What to Avoid When Taking Dydrogesterone for Safe and Effective Treatment

October 7, 2025 •

4 min read

Dydrogesterone is a synthetic progestogen prescribed in over 10 million pregnancies worldwide [1.6.2]. To ensure its effectiveness and safety, it's crucial to understand what to avoid when taking dydrogesterone, from medications to certain lifestyle habits.

Quick Summary

For safe dydrogesterone use, avoid certain epilepsy, infection, and HIV drugs. It is contraindicated for those with specific cancers or severe liver disease. Alcohol and smoking should also be avoided to prevent adverse effects.

Key Points

Contraindicated Conditions: Avoid dydrogesterone if you have undiagnosed vaginal bleeding, severe liver disease, or a history of hormone-dependent cancers like breast cancer [1.4.2, 1.4.5].
Drug Interactions: Do not take with certain antiepileptics (e.g., carbamazepine), anti-infectives (e.g., rifampicin), or specific antiviral medications for HIV [1.3.3].
Herbal Supplements: Avoid St. John's Wort, as it can significantly reduce the effectiveness of dydrogesterone [1.3.3].
Alcohol: It is unsafe to consume alcohol while taking dydrogesterone, as it can lead to unpleasant side effects and interfere with treatment [1.2.5, 1.6.7].
Mental Alertness: The medication may cause dizziness or drowsiness; avoid driving or operating heavy machinery until you know how it affects you [1.2.4].
Medical Disclosure: Always inform your doctor about your full medical history, including any history of blood clots, depression, or heart conditions [1.2.3, 1.4.2].
Pregnancy and Breastfeeding: Dydrogesterone should not be used by breastfeeding mothers as it may pass into the milk [1.2.1]. Use during pregnancy should be only as prescribed by a doctor [1.2.1].

Understanding Dydrogesterone and Its Importance

Dydrogesterone is an orally active progestogen, a synthetic version of the natural hormone progesterone [1.6.8]. It is used to treat a wide range of gynecological conditions, including menstrual disorders, infertility due to luteal insufficiency, endometriosis, and to prevent miscarriage in certain situations [1.6.2]. It works by preparing the uterine lining for pregnancy and helps in maintaining it [1.5.5]. Unlike some other progestins, it typically does not inhibit ovulation [1.6.2]. Before starting treatment, a thorough medical history, including a family history and breast examination, is necessary [1.2.6]. Understanding contraindications and interactions is vital for patient safety.

Medical Conditions (Contraindications)

Certain pre-existing medical conditions make taking dydrogesterone unsafe. It is strictly contraindicated for individuals with [1.4.2, 1.4.5]:

Known or suspected progestogen-dependent cancers: This includes cancers like breast cancer, meningioma, or uterine cancer, which may grow in the presence of progestogens [1.4.5, 1.6.6].
Undiagnosed vaginal bleeding: If you are experiencing abnormal vaginal bleeding, the cause must be identified before starting dydrogesterone, as the medication could mask a serious underlying condition [1.4.2, 1.4.6].
Severe liver disease or dysfunction: The drug is metabolized by the liver, and in patients with severe liver problems, it should be avoided until liver function tests return to normal [1.4.5, 1.6.6].
Known hypersensitivity: Patients with a known allergy to dydrogesterone or any of its ingredients should not take the medication [1.2.1, 1.4.5].
Blood clot disorders: Caution should be exercised in patients with a history of thromboembolism (blood clots), as dydrogesterone may increase this risk [1.2.3, 1.4.2].

Additionally, caution is advised for patients with a history of depression, heart disease, epilepsy, asthma, migraine, or diabetes [1.4.2, 1.2.5]. Always disclose your full medical history to your healthcare provider.

Drug and Substance Interactions to Avoid

Several medications and substances can interact with dydrogesterone, potentially reducing its effectiveness or increasing the risk of side effects. The metabolism of dydrogesterone can be increased by substances that induce certain liver enzymes (CYP enzymes) [1.3.3].

Prescription and Over-the-Counter Medications

Key drug classes to be aware of include:

Anticonvulsants: Drugs used for epilepsy such as phenobarbital, phenytoin, and carbamazepine can speed up the metabolism of dydrogesterone, reducing its effect [1.3.2, 1.3.3].
Anti-infectives: Certain medications for infections, like the antibiotics rifampicin and rifabutin, can also decrease the effectiveness of dydrogesterone [1.3.2, 1.3.3].
Antivirals: HIV medications such as ritonavir, nevirapine, and efavirenz can alter the drug's metabolism [1.3.3]. While some are inhibitors, they can have an inducing effect on steroid hormones [1.3.3].
Anticoagulants (Blood Thinners): Dydrogesterone may decrease the therapeutic activities of anticoagulants like warfarin and rivaroxaban [1.3.1].

Herbal Supplements and Other Substances

St. John's Wort: This herbal preparation, often used for depression, is known to induce liver enzymes and can significantly decrease the effectiveness of dydrogesterone [1.3.3].
Other Herbal Preparations: Herbal remedies containing sage or ginkgo biloba may also interact with the medication [1.2.1, 1.3.3].
Grapefruit Juice: While some sources state there are no significant food interactions [1.5.2], others suggest that grapefruit juice can inhibit enzymes that break down progesterone, potentially increasing its levels and side effects [1.5.1, 1.5.4, 1.5.7]. It's best to be cautious.


Interaction Type	Examples	Potential Effect on Dydrogesterone	Reference
CYP Enzyme Inducers	Carbamazepine, Phenytoin, Rifampicin, St. John's Wort	Decreased effectiveness due to faster metabolism	[1.3.3]
Anticoagulants	Warfarin, Apixaban, Rivaroxaban	May decrease the anticoagulant effect	[1.3.1]
HIV Protease Inhibitors	Ritonavir, Nelfinavir	Altered metabolism (can be complex)	[1.3.3]
Herbal Supplements	Ginkgo Biloba, Sage	Potential for interactions affecting metabolism	[1.2.1, 1.3.3]
Food/Beverage	Grapefruit Juice, Alcohol	May alter drug levels or increase side effects	[1.5.1, 1.6.7]

Lifestyle Factors and Activities

Your daily habits can also influence your treatment with dydrogesterone.

Alcohol: It is recommended to avoid or limit alcohol consumption. Alcohol can interfere with hormone levels and may increase the risk of side effects [1.6.7, 1.2.2].
Smoking: Smoking can increase certain cardiovascular risks associated with hormone therapies [1.2.3, 1.5.5]. Quitting smoking is advised to reduce the risk of conditions like heart disease and stroke [1.5.5].
Driving and Operating Machinery: Dydrogesterone may cause dizziness or drowsiness in some individuals, especially in the first few hours after taking it [1.2.1, 1.6.4]. It is advised to avoid activities that require full mental alertness until you know how the medication affects you [1.2.4].
Diet and Exercise: While there are no strict dietary restrictions, maintaining a healthy weight through a balanced diet and regular exercise is recommended [1.2.2, 1.5.2]. This can also help manage potential side effects like weight gain and support overall well-being [1.5.5].

Conclusion: Prioritize Open Communication with Your Doctor

To ensure the safe and effective use of dydrogesterone, it is crucial to avoid certain medications, herbal supplements, and lifestyle habits. Contraindications such as a history of hormone-sensitive cancers or severe liver disease must be respected. Always provide your healthcare provider with a complete list of all medications, supplements, and pre-existing health conditions before starting treatment. Promptly report any unusual symptoms, such as breakthrough bleeding, severe headaches, or signs of a blood clot [1.4.6, 1.4.7]. By being informed and maintaining open communication with your doctor, you can navigate your treatment with confidence.

For more detailed information from a manufacturer, you can review prescribing information, such as this example from the MIMS database.

Frequently Asked Questions

You should avoid certain drugs for epilepsy (like carbamazepine, phenobarbital), infections (rifampicin), and HIV (ritonavir, nevirapine), as well as the herbal supplement St. John's Wort, as they can reduce dydrogesterone's effectiveness [1.3.3, 1.3.7].

No, it is recommended not to consume alcohol with dydrogesterone. Alcohol can interfere with treatment and increase the risk of unpleasant side effects [1.2.5, 1.6.7].

Individuals with undiagnosed vaginal bleeding, severe liver disease, a known allergy to the drug, or a history of hormone-dependent cancers (like breast cancer or meningioma) should not take dydrogesterone [1.4.2, 1.4.5, 1.6.6].

While weight gain is a possible side effect, it is not commonly reported. Maintaining a healthy lifestyle and balanced diet is advisable while taking this medication [1.5.2, 1.6.6].

Dydrogesterone can cause dizziness or drowsiness in some people. It is advised to avoid driving or operating machinery until you understand how the medication affects your mental alertness [1.2.4, 1.6.4].

There are no significant food interactions, but some sources advise caution with grapefruit and grapefruit juice as they may increase drug levels [1.5.2, 1.5.1]. Limiting caffeine and spicy foods may help reduce potential hot flushes [1.5.1].

If you have a history of depression, dydrogesterone should be used with caution as it may worsen the condition. It is essential to inform your doctor, who will monitor you closely during treatment [1.4.2, 1.6.6].