Can Duphaston (dydrogesterone) cause breast tenderness?

Duphaston (Dydrogesterone) and Breast Tenderness

Yes, Duphaston (dydrogesterone) can cause breast tenderness as a side effect, which is a common adverse effect of progestins and hormone therapies. 1

Mechanism and Evidence

Dydrogesterone is a synthetic progestogen with properties similar to natural progesterone. The relationship between progestogens and breast tenderness is well-established:

• Progestins, including dydrogesterone, can cause breast tenderness through their hormonal effects on breast tissue 1
• In hormone replacement therapy regimens, progestogens have been documented to produce a transient increase in breast tenderness, particularly hydroxyprogesterone derivatives 2
• Breast tenderness is listed as a reproductive adverse effect in prescribing information for hormonal therapies containing progestins 1

Risk Factors and Patterns

The likelihood and severity of breast tenderness with Duphaston may vary based on:

• Age and menopausal status - older women and those further from menopause may be more susceptible to developing breast tenderness when starting hormone therapy 3
• Previous history of breast tenderness - paradoxically, some women with pre-existing breast tenderness may experience improvement with hormone therapy 3
• Dose and duration - higher doses may increase risk of breast tenderness
• Individual sensitivity to hormonal fluctuations

Clinical Significance

Breast tenderness associated with progestogens like dydrogesterone is generally:

• Transient in nature, often improving after continued use 2
• Typically mild to moderate in severity
• Not usually associated with serious pathology
• A common reason for discontinuation of hormone therapy

Management Options

For patients experiencing breast tenderness while taking Duphaston:

1. Reassurance that the symptom is common and often temporary

2. Supportive measures:

   • Well-fitted, supportive bra
   • Local heat or cold application
   • Over-the-counter NSAIDs for pain relief 4

3. Dose adjustment may be considered if symptoms are severe

4. Monitoring for persistence or worsening of symptoms

Important Considerations

• New-onset breast tenderness during hormone therapy should be evaluated appropriately, as some studies have shown an association between new-onset breast tenderness during combined hormone therapy and increased breast cancer risk 5
• Breast tenderness that is focal, persistent, or associated with other breast changes (mass, skin changes, nipple discharge) requires prompt evaluation 4
• Dydrogesterone may actually have some protective effects on breast tissue through inhibition of sulfatase and 17beta-hydroxysteroid dehydrogenase activities in breast cells 6

Red Flags Requiring Further Evaluation

• Persistent focal pain rather than diffuse tenderness
• Pain associated with a palpable mass
• Skin changes or nipple discharge
• Unilateral symptoms that don't correlate with menstrual cycle

For women taking Duphaston who develop breast tenderness, monitoring the pattern and duration of symptoms is important, with reassessment if symptoms persist beyond 2-3 months or change in character.