Dydrogesterone Treatment Regimen for Endometriosis
For women of reproductive age with endometriosis, dydrogesterone should be administered at 10 mg orally daily from day 5 to day 25 of each menstrual cycle for 3-6 months, with the option to increase to 20 mg daily in severe cases. 1
Positioning in Treatment Algorithm
- Dydrogesterone functions as a first-line hormonal therapy option alongside combined oral contraceptives and other progestins 2, 3
- NSAIDs should be initiated first for immediate pain relief before starting hormonal therapy 2, 3
- Progestins (including dydrogesterone) demonstrate similar efficacy to oral contraceptives in reducing pain and lesion size 3
- Reserve GnRH agonists for refractory cases when first-line therapies fail 3
Specific Dosing Protocol
- Standard dose: 10 mg orally once daily 1
- Timing: Days 5-25 of each menstrual cycle (cyclical regimen, not continuous) 1
- Duration: 3-6 months of treatment 1
- Severe endometriosis: Increase to 20 mg daily 1
Expected Clinical Outcomes
- Pain relief begins after the first treatment cycle, with significant improvements in pelvic pain, dysmenorrhea, and dyspareunia 1
- By 6 months: 95% reduction in pelvic pain, 87% reduction in dysmenorrhea, and 85% reduction in dyspareunia 1
- Menstrual bleeding amount decreases significantly by 2 months (12% reduction) 1
- Duration of bleeding reduces significantly starting after the first month (10% reduction) 1
- Sexual function improves, with significant increases in desire, orgasm, satisfaction scores, and decreased pain during intercourse 4
- Pregnancy rates increase compared to gestrinone treatment 5
Mechanism and Clinical Advantages
- Dydrogesterone inhibits ectopic endometrial proliferation through multiple pathways: slowing progesterone metabolism, inhibiting angiogenesis and extracellular matrix degradation, inducing apoptosis, and reducing inflammatory factors 6
- Critical advantage: Does not suppress ovulation, making it suitable for women who may desire fertility 7
- Lower risk of adverse events compared to gestrinone and GnRH agonists 5
- Reduces endometriosis recurrence risk compared to GnRH agonists 5
Post-Surgical Use
- Highly effective as post-laparoscopic treatment to prevent recurrence 1
- 21.1% of patients achieved cure status and 66.7% showed improvement in post-surgical settings 1
- 74% of patients and 70% of physicians rated therapy as excellent to good 1
Safety Profile
- No adverse events reported in clinical studies 1
- Safer profile than gestrinone (fewer adverse events) and GnRH agonists (no elevated transaminase levels) 5
- Does not cause the hypoestrogenic side effects associated with GnRH agonists 7
Important Clinical Caveats
- Dydrogesterone does not eradicate endometriosis lesions—it provides symptomatic relief through hormonal suppression, similar to all medical therapies 3, 8
- Up to 44% of women experience symptom recurrence within one year after surgery, emphasizing the need for ongoing medical management 2, 3
- Medical treatment does not improve future fertility outcomes; hormonal suppression should not be used in women actively trying to conceive 3
- For severe endometriosis, medical treatment alone may be insufficient, and surgical intervention should be considered 2, 3