Dydrogesterone for Endometrial Polyp Recurrence Prevention
Dydrogesterone is prescribed for 6 months after endometrial polyp resection to prevent polyp recurrence by providing progestational endometrial protection, which reduces the risk of new polyp formation and abnormal uterine bleeding. 1
Mechanism and Rationale
- Endometrial polyps have a high recurrence rate (up to 25-40%) after resection, and progestin therapy helps prevent this recurrence by counteracting unopposed estrogen effects on the endometrium 2
- Dydrogesterone specifically provides endometrial protection by preventing proliferative changes that could lead to new polyp formation 3
- The 6-month duration is based on evidence that maintenance progestin treatment for at least 6 months provides optimal endometrial protection after initial response 4
Dosing and Administration
- Typical dosing of dydrogesterone is 5-10 mg daily, as these doses have been shown to provide adequate endometrial protection 3, 5
- The 6-month treatment period aligns with clinical practice guidelines that recommend assessment of response to progestin therapy at 6 months 4
- Continuous rather than cyclic administration may provide better protection against recurrence 6
Clinical Evidence Supporting Use
- Studies show that progestin therapy after endometrial interventions provides a 97-98% success rate in preventing proliferative endometrial changes when used at appropriate doses 3
- A recent clinical trial protocol is specifically investigating dydrogesterone for preventing endometrial polyp recurrence after transcervical resection, highlighting the clinical relevance of this approach 1
- Long-term progestin therapy has been shown to reduce disease recurrence risk with an odds ratio of 0.56 (95% CI 0.32-0.99) compared to no medication 6
Monitoring During Treatment
- Patients should be monitored with endometrial sampling (biopsies or D&C) every 3-6 months during treatment 4
- Transvaginal ultrasound is recommended to assess for polyp recurrence during and after the treatment period 1, 2
- Clinical evaluation should include assessment of abnormal uterine bleeding symptoms, which are common presentations of polyp recurrence 1, 2
Important Considerations and Contraindications
- Dydrogesterone should be used cautiously in patients with contraindications to progestin therapy, including history of breast cancer, stroke, myocardial infarction, pulmonary embolism, deep vein thrombosis, and active smoking 4
- For patients desiring fertility, the treatment approach should be discussed thoroughly, as progestin therapy may temporarily affect fertility but helps preserve long-term endometrial health 4
- After completion of the 6-month treatment period, patients should continue regular follow-up every 6 months to monitor for late recurrence 4
Alternative Options
- For patients who cannot tolerate oral dydrogesterone, alternative progestins such as medroxyprogesterone acetate (400-600 mg/day) or megestrol acetate (160-320 mg/day) may be considered 4
- A levonorgestrel-releasing intrauterine device may also be an effective alternative for preventing polyp recurrence 4