown significant efficacy in treating irregular menstrual cycles due to abnormal uterine bleeding - ovulation dysfunction (AUB-O) 5.
• The incidence of bleeding is lower with lower doses of estradiol, and higher doses of dydrogesterone are associated with a higher incidence of cyclic bleeds 4.
• Dydrogesterone therapy was effective in achieving menstrual cycle regularization for Chinese patients with AUB-O 5.
• The endometrial safety of dydrogesterone combined with estradiol is high, with adequate progestational response seen in more than 98% of patients 3, 4, 6.