What medications are commonly prescribed with Duphaston (dydrogesterone)?

Estrogen is Commonly Prescribed with Duphaston (Dydrogesterone)

Duphaston (dydrogesterone) is most commonly prescribed with transdermal 17β-estradiol (50-100 μg daily) for hormone replacement therapy in postmenopausal women and women with premature ovarian insufficiency. 1, 2

Primary Combination: Estrogen-Progestin Hormone Replacement Therapy

First-Line Estrogen Pairing

• Transdermal 17β-estradiol patches (50-100 μg daily) are the preferred estrogen to combine with dydrogesterone due to lower cardiovascular and thrombotic risk compared to oral formulations 1, 2
• The patches are changed twice weekly or weekly depending on the brand 1
• This combination provides endometrial protection while minimizing first-pass hepatic effects 1

Dydrogesterone Dosing Regimens with Estrogen

Sequential (Cyclic) Regimen:

• Dydrogesterone 10 mg daily for 12-14 days per 28-day cycle when combined with continuous estradiol 1, 2
• This regimen induces withdrawal bleeding and is appropriate when contraception is not required but bleeding is acceptable 1
• Never use dydrogesterone for fewer than 12 days per cycle—this provides inadequate endometrial protection 2

Continuous Combined Regimen:

• Dydrogesterone 5 mg daily administered continuously without interruption when combined with continuous estradiol 1, 2
• This regimen avoids withdrawal bleeding for women who prefer amenorrhea 1
• Tablets containing 1-2 mg of 17β-estradiol and 5 mg of dydrogesterone can be administered continuously 1

Alternative Estrogen Formulations

Oral Estradiol Option

• Oral 17β-estradiol 1-2 mg daily can be paired with dydrogesterone as a second-choice alternative to transdermal delivery 1, 2
• Combined tablets containing estradiol and dydrogesterone (or dienogest) are available for continuous administration 1

Combined Contraceptive Options

• When contraception is required, 17β-estradiol-based combined oral contraceptives are first choice 1, 2
• Options include 17β-estradiol with acetate nomegestrol or 17β-estradiol with dienogest 1, 2

Clinical Context and Indications

Hormone Replacement Therapy

The estrogen-dydrogesterone combination is prescribed for:

• Postmenopausal women with intact uterus requiring endometrial protection 2
• Women with premature ovarian insufficiency (after at least 2 years of estrogen-only therapy or when breakthrough bleeding occurs) 1, 2
• Treatment should continue until the average age of natural menopause (45-55 years) in women with premature ovarian insufficiency 2

Pregnancy-Related Uses

While dydrogesterone is used alone for pregnancy support in some contexts 3, 4, 5, the question about "commonly prescribed with" refers primarily to the HRT context where estrogen co-administration is standard practice 1, 2

Important Clinical Considerations

Monitoring and Duration

• Annual clinical review focusing on compliance, bleeding patterns, and symptom control is recommended 2
• No routine laboratory monitoring is required unless specific symptoms arise 2
• Use the lowest effective dose for the shortest duration consistent with treatment goals 2

Cardiovascular Risk Profile

• Micronized progesterone (200 mg daily for 12-14 days per month) is actually preferred over dydrogesterone as first-line progestin due to lower cardiovascular and thrombotic risk 1, 2
• Dydrogesterone is considered a second-choice progestin after micronized progesterone and before medroxyprogesterone acetate or norethisterone 1

Critical Pitfall to Avoid

• The 12-14 day duration of progestin administration is critical in sequential regimens—shorter durations provide inadequate endometrial protection and increase endometrial hyperplasia risk 2