Dydrogesterone Side Effects in Women with Endometriosis
Dydrogesterone is generally well-tolerated with minimal side effects, making it a favorable progestogen option for women with endometriosis, particularly when compared to other hormonal treatments. 1
Common Side Effects
The side effect profile of dydrogesterone is notably benign:
- Transient mastalgia (breast tenderness) and dizziness were the only reported side effects in clinical studies, occurring in only 2 out of 49 patients treated for endometriosis 2
- No menstrual cycle disturbances or amenorrhea were reported, which distinguishes dydrogesterone from other progestogen therapies 2
- Sexual function may actually improve rather than worsen, with studies showing increased desire, satisfaction, and orgasm scores after 6 months of treatment 3
Metabolic and Cardiovascular Profile
Dydrogesterone demonstrates favorable metabolic characteristics:
- Less negative effect on lipid metabolism compared to other synthetic progestogens, making it preferred for prolonged treatment 1
- Less androgenic effects than alternative progestogens like medroxyprogesterone acetate 1
- Neutral or beneficial cardiovascular profile, unlike some synthetic progestogens that may negatively impact blood pressure, vasomotion, and carbohydrate metabolism 1
Safety Considerations
Endometrial Protection
- When used with estrogen therapy in women with an intact uterus, dydrogesterone provides adequate endometrial protection at doses of 5-10 mg daily for 12-14 days per month in cyclic regimens 1
- The evidence for endometrial protection is less robust than for micronized progesterone or medroxyprogesterone acetate, though it remains a recommended option 1
Clinical Context for Endometriosis
- Pain relief typically occurs within 4-8 weeks of treatment, with dyspareunia taking longer to resolve 2
- Pregnancy rates improved in infertility patients with endometriosis, with 56.7% achieving pregnancy after treatment 4
- Endometriosis regression was confirmed in 30 out of 32 patients (94%) who underwent culdoscopy after treatment 2
Comparative Advantages
When compared to alternative treatments for endometriosis:
- Lower risk of adverse events compared to gestrinone 5
- Lower risk of endometriosis recurrence and elevated transaminase levels compared to GnRH agonists 5
- No thrombotic risk elevation has been demonstrated, unlike some combined hormonal contraceptives 1
Important Caveats
- The overall quality of evidence for dydrogesterone in endometriosis treatment remains very low to moderate, with most studies being small or of limited methodological rigor 5
- Long-term safety data beyond 24 months is limited 1
- Breakthrough bleeding should prompt evaluation for underlying gynecological problems, though this is uncommon with dydrogesterone 1