Vol. 7, Issue 1, Part A (2025)

Background: Dydrogesterone has been in use for over 60 years and has demonstrated a favorable efficacy and safety balance across multiple obstetric and gynecological indications. Despite the extensive literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients

Aim: To assess the dydrogesterone dosing patterns in Indian women with recurrent pregnancy loss, infertility due to luteal phase deficit, and gynecological conditions such as endometriosis in the real-world setting.

Methodology: A rigorous literature search was performed by an information specialist clinician for relevant publications using databases. 63 Gynecologists from across India with at least 10 years of experience were invited to participate in the web-based survey. 

Results: 65% experts opined that a 12-week treatment with dydrogesterone is optimal for achieving positive outcomes in women with recurrent pregnancy loss. Treatment till term was preferred by 28.57% of experts, reflecting a practice of continuing dydrogesterone SR therapy throughout pregnancy. In patients at risk of first-trimester abortion, the most preferred regimen (46.03%) was a 40 mg oral loading dose of dydrogesterone followed by 10 mg orally three times daily until 12 completed weeks of gestation or 1 week after bleeding stops, The 40 mg dydrogesterone dose followed by 20 mg SR daily was preferred by 36.51% respondents. In endometriosis, the most preferred dosing regimen (39.68%) was 10 mg of dydrogesterone twice daily for six months, starting from the 5th day of the menstrual cycle. The 20 mg SR per day dose was preferred by 66.67% for treating pelvic pain in women with endometriosis. The 10 mg twice-per-day dose (53.97%) was widely regarded as effective for managing dysmenorrheal. The 20 mg SR regimen was the preferred dose by 61.90% of respondents in young women undergoing Progestin-Primed Ovarian Stimulation with dydrogesterone to suppress LH pulse surge under stimulation in an oocyte donor programme. 90.48% of respondents reported observing a dose-dependent improvement in outcomes in patients undergoing ART.

Conclusion: Oral dydrogesterone carries the least risk of miscarriage while treating threatened abortion and recurrent pregnancy loss as compared to other progesterone. Dydrogesterone is now emerging as a preferred progesterone in both obstetric and gynecological disorders in the real-world setting in India.