Dienogest
A hybrid 19-nortestosterone progestin with anti-androgenic activity but no androgenicity. First-line medical therapy for endometriosis and a component of combined contraceptives; suppresses ovarian estrogen production while acting directly on endometrial lesions.
01 Overview
Dienogest combines features of 19-nortestosterone and progesterone derivatives, giving potent progestogenic and anti-androgenic activity with essentially no androgenic, estrogenic or glucocorticoid effects. As monotherapy (Visanne) it is a standard treatment for endometriosis, reducing pelvic pain by inducing a hypoestrogenic, decidualised state and acting directly on lesions.
It is also used with estradiol valerate in a combined contraceptive (Qlaira/Natazia). It is generally well tolerated; the main issue is a change in bleeding pattern, and unlike GnRH analogues it has only modest effects on bone.
02 Mechanism
Selective progesterone-receptor agonist with anti-androgenic activity; moderately suppresses gonadotropins and directly downregulates endometrial lesion activity, creating a hypoestrogenic decidual environment.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Endometriosis | 2 mg/day | Oral | 2 mg once daily continuous. |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Endometriosis pain reliefReduces endometriosis-associated pelvic pain comparably to GnRH analogues with better tolerability. | Clinical | ||
| Anti-androgenic effectMay improve acne and androgenic symptoms. | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Irregular bleedingAltered bleeding patterns, spotting or amenorrhoea are typical. | Mild | Very common | Clinical | |
| Mood changes / low moodDepressed mood and headache reported. | Mild | Common | Clinical |