Recommended Dosage and Usage of Dydrogesterone (Progestogen)
For adult women requiring hormone replacement therapy (HRT), dydrogesterone should be administered at 5-10 mg daily for 12-14 days per month in sequential regimens, or 5 mg daily in continuous combined regimens. 1
Dosage Recommendations by Clinical Indication
Hormone Replacement Therapy
- For sequential HRT regimens: 10 mg dydrogesterone daily for 12-14 days per month provides adequate endometrial protection when combined with estradiol 2
- For continuous combined HRT regimens: 5 mg dydrogesterone daily when continuously combined with 1 mg estradiol 3
- Dydrogesterone is preferred to other progestogens for prolonged treatment due to its less negative effect on lipid metabolism and fewer androgenic effects 1
Premature Ovarian Insufficiency (POI)
- For adolescents (14-16 years): Begin with 5-10 mg dydrogesterone daily for 12-14 days per month after 2 years of estrogen therapy or when breakthrough bleeding occurs 1
- For adult women with POI: 10 mg dydrogesterone daily for 12-14 days per month in sequential regimens 1
Other Indications
- For threatened or recurrent miscarriage: 20-30 mg daily 4, 5, 6
- For prevention of preeclampsia in high-risk pregnancies: 30 mg daily from 6-20 weeks gestation 5
- For dysmenorrhea, irregular menstrual cycles, and premenstrual syndrome: Individualized dosing based on symptom severity 6
Administration Methods and Timing
Sequential Regimen
- Estrogen administered continuously
- Dydrogesterone added cyclically for 12-14 days every 28 days
- Induces withdrawal bleeding, which some patients prefer 1
Continuous Combined Regimen
- Both estrogen and dydrogesterone administered continuously
- Avoids withdrawal bleeding, which some patients prefer 1
- Typically used in women who have been amenorrheic for at least 1 year
Clinical Considerations
Advantages of Dydrogesterone
- Similar molecular structure to natural progesterone but with enhanced oral bioavailability 3
- Does not inhibit ovulation at standard doses 6
- Devoid of estrogenic or androgenic properties 6
- Does not induce significant metabolic side effects 6
- More favorable cardiovascular and metabolic profile compared to some synthetic progestogens 2
Special Populations
- For women with endometriosis who required oophorectomy: Combined estrogen/progestogen therapy (including dydrogesterone) can effectively treat vasomotor symptoms and may reduce risk of disease reactivation 1
- For women with POI and migraine: Dydrogesterone can be safely used as migraine is not a contraindication to HRT 1
Duration of Treatment
- For women with POI: HRT including dydrogesterone should be continued until the average age of natural menopause (45-55 years) 2
- For menopausal HRT: Duration should be determined by ongoing assessment of benefits versus risks 2
Common Pitfalls and Caveats
- Inadequate progestogen exposure can lead to endometrial hyperplasia in women taking estrogen 3
- Starting progestogen too early in adolescents with POI may compromise final height if growth is still ongoing 1
- Monitoring for side effects is essential, though dydrogesterone has a favorable safety profile compared to other progestogens 2