Indications
Dienogest is a progestogen (a man-made form of the female hormone progesterone) used on its own to treat endometriosis, a condition in which tissue similar to the lining of the womb grows outside the womb and causes pelvic pain, painful periods and pain during sex. In lower doses it is also an ingredient of some combined contraceptive pills together with an oestrogen such as Ethinylestradiol or Estradiol Valerate.
How It Works
Dienogest acts on progesterone receptors. It lowers the body’s own oestrogen production to a moderate level and has a direct effect on endometriosis tissue, causing it to shrink and become less active. This reduces pain and inflammation. It also stops ovulation in most women.
Dosage and Administration
Dienogest is a hormone treatment and should be taken as prescribed by your doctor. For endometriosis it is usually taken as one tablet every day at about the same time, continuously without a break, starting on any day of the cycle. If a tablet is missed, or if you vomit within a few hours of taking it, follow the advice in the pack leaflet or ask your pharmacist. For combined contraceptive pills, follow the instructions for that product.
Interactions
Enzyme inducers such as Rifampicin, Carbamazepine, Phenytoin, Phenobarbital, some HIV medicines and St John’s Wort can lower Dienogest levels and reduce its effect. Strong enzyme blockers such as Ketoconazole, Itraconazole, Clarithromycin and grapefruit juice can raise its levels. Dienogest alone is not a reliable contraceptive unless your doctor advises otherwise; use non-hormonal contraception such as condoms.
Contraindications
Do not take if you are pregnant or think you may be, or if you have a current blood clot in the veins (such as deep vein thrombosis or pulmonary embolism), heart disease or stroke, diabetes with blood vessel damage, severe liver disease or liver tumour, a hormone-sensitive cancer such as breast cancer, or unexplained vaginal bleeding. Combined pills containing Dienogest have additional restrictions related to the oestrogen.
Side Effects
- Irregular bleeding or spotting, especially in the first months
- Headache and breast discomfort
- Low mood, mood swings or depression
- Acne and weight gain
- Hot flushes and decreased sex drive
Get urgent medical help if you have pain or swelling in one leg, sudden chest pain or breathlessness, coughing up blood, sudden severe headache, weakness or numbness on one side of the body, trouble speaking or seeing, yellowing of the skin or eyes, very heavy or prolonged bleeding, or thoughts of self-harm.
Pregnancy and Lactation
Dienogest must not be used during pregnancy; stop taking it and see your doctor if you become pregnant. It is not recommended during breastfeeding.
Precautions and Warnings
Tell your doctor if you have a history of depression, high blood pressure, diabetes, liver disease, a previous ectopic pregnancy, or risk factors for blood clots. Long use may slightly reduce bone density, especially in teenagers, so your doctor will weigh this up. Your periods may change or stop during treatment. Have regular check-ups while taking it.
Overdose
Taking too many tablets may cause nausea, vomiting and vaginal bleeding. Serious harm is unlikely, but contact a doctor for advice, especially if a child has swallowed tablets.
Therapeutic Class
Hormone, progestogen (progestin), used for endometriosis and in hormonal contraception.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.