What is the dose of dydrogesterone (progestogen) for withdrawal bleeding after a missed period?

Dydrogesterone Dosing for Withdrawal Bleeding After Missed Period

For inducing withdrawal bleeding after a missed period in premenopausal women with normal estrogen levels, dydrogesterone 10 mg daily for 14 days is the recommended dose. 1

Dosing Regimen

• Administer dydrogesterone 10 mg daily for days 1-14 of a 28-day cycle, followed by discontinuation for days 15-28 to allow withdrawal bleeding 1

• This regimen induces withdrawal bleeding in approximately 65% of women during the first cycle, which is twice the rate of placebo (30.8%) 1

• Withdrawal bleeding typically occurs predictably within the 14-day hormone-free interval after stopping dydrogesterone 1, 2

Clinical Effectiveness

• The 10 mg daily dose for 14 days has been specifically validated in premenopausal women with secondary amenorrhea and normal estrogen levels 1

• This dosing maintains regular bleeding patterns over multiple cycles, with significantly superior regularity compared to placebo over 6 cycles 1

• If withdrawal bleeding does not occur within 3 weeks after completing the 14-day course, pregnancy testing is advised 3

Important Clinical Considerations

• This regimen is appropriate for women with normal estrogen levels who have missed periods but are not menopausal 1

• The 10 mg dose provides adequate progestational transformation of the endometrium without requiring higher doses 1

• For postmenopausal women requiring hormone replacement therapy, the same 10 mg daily dose for 12-14 days per month is used when combined with continuous estrogen 4, 5, 2

Common Pitfall to Avoid

• Do not use doses lower than 10 mg for 14 days, as studies demonstrate that at least 10 mg for 14 days is required for acceptable endometrial protection and reliable withdrawal bleeding 6

• Shorter durations (less than 12-14 days) provide inadequate endometrial protection and should be avoided 4