Duphaston (dydrogesterone) is a progestogen medication specifically engineered to mimic the effects of natural progesterone in the body. It is a cornerstone of hormonal therapy, offering a well-tolerated and effective option for managing conditions driven by progesterone deficiency or imbalance. Unlike some older progestogens, its molecular structure is designed for high selectivity, targeting progesterone receptors with a reduced likelihood of androgenic, estrogenic, glucocorticoid, or other undesirable hormonal side effects. This makes it a preferred choice for gynecologists and endocrinologists seeking to restore hormonal equilibrium with precision.

Features

• Active Ingredient: Dydrogesterone (a retroprogesterone).
• High receptor selectivity for the progesterone receptor.
• Oral tablet formulation for convenient administration.
• Well-established pharmacokinetic profile with predictable absorption.
• Not derived from testosterone, minimizing androgenic effects.
• Extensive clinical history and a robust safety database.

Benefits

• Effectively supports and maintains the secretory endometrium, which is crucial for successful embryo implantation and pregnancy.
• Provides reliable relief from symptoms associated with progesterone deficiency, such as painful periods, irregular bleeding, and premenstrual syndrome.
• Helps reduce the risk of endometrial hyperplasia in women undergoing estrogen-based hormone replacement therapy (HRT).
• Offers a favorable side effect profile compared to older synthetic progestins, with a low incidence of weight gain, acne, or other androgenic effects.
• Supports a normal endocrine environment for the management of endometriosis and dysfunctional uterine bleeding.
• Can be used in fertility treatments to create a hormonally receptive environment for pregnancy.

Common use

Duphaston is primarily prescribed for the treatment of disorders related to progesterone insufficiency. Its most common applications include:

• Luteal Phase Support: Used in infertility management and Assisted Reproductive Technology (ART) to support the endometrial lining after ovulation or embryo transfer.
• Endometriosis: Management of pain and symptoms associated with endometriosis.
• Dysfunctional Uterine Bleeding (DUB): Treatment of irregular, heavy, or painful menstrual bleeding where an underlying progesterone deficiency is identified.
• Secondary Amenorrhea: Induction of withdrawal bleeding in women with absent menstrual periods.
• Premenstrual Syndrome (PMS): Alleviation of severe physical and emotional symptoms preceding menstruation.
• Hormone Replacement Therapy (HRT): Combined with estrogen to protect the uterine lining from hyperplasia and potential cancer risk in postmenopausal women.

Dosage and direction

Dosage is highly individualized and must be determined by a physician based on the specific indication and patient response. Treatment typically follows the cyclical rhythm of the natural menstrual cycle.

• Endometriosis: 10 mg two or three times daily from day 5 to day 25 of the cycle.
• Infertility / Luteal Support: 10 mg twice daily from day 14 to day 25 of the cycle. Treatment should be continued through the first trimester if pregnancy is confirmed.
• Dysfunctional Bleeding: 10 mg twice daily for 5 to 7 days to stop bleeding. To prevent recurrence, a cyclical regimen of 10 mg twice daily from day 11 to day 25 is used.
• HRT (with estrogen): 10 mg daily for the last 12-14 days of each estrogen cycle.
• Administration: Tablets should be swallowed whole with water, with or without food. Adherence to the prescribed schedule is critical for efficacy.

Precautions

A thorough medical evaluation is necessary before initiating treatment.

• Medical History: Disclose any history of depression, liver disorders, cardiovascular disease, diabetes, epilepsy, migraines, or kidney problems.
• Monitoring: Regular monitoring of the endometrial lining is advised during long-term use, particularly in HRT.
• Pregnancy: Duphaston can be used during pregnancy for luteal phase support as directed by a physician. It is not indicated for use as a contraceptive.
• Breastfeeding: Small amounts of dydrogesterone may pass into breast milk. Use during lactation requires a careful risk/benefit assessment by a doctor.
• Driving and Operating Machinery: Duphaston is not known to impair these abilities, but patients should be aware of their individual response, especially when starting treatment.

Contraindications

Duphaston is contraindicated in patients with:

• Known hypersensitivity to dydrogesterone or any excipients in the formulation.
• Undiagnosed vaginal bleeding.
• Known or suspected progesterone-dependent neoplasms, such as meningioma.
• Severe liver dysfunction or hepatic tumors.
• Current or history of arterial thromboembolic events (e.g., stroke, myocardial infarction).
• Acute porphyria.

Possible side effect

Duphaston is generally well-tolerated. Most side effects are mild and transient. Reported adverse reactions may include:

• Common (≥1/100 to <1/10): Headache, nausea, abdominal pain, breast tenderness/discomfort, breakthrough bleeding/spotting.
• Uncommon (≥1/1,000 to <1/100): Dizziness, vomiting, diarrhea, pruritus (itching), rash, urticaria (hives), edema, weight changes.
• Rare (<1/1,000): Hemolytic anemia, drowsiness, jaundice, hypersensitivity reactions.
• Very Rare: Depression, libido changes.

Drug interaction

The metabolism of dydrogesterone primarily involves CYP3A4 enzymes. Concomitant use of drugs that induce or inhibit this enzyme system may alter its plasma levels.

• Potent Inducers of CYP3A4 (e.g., Rifampicin, Phenobarbital, Phenytoin, Carbamazepine, St. John’s Wort) may increase the metabolism of dydrogesterone, potentially reducing its therapeutic effect.
• Potent Inhibitors of CYP3A4 (e.g., Ketoconazole, Ritonavir) may decrease the metabolism of dydrogesterone, potentially increasing the risk of side effects. Inform your doctor about all medications you are taking, including prescription, over-the-counter, and herbal products.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Do not take a double dose to make up for a forgotten tablet. Maintaining the cyclical regimen is important; consult your physician if multiple doses are missed.

Overdose

There have been no reports of serious harmful effects from acute overdose. Based on the extensive profile of dydrogesterone, no specific antidote exists. In the event of a significant overdose, symptomatic and supportive care is recommended. Gastric lavage may be considered if ingestion was very recent. Medical attention should be sought.

Storage

• Store below 30°C (86°F).
• Keep in the original blister pack to protect from light and moisture.
• Keep out of the sight and reach of children.
• Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

• Dr. Elena V., Gynecologist: “In my practice, Duphaston has been invaluable for luteal phase support. Its selective action and lack of androgenic side effects make it a reliable choice for patients undergoing fertility treatments. The predictability of patient response is excellent.”
• Fertility Patient, 34: “After two miscarriages linked to a short luteal phase, my doctor prescribed Duphaston. I followed the cyclical regimen and am now 24 weeks pregnant. The peace of mind it provided was immense. I experienced minimal side effects, just some mild breast tenderness.”
• Dr. Mark T., Endocrinologist: “For managing dysfunctional uterine bleeding in perimenopausal women, Duphaston offers a targeted solution. It effectively transforms the endometrium and regulates cycles without the metabolic concerns associated with older progestins. A well-researched and trusted agent.”
• Patient with Endometriosis, 29: “The pain from my endometriosis was debilitating. Since starting on Duphaston, the intensity of my cramps has reduced significantly. It hasn’t eliminated the condition, but it has given me a much better quality of life during my cycle.”