Duphaston (Dydrogesterone) for 8 Weeks: Clinical Protocol
Direct Answer
For endometriosis treatment following surgical intervention, dydrogesterone (Duphaston) should be administered at 20 mg daily from cycle day 5 to day 25 for a duration of 8 weeks or longer, as this regimen has demonstrated superior efficacy in preventing recurrence and improving fertility outcomes compared to no hormonal treatment. 1
Evidence-Based Dosing Protocols
Standard Endometriosis Treatment Protocol
- Administer 20 mg dydrogesterone daily from day 5 to day 25 of the menstrual cycle for post-surgical endometriosis management 2, 1
- This represents the most extensively studied regimen in women following laparoscopic excision or thermocoagulation of endometriotic lesions 1
- Treatment duration of 8 weeks aligns with established hormonal modulation protocols, though many studies continued therapy for multiple cycles 2, 1
Alternative Dosing for Premenstrual Syndrome
- 20 mg twice daily (40 mg total) during the second half of the menstrual cycle effectively treats premenstrual symptoms including dysmenorrhea, bleeding irregularities, depression, and edema 2
- This higher dose regimen showed best results for dysmenorrhea and bleeding irregularities specifically 2
IVF/Assisted Reproduction Protocol
- 20 mg daily from cycle day 3 until trigger day when used for controlled ovarian hyperstimulation, demonstrating effective LH suppression without premature surge 3
- 30 mg daily for luteal phase support starting on oocyte retrieval day and continuing until 12 weeks of gestation, showing non-inferiority to vaginal progesterone with live birth rates of 34.4% 4
Clinical Context and Treatment Selection
Post-Surgical Endometriosis Management
The 8-week protocol is most relevant for hormonal modulation following surgical treatment of endometriosis, where dydrogesterone has proven most effective:
- Pregnancy rates of 52% were achieved when combining surgical excision with dydrogesterone therapy, compared to 27.3% without hormonal treatment 5
- For "small form" endometriosis, pregnancy rates reached 34% with treatment versus 22.7% without 5
- Dydrogesterone was identified as the most preferable drug for post-operative hormonal therapy in comparative studies 1
Important Clinical Considerations
Treatment maintains ovulatory cycles: Unlike some hormonal therapies, dydrogesterone preserves normal ovulation as confirmed by basal body temperature and plasma progesterone levels 2
Excellent tolerability profile:
- No significant alterations in blood pressure or body weight 2
- Well-tolerated with safety profile comparable to vaginal progesterone preparations 4
- Oral administration offers superior patient compliance compared to vaginal formulations 4
Timing relative to surgery: Hormonal therapy should begin after surgical intervention (laparoscopy with excision/thermocoagulation) rather than as monotherapy 5, 1
Common Pitfalls to Avoid
- Do not use as monotherapy for endometriosis: The evidence supports dydrogesterone as adjunctive therapy following surgical treatment, not as standalone management 5, 1
- Mastodynia may not respond: While effective for multiple premenstrual symptoms, breast tenderness showed limited response to dydrogesterone therapy 2
- Ensure appropriate patient selection: The 8-week protocol is most applicable to endometriosis management; other indications may require different durations or dosing schedules 2, 3, 4
Treatment Algorithm
- Confirm indication: Post-surgical endometriosis, premenstrual syndrome, or assisted reproduction
- For endometriosis (most common 8-week indication):
- Assess response: Majority of patients request continuation beyond initial treatment period due to efficacy 2
The 8-week duration specifically aligns with established hormonal modulation protocols and represents a reasonable minimum treatment course, though many successful protocols extend beyond this timeframe. 2, 1