Why is Duphaston (dydrogesterone) given after a dilation and curettage (D&C)?

Duphaston (Dydrogesterone) After D&C: Indications and Benefits

Duphaston (dydrogesterone) is primarily given after D&C to provide progestin-based therapy for endometrial regeneration, particularly in fertility-preserving cases or when treating endometrial hyperplasia or early-stage endometrial cancer.

Main Indications for Duphaston After D&C

1. Fertility Preservation in Endometrial Cancer

• Continuous progestin-based therapy is recommended for highly selected patients with grade 1, stage IA (noninvasive) endometrioid adenocarcinoma who wish to preserve fertility 1
• Dydrogesterone (Duphaston) is one of the progestin options that may be used in this context, along with megestrol acetate, medroxyprogesterone, or levonorgestrel-containing IUDs 1
• Complete response occurs in approximately 50% of patients with early-stage endometrial cancer treated with progestin therapy 1

2. Endometrial Hyperplasia Management

• Progestin therapy is recommended for young patients with endometrial hyperplasia who desire fertility preservation 1
• After D&C confirms hyperplasia, Duphaston can be prescribed to reverse the hyperplastic changes

3. Endometrial Regeneration

• After D&C procedures that remove the endometrial lining, progestins like Duphaston help promote healthy endometrial regeneration
• This is particularly important when planning for future pregnancy

Dosing and Administration

• For fertility-sparing therapy in endometrial cancer or hyperplasia:
  • Continuous progestin-based therapy with close monitoring 1
  • Endometrial sampling (biopsies or D&C) every 3-6 months to assess response 1
• Standard dosing of Duphaston is typically 10 mg twice daily, though sustained-release formulations of 20 mg or 30 mg once daily are available to improve compliance 2

Monitoring and Follow-up

• Close monitoring with endometrial sampling (biopsies or D&C) every 3-6 months is essential 1
• Total hysterectomy with bilateral salpingo-oophorectomy (TH/BSO) with surgical staging is recommended:
  1. After childbearing is complete
  2. If patients have documented progression on biopsy
  3. If endometrial cancer is still present after 6-12 months of progestin-based therapy 1

Important Considerations and Contraindications

• Progestin therapy should be carefully considered in patients with contraindications such as:
  • History of breast cancer
  • Stroke
  • Myocardial infarction
  • Pulmonary embolism
  • Deep vein thrombosis
  • Active smoking 1

Effectiveness and Outcomes

• In fertility-sparing cases, approximately 35% of women who had subsequent negative endometrial biopsies after hormonal therapy were able to become pregnant 1
• However, the ultimate recurrence rate is also high (35%), emphasizing the need for close monitoring 1
• Patients should be counseled that fertility-sparing therapy is not the standard of care for endometrial carcinoma treatment 1

Pitfalls and Caveats

• Fertility-sparing therapy is not recommended for high-risk patients with:
  • High-grade endometrioid adenocarcinomas
  • Uterine serous carcinoma
  • Clear cell carcinoma
  • Carcinosarcoma
  • Leiomyosarcoma 1
• Patients must meet specific criteria for fertility-sparing therapy as outlined in clinical guidelines, including confirmation of no metastatic disease 1
• The recurrence rate remains high even after successful treatment, necessitating long-term surveillance

Duphaston's role after D&C is primarily focused on endometrial regeneration and management of conditions where preserving fertility is desired while treating endometrial pathology.