What is Dydrogesterone?
Dydrogesterone is an orally active, synthetic progestogen, which is a type of medication that mimics the effects of the natural hormone progesterone. It is a stereoisomer of progesterone, often called a retroprogesterone, meaning it has the same chemical formula but a different three-dimensional structure. This unique structure gives it high oral bioavailability and a high selectivity for progesterone receptors, allowing it to be effective compared to oral micronized progesterone.
Developed in the 1950s and introduced for medical use in 1961, dydrogesterone is used for conditions associated with progesterone deficiency. Unlike many other progestins, it is noted for its favorable safety profile. It does not interfere with ovulation at typical therapeutic uses and lacks androgenic (male hormone-like) or estrogenic effects, which minimizes side effects like weight gain, acne, or changes in cholesterol levels. It is currently licensed for use in over 100 countries worldwide, though it is not available in the United States, United Kingdom, or Australia for commercial reasons.
Another Name for Dydrogesterone: Brand Names and Availability
The most widely recognized brand name for dydrogesterone is Duphaston. It is also marketed under other names in various regions, including:
- Dabroston
- Dirogest
- Dydrotone
- Gestatron
Dydrogesterone is also available in combination with estradiol for hormone replacement therapy (HRT) under brand names like Femoston. While widely available across Europe and Asia, it has been discontinued in the US, UK, and Australia.
Mechanism of Action
Dydrogesterone works by selectively binding to and activating progesterone receptors, particularly in the uterus, mimicking the action of natural progesterone. Its primary function is to help regulate the healthy growth and subsequent shedding of the uterine lining (endometrium).
In an estrogen-primed uterus, dydrogesterone induces the transition from a proliferative (growth) phase to a secretory (preparation for pregnancy) phase. Crucially, it achieves this without typically inhibiting ovulation, which makes it a suitable option for women who are trying to conceive. It also has anti-inflammatory and immunomodulatory effects, which are beneficial in treating conditions like endometriosis and preventing miscarriage. Its main active metabolite, 20α-dihydrodydrogesterone (DHD), also contributes to its progestogenic activity.
Clinical Applications and Uses
Dydrogesterone is prescribed for a wide array of gynecological issues related to progesterone deficiency:
- Menstrual Disorders: It is used to treat painful periods (dysmenorrhea), irregular cycles, abnormal uterine bleeding, and premenstrual syndrome (PMS).
- Endometriosis: Dydrogesterone helps relieve pain and reduce endometrial lesions without stopping ovulation, which is advantageous for women with endometriosis who wish to become pregnant. It is used based on individual needs and the specific purpose of use.
- Infertility and Luteal Support: It is used to treat infertility caused by luteal insufficiency (inadequate progesterone levels after ovulation). It is also increasingly used for luteal phase support in assisted reproductive technology (ART) treatments like IVF.
- Threatened and Recurrent Miscarriage: Studies and meta-analyses have shown that dydrogesterone can significantly reduce the rate of miscarriage in cases of threatened and recurrent abortion, with some research indicating a reduction of up to 47% in the odds of miscarrying.
- Hormone Replacement Therapy (HRT): In postmenopausal women with an intact uterus, dydrogesterone is combined with an estrogen to protect the endometrium from hyperplasia (abnormal thickening) and cancer that can be caused by unopposed estrogen.
Dydrogesterone vs. Other Progestogens
Dydrogesterone has a distinct profile compared to other progestogens like natural micronized progesterone and older synthetic progestins.
| Feature | Dydrogesterone (Duphaston) | Micronized Progesterone | Norethisterone |
|---|---|---|---|
| Type | Synthetic Retroprogesterone | Bio-identical Progesterone | Synthetic Progestin |
| Administration | Oral | Oral, Vaginal, Intramuscular | Oral |
| Bioavailability | High oral bioavailability (28%) | Low oral bioavailability | Good oral bioavailability |
| Effect on Ovulation | Generally does not inhibit ovulation | Does not inhibit ovulation | Can inhibit ovulation |
| Androgenic Effects | None | None | More frequent androgenic side effects (e.g., acne) |
| Metabolic Profile | Favorable impact; does not negatively affect lipid profiles | Neutral | Less favorable impact on lipids |
Potential Side Effects and Safety Profile
Dydrogesterone is generally well-tolerated. The most common side effects include migraines or headaches, nausea, breast tenderness, and menstrual irregularities like spotting. Less common side effects can include dizziness, depression, allergic skin reactions, and weight gain.
It has a favorable safety profile compared to other progestins, particularly regarding its lack of androgenic, estrogenic, and glucocorticoid activity. Unlike some older progestins used in HRT, dydrogesterone is not associated with a significantly increased risk of breast cancer or venous thromboembolism when combined with an estrogen. It is contraindicated in individuals with a known hypersensitivity, undiagnosed vaginal bleeding, or known or suspected progestogen-dependent tumors like meningioma.
Conclusion
Another name for dydrogesterone is, most commonly, Duphaston. This synthetic progestogen is a highly selective and effective medication for managing a wide spectrum of gynecological and obstetric conditions stemming from progesterone deficiency. Its unique chemical structure provides excellent oral bioavailability and a favorable safety profile, distinguishing it from natural progesterone and other synthetic progestins. By providing progesterone-like support without inhibiting ovulation or causing significant androgenic side effects, dydrogesterone remains a vital therapeutic option for women worldwide dealing with issues from menstrual pain and endometriosis to infertility and risk of miscarriage.
For more in-depth pharmacological information, you can visit DrugBank.
Disclaimer: Information provided is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
