{"paper_id":"866f08f6-9f09-4710-bdd6-03571a883630","body_text":"~ 57 ~ \n \nISSN Print: 2664-8334 \nISSN Online: 2664-8342 \nImpact Factor (RJIF): 6.15 \nIJOG 2025; 7(1): 57-62 \nwww.obstetricsjournals.com \nReceived: 12-07-2025  \nAccepted: 18-08-2025 \n \nDr Kumari Mamta  \nObstetrician and \nGynaecologist, Kurji Hospital, \nPatna, Bihar, India\n \n \nDr. Snehal Anil Trimbake  \nMBBS, DGO (Cosmetology & \nGynecology), Trimbake \nHospital & Maternity, Karad, \nSatara, Maharashtra, India\n \n \nDr. Pravat Chandra Nayak  \nObstetrician and Gynaecologist \n(OB/GYN), Bhadrak, Odisha, \nIndia\n \n \nDr. Naini Tandon  \nObstetrician and Gynaecologist \n(OB/GYN), Lucknow, Uttar \nPradesh, India\n \n \nDr. Goutam Dutta Sarma  \nGynaecologist and Obstetrics \nSpecialist, Manipal Hospitals, \nBroadway, Kolkata, West \nBengal, India\n \n \nDr. Richa Chhabrani \nObstetrician and Gynaecologist \nSpecialist, Shri Radhakrishna \nHospital and Research \nInstitute, Nagpur, \nMaharashtra, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Kumari Mamta  \nObstetrician and \nGynaecologist, Kurji Hospital, \nPatna, Bihar, India \n \nEvaluation of the role of dydrogesterone in the real-\nworld setting in women with recurrent pregnancy loss, \nendometriosis \n \nKumari Mamta, Snehal Anil Trimbake, Pravat Chandra Nayak, Naini \nTandon, Goutam Dutta Sarma and Richa Chhabrani\n \n \nDOI: https://www.doi.org/10.33545/26648334.2025.v7.i1a.43  \n \nAbstract \nBackground: Dydrogesterone has been in use for over 60 years and has demon strated a favorable \nefficacy and safety balance across multiple obstetric and gynecologica l indications. Despite the \nextensive literature on dydrogesterone, studies on dydrogesterone utilizati on patterns are largely \nlacking in Indian patients \nAim: To assess the dydrogesterone dosing patterns in Indian women with recurrent pregnancy loss, \ninfertility due to luteal phase deficit, and gynecological conditions su ch as endometriosis in the real-\nworld setting. \nMethodology: A rigorous literature search was performed by an information specialist c linician for \nrelevant publications using databases. 63 Gynecologists from across India wit h at least 10 years of \nexperience were invited to participate in the web-based survey.  \nResults: 65% experts opined that a 12-week treatment with dydrogesterone is optimal for achieving \npositive outcomes in women with recurrent pregnancy loss. Treatment till term was preferred by \n28.57% of experts, reflecting a practice of continuing dydro gesterone SR therapy throughout \npregnancy. In patients at risk of first-trimester abortion, the most preferre d regimen (46.03%) was a 40 \nmg oral loading dose of dydrogesterone followed by 10 mg orall y three times daily until 12 completed \nweeks of gestation or 1 week after bleeding stops, The 40 mg dydr ogesterone dose followed by 20 mg \nSR daily was preferred by 36.51% respondents. In endometriosis, the m ost preferred dosing regimen \n(39.68%) was 10 mg of dydrogesterone twice daily for six months, startin g from the 5th day of the \nmenstrual cycle.  The 20 mg SR per day dose was preferred by 66.67% for treating pe lvic pain in \nwomen with endometriosis. The 10 mg twice-per-day dose (53.9 7%) was widely regarded as effective \nfor managing dysmenorrheal. The 20 mg SR regimen was the prefe rred dose by 61.90% of respondents \nin young women undergoing Progestin-Primed Ovarian Stimulation with dydrogesterone to suppress \nLH pulse surge under stimulation in an oocyte donor programme. 90.48% of respondents reported \nobserving a dose-dependent improvement in outcomes in patients undergoing ART. \nConclusion: Oral dydrogesterone carries the least risk of miscarriage while treating threatened abortion \nand recurrent pregnancy loss as compared to other progesterone. Dyd rogesterone is now emerging as a \npreferred progesterone in both obstetric and gynecological disorders in the real-world setting in India. \n \nKeywords: Dydrogesterone, recurrent abortion, endometriosis, pregnancy, ART \n \nIntroduction \nDydrogesterone has been in use for over 60 years and has dem onstrated a favorable efficacy \nand safety balance across multiple obstetric and gynecological indications  [1, 2] . Amongst \ndiverse progesterone-deficient obstetrical conditions such as recurrent pregnancy  loss and \ninfertility due to luteal phase deficit, Dydrogesterone has been proven to be effec tive and \nsafe. In fact, dydrogesterone is the most commonly prescribed progesterone during \npregnancy [3, 4, 5] . Dydrogesterone is also useful in the management of diverse gyneco logical \nconditions such as endometriosis, dysfunctional uterine bleeding, secondary amenorrhea, \nirregular menstrual cycles, and premenstrual syndrome [3, 4, 5].  \nDydrogesterone is a stereoisomer of progesterone that is pharmacologically  close to \nendogenous progesterone [6, 7, 8, 9]. It has high oral bioavailability and is more specific or more \nselective for progesterone receptors than micronized progesterone. Therefore, a  10-20 times \nlower oral dose than micronized progesterone is required to exert the pharmacological action  \nInternational Journal of Obstetrics and Gynaecology  2025; 7(1): 57-62 \n \n\n\n \n~ 58 ~ \nInternational Journal of Obstetrics and Gynaecology https://www.obstetricsjournals.com \n \n[6, 7, 8] . Several studies have shown that dydrogesterone \ndirectly stimulates progesterone receptors without affecting \nprogesterone levels. Dydrogesterone also binds 50% more to \nthe receptor than progesterone itself [7].  \nOral dydrogesterone is associated with the lowest risk of \nmiscarriage in women with threatened abortion and \nrecurrent pregnancy loss as compared to other progesterones  \n[3, 4, 5] . Oral micronized progesterone has limited use in \nclinical practice because it undergoes extensive first-pass \nmetabolism and has a relatively low bioavailability  [9]. The \ndosing of dydrogesterone varies depending upon the \nindication (Table 1). \n \nTable 1: Doses of dydrogesterone in some obstetrics and gynecology indications \n \nIndication Dose of dydrogesterone \nEndometriosis 1 to 3 tablets of Dydrogesterone (10 mg) from the 5th to the 25th day of the cycle or for the entire cycle. Dosages of 10 \nmg several times a day should be spread over the day. Treatment should start at the highest dose \nDysmenorrhoea 1 to 2 tablets of Dydrogesterone (10 mg) to be given from the 5th to the 25th day of the cycle. \nInfertility as a result \nof corpus luteum \ninsufficiency \n1 tablet of Dydrogesterone (10 mg) every day from the 14th to the 25th day of the cycle. \nTreatment should be continued for at least 6 consecutive cycles. \nIt is advisable to continue this treatment for the first months of any pregnancy at dosages as indicated for habitual \nabortion. \nThreatened abortion \n4 tablets of Dydrogesterone at once, followed by 1 tablet of Dydrogesterone mg every 8 hours. Dosages of 10 mg \nseveral times a day should be spread over the day. It is recommended that treatment should start at the highest dose. If \nthe symptoms persist or recur during the treatment, the dose should be increased by 1 tablet of Dydrogesterone every 8 \nhours. The effective dose should be maintained for one week after symptoms have ceased; it can then be gradually \nreduced. If the symptoms recur, the treatment should be resumed immediately at the effective dose. \nHabitual abortion \n1 tablet of Dydrogesterone 10 mg per day up to the 20th week of pregnancy; the dose can then be gradually reduced. \nTreatment should preferably be started before conception. If the symptoms of threatened abortion occur during \ntreatment, treatment should be continued as described for that indication. \n \nDespite the extensive literature on dydrogesterone, studies \non dydrogesterone utilization patterns are largely lacking in \nIndian patients. Therefore, the present surveillance study \nwas conducted with the objective of assessing the \ndydrogesterone dosing patterns in Indian women with \nconditions such as dysfunctional uterine bleeding, \nendometriosis, recurrent pregnancy loss, and assisted \nreproductive technology (ART) in the real-world setting.  \n \nAim  \nTo assess the dydrogesterone dosing patterns in Indian \nwomen with recurrent pregnancy loss, infertility due to \nluteal phase deficit, and gynecological conditions such as \nendometriosis in the real-world setting  \n \nMethodology  \nThe expert opinions were elicited according to an a priori \nprotocol, with the following steps: (1) Perform a systematic \nliterature review, (2) Invite the expert gynecologists to \nanswer a web-based questionnaire about the use of \ndydrogesterone, and (3) Analyze the opinions of the expert \ngynecologists and develop the report and manuscript for \npublication based on survey results. \n \nLiterature Review for Framing the questionnaire for the \nweb-based survey  \nA rigorous literature search was performed by an \ninformation specialist clinician for relevant publications \nusing databases in English, including PubMed, Web of \nScience, Scopus, and Google Scholar. The keywords \nincluded dydrogesterone, luteal phase support, threatened \nabortion recurrent abortion, assisted reproductive \ntechnology, and hormone replacement therapy. A structured \nquestionnaire was prepared after the literature review  \n \nSelection of experts \n63 Gynecologists from across India with at least 10 years of \nexperience were invited to participate in the web-based \nsurvey. Each gynecologist shared the experience of the past \n10 patients they had treated with dydrogesterone. \nCollection of data and analysis  \nThe web-based survey forms were retrieved, and data was \ncollated. Analysis of the cumulative data was used to \nprepare the report and subsequent manuscript for \npublication, the experts ratified the findings of the report \nand approved the final manuscript.  \n \nRecurrent pregnancy loss \nBackground  \nAccording to the European Society of Human Reproduction \nand Embryology (ESHRE) guidelines, recurrent pregnancy \nloss (RPL) is defined as the loss of two or more pregnancies. \nThe American Society of Reproductive Medicine (ASRM) \ndefines RPL as the loss of two or more clinical pregnancies. \nNeither of these definitions requires the pregnancies to be \nconsecutive, although most women with RPL do experience \na consecutive loss. About 5% of women experience RPL. \nApproximately 23 million pregnancy losses occur globally \nevery year, which is estimated to account for 15-20% of all \nclinically recognized pregnancies. Progesterone plays a \ncritical role in the maintenance of pregnancy, and \nprogesterone supplementation is useful in reducing the risk \nof pregnancy loss  [10]. Several mechanisms may explain the \npositive effect of dydrogesterone treatment in RPL patients. \nOne of the most important explanations is the \nimmunomodulatory effect  [11] . Dydrogesterone significantly \ndown-regulated the secretion of the Th1 cytokines IFN- α \nand TNF- γ and the Th17 cytokine IL -17A and IL-23  [12] . \nCompared to vaginal progesterone, oral dydrogesterone has \nbeen proven to be superior in preventing per vaginal \nbleeding and prolonging the viability of the pregnancy until \nthe end of the second trimester  [13] . Several studies have \nfound positive effects of dydrogesterone treatment in RPL \npatients. A randomized controlled trial conducted by  [14]  \nreported that women who were treated with dydrogesterone \nhad reduced chances of spontaneous abortion as compared \nto women in the control group, who received no additional \ntreatment (13.4% vs. 29%, respectively; p-value ≤ 0.05 ) [14]. \nDydrogesterone 40 mg stat dose followed by 10 mg twice a \nday for one week provides corpus luteal support and has\n\n \n~ 59 ~ \nInternational Journal of Obstetrics and Gynaecology https://www.obstetricsjournals.com \n \nbeen shown to reduce the incidence of pregnancy loss in \nthreatened abortion during the first trimester in women \nwithout a history of recurrent abortion [15]. \n \nExpert opinion on the preferred dosing regimen of \ndydrogesterone in patients with recurrent pregnancy \nloss to improve outcomes \nIn order to prevent recurrent pregnancy loss, 50.79% of \nexperts opined that the most preferred dosing regimen was a \nregular dose of 10 mg twice daily. The loading dose of 40 \nmg followed by 10 mg as a maintenance dose was preferred \nby 31.75% of experts. The lower-loading dose options (20 \nmg SR and 30 mg SR followed by 10 mg) were the least \npreferred dosing regimen (17.46%). \n \nExpert opinion on the duration of treatment with \ndydrogesterone for positive outcomes in women with \nrecurrent pregnancy loss \nThe majority of respondents (65.08%) indicated that a 12-\nweek treatment duration is optimal for achieving positive \noutcomes in women with recurrent pregnancy loss. \nTreatment till term was preferred by 28.57% of experts, \nreflecting a practice of continuing dydrogesterone SR \ntherapy throughout pregnancy in selected cases where \nongoing progesterone support is deemed necessary. Shorter \ndurations, such as 8 weeks and 10 weeks, were rarely \nchosen (both 3.17%), indicating that clinicians do not \nwidely prefer stopping treatment before the first trimester is \ncompleted. \n \nExpert opinion regarding the dosing dydrogesterone \nregimen they follow in patients at risk of abortion in the \nfirst trimester \nIn patients at risk of first-trimester abortion, the most \npreferred regimen (46.03%) was a 40 mg oral loading dose \nfollowed by 10 mg orally three times daily until 12 \ncompleted weeks of gestation or 1 week after bleeding \nstops, The 40 mg dose followed by 20 mg SR daily was \npreferred by 36.51% respondents indicating its growing \nacceptance among clinicians for convenience and sustained \ntherapeutic effect. The 30 mg SR daily dose was preferred \nby 15.87% of respondents, while the 40 mg oral dose three \ntimes daily was accepted by just 1.59% of respondents. \n \nEndometriosis  \nBackground: Endometriosis is characterized by chronic -\npelvic pain, dysmenorrhea, infe rtility associated with \nreduced ovarian reserve, diminished antral follicle count,\nand anti -Müllerian hormone levels. Endometriosis has a \nsignificant adverse impact on the health -related quality of \nlife (HR -QoL) and psychological well -being of affected \nwomen [11]. Endometriosis is an estrogen -dependent \ncondition [11]. \nDydrogesterone can induce atrophy in ectopic endometrial \ntissue and inhibit the formation of de novo endometriotic \ntissue while leaving the endometrium unaffected. \nDydrogesterone relieves. the symptoms of endometriosis. \nDydrogesterone can be used in women who are attempting \nto become pregnant\n [11]. \nThere are two regimens of dydrogesterone used for treating \nendometriosis: a prolonged cyclical regimen (between the \n5th and the 25th days of the menstrual cycle) and a \ncontinuous regimen, with doses ranging from 10 to 30 mg \ndaily Although dydrogesterone has been available for \nseveral years, it is unknown whether these regimens are \ncomparable in terms of reducing the severity of \nendometriosis-related pelvic pain and improving associated \nHR-QoL parameters\n [11]. A prolonged cyclical regimen of \ndydrogesterone 20 or 30 mg daily taken between the 5th a nd \nthe 25th days of the menstrual cycle and a continuous \nregimen of dydrogesterone 20 or 30 mg daily were effective \nand achieved a comparable reduction in chronic pelvic pain. \nA greater reduction of chronic pelvic pain in patients taking \ndydrogesterone 30 mg daily [11]. \n \nExpert opinion regarding  the dosing regimen of \ndydrogesterone in women with mild endometriosis \nIn endometriosis, the most preferred dosing regimen \n(39.68%) was 10 mg of dydrogesterone twice daily for six \nmonths, starting from the 5th day of the menstrual cycle, \nindicating that a longer treatment duration was favored for \nmanaging mild endometriosis effectively. Shorter-duration \nregimens such as 10 mg twice daily for three months \n(30.16%) and 20 mg SR for three months (30.16%) were \nequally preferred by a significant number of experts.  \n \nExpert opinion on the dydrogesterone regimen they \npreferred in women with endometriosis \nThe cyclical regimen was the most preferred regimen \n(53.97%), where dydrogesterone was administered from the \n5th to the 25th day of the menstrual cycle. The continuous \nregimen was preferred by 46.03% respondents with daily \ndoses of 10 mg to 30 mg SR. (Figure 1) \n \n \nA. A cyclical regimen, from the 5th to the 25th days of the menstrual cycle  \nB. A continuous one, with daily doses ranging from 10mg to 30mg SR \n \nFig 1: Dydrogesterone regimen preferred in women with endometriosis \n\n\n \n~ 60 ~ \nInternational Journal of Obstetrics and Gynaecology https://www.obstetricsjournals.com \n \nExpert opinion on the dose of dydrogesterone that \nsignificantly reduced pelvic pain in women with \nendometriosis \nThe 20 mg SR per day dose was preferred by 66.67% for \ntreating pelvic pain in women with endometriosis. This \nsuggests that the majority of clinicians find this dose to \nprovide an optimal balance between efficacy and safety. The \n30 mg SR per day dose was preferred by 30.16% of \nrespondents as the second most preferred option to be used \nin patients who may require a higher dosage for more severe \npain symptoms. The 40 mg per day dose was rarely used \n(3.17%) possibly due to concerns about side effects or lack \nof additional benefit over lower doses. \n \nExpert opinion on the dose of dydrogesterone useful in \nwomen with dysmenorrhea  \nThe 10 mg twice-per-day dose (53.97%) was widely \nregarded as effective for managing dysmenorrhea in clinical \npractice. The 20 mg SR per day dose was also highly \npreferred (46.03%), demonstrating its utility as a sustained-\nrelease option that simplifies dosing while providing \ncomparable efficacy. (Figure 2)  \n \n \nA. 10 mg per day twice per day for 21 days from the 5th to 25th day of each menstrual cycle. \nB. 20 mg SR per day for 21 days from the 5th to 25th day of each menstrual cycle. \n \nFig 2: Dydrogesterone dose in women with dysmenorrhea \n \nLuteal phase support  \nBackground  \nThe luteal phase is defined as the period between ovulation \nand the onset of menses following luteolysis. During the \npreovulatory peak of gonadotropins, luteinizing hormone \n(LH) allows the transformation of granulosa cells into large \nluteal cells, which ensures the production of progesterone. \nDuring the luteal phase, LH allows the maintenance of \noptimal secretion of progesterone. The subsequent secretory \ntransformation of the endometrium opens a short window of \nimplantation. The progesterone secreted by the corpus \nluteum allows maintenance of pregnancy during part of the \nfirst trimester. It has an immunomodulatory effect and \nregulates sub endometrial blood flow, and helps to maintain \npregnancy by preventing embryo rejection. Dydrogesterone \nefficacy and safety has been evaluated in several clinical \nstudies, and it has been demonstrated to be non-inferior to \nmicronized vaginal progesterone (MVP). \nOral dydrogesterone may potentially become a preferred \ndrug for luteal phase support in millions of women \nundergoing In vitro  fertilization (IVF)  [16] . Oral \ndydrogesterone 10 mg three times daily may replace \nmicronized vaginal progesterone as the standard of care for \nluteal phase support in IVF, owing to the oral route being \nmore patient-friendly than intravaginal administration, as \nwell as it being a well-tolerated and efficacious treatment  \n[17]. \nIn a meta-analysis, with daily administration of oral \ndydrogesterone (20 to 40 mg) versus MVP capsules (600 to \n800 mg) or gel (90 mg), the pregnancy or live birth rates in \nwomen undergoing fresh cycle IV were compared. A higher \npregnancy rate and live birth rate were observed in women \nreceiving oral dydrogesterone versus MVP for luteal phase \nsupport [9]. \n \nExpert opinion regarding the dose of dydrogesterone \ngiven in young women undergoing Progestin-Primed \nOvarian Stimulation with dydrogesterone to suppress \nLH pulse surge under stimulation in an oocyte donor \nprogramme. \nThe 20 mg SR regimen was the preferred dose by 61.90% of \nrespondents, indicating that clinicians favor the sustained-\nrelease option for its convenience, consistent efficacy, and \nability to maintain steady hormone levels throughout the \nstimulation process. The 10 mg every 8 hours regimen \n(38.10%) is also a widely used alternative, reflecting its \nclinical utility in situations where immediate and consistent \nhormone suppression is needed, albeit with a more frequent \ndosing schedule. \n \nExpert opinion regarding preferred dose of \ndydrogesterone for luteal phase support in women \nundergoing ART \nThe 10 mg bid dose (44.44%) was the most preferred \nregimen, indicating its widespread use and perceived \nefficacy for luteal phase support in women undergoing \nAssisted Reproductive Technology (ART). The 20 mg SR \ndose was preferred by 38.1% of experts, reflecting the \nadvantages of convenience and consistent hormone levels. \nThe 30 mg SR dose was preferred by just 17.46% of \nexperts.  \n \nExpert opinion regarding dose dependent improvement \nin outcomes in patients undergoing ART \n90.48% of respondents reported observing a dose-dependent \nimprovement in outcomes in patients undergoing ART, \nindicating a strong consensus that adjusting the dose of \ndydrogesterone positively influences treatment success \nrates. Only 9.52% opined that they did not observe dose-\ndependent improvements, which might be due to either \n\n\n \n~ 61 ~ \nInternational Journal of Obstetrics and Gynaecology https://www.obstetricsjournals.com \n \nclinical variations, patient-specific factors, or alternative \ntreatment approaches. \n \nExpert opinion on a dose-dependent change in \ntolerability profile and adherence to treatment with \ndydrogesterone in their patients undergoing art \n69.84% of clinicians observed a dose-dependent change in \ntolerability and adherence, indicating that dosage \nadjustments directly impact patient experience and \ncompliance with dydrogesterone treatment during ART. \n \nExpert opinion on dose-dependent risk of congenital \nanomalies in women treated with dydrogesterone in the \nfirst trimester for reducing the risk of abortion \nThe majority of respondents (74.60%) opined that there is \nno dose-dependent risk of congenital anomalies associated \nwith the use of dydrogesterone in the first trimester to \nreduce the risk of abortion. This reflects confidence in the \nsafety profile of dydrogesterone when used appropriately \nduring early pregnancy. \n \nConclusion  \nDydrogesterone has been in use for over 60 years and has \ndemonstrated a favorable efficacy, safety, and tolerability \nprofile across multiple obstetric and gynecological \nindications. Dydrogesterone SR is the most commonly \nprescribed progesterone during pregnancy. Oral \ndydrogesterone carries the least risk of miscarriage while \ntreating threatened abortion and recurrent pregnancy loss as \ncompared to other progesterone. Various guidelines, such as \nFOGSI, the American College of Obstetricians and \nGynecologists (ACOG) guidance, and ESHRE guidelines, \nhave discussed the studies of dydrogesterone in \nendometriosis and recurrent pregnancy loss.  \nIn order to prevent recurrent pregnancy loss, the most \npreferred dosing regimen (50.79%) among respondents was \na regular dose of 10 mg twice daily. The loading dose of 40 \nmg followed by 10 mg as a maintenance dose is the second \nmost chosen option (31.75%). The majority of respondents \n(65.08%) indicated that a 12-week treatment duration is \noptimal for achieving positive outcomes in women with \nrecurrent pregnancy loss. In patients at risk of first-trimester \nabortion, the most preferred regimen (46.03%) was a 40 mg \noral loading dose followed by 10 mg orally three times daily \nuntil 12 completed weeks of gestation or 1 week after \nbleeding stops. In endometriosis, the most preferred dosing \nregimen (39.68%) was 10 mg of dydrogesterone twice daily \nfor six months, starting from the 5th day of the menstrual \ncycle, indicating that a longer treatment duration was \nfavored for managing mild endometriosis effectively. \nShorter-duration regimens, such as 10 mg twice daily for \nthree months (30.16%) and 20 mg SR for three months \n(30.16%), were equally preferred by a significant number of \nexperts. The 20 mg SR per day dose was preferred by \n66.67% for treating pelvic pain in women with \nendometriosis. The 10 mg twice-a-day dose of \ndydrogesterone was preferred by 44.44% of experts, \nindicating its widespread use and perceived efficacy for \nluteal phase support in women undergoing ART. The 20 mg \nSR dose was preferred by 38.1% experts owing to the \nadvantages of convenience and consistent hormone levels. \nDydrogesterone is now emerging as a preferred \nprogesterone in both obstetric and gynecological disorders \nin the real-world setting in India. \nConflict of Interest: All authors have no conflict of interest \nto declare. \n \nFunding: The study was supported by Aristo \nPharmaceuticals Private Limited Mumbai. \n \nAcknowledgment: None. \n \nReferences \n1. Queisser-Luft A. Dydrogesterone use during \npregnancy: overview of birth defects reported since \n1977. Early Hum Dev. 2009;85(6):375-377. \ndoi:10.1016/j.earlhumdev.2008.12.016. \n2. 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Omar MH, Mashita MK, Lim PS, Jamil MA. \nDydrogesterone in threatened abortion: pregnancy \noutcome. J Steroid Biochem Mol Biol. 2005;97(5):421-\n425. \n16. Patki A. Role of dydrogesterone for luteal phase \nsupport in assisted reproduction. Reprod Sci. \n2024;31(1):17-29. \n17. Tournaye H, Sukhikh GT, Kahler E, Griesinger G. A \nphase III randomized controlled trial comparing the \nefficacy, safety and tolerability of oral dydrogesterone \nversus micronized vaginal progesterone for luteal \nsupport in in vitro  fertilization. Hum Reprod. \n2017;32(5):1019-1027.","source_license":"CC0","license_restricted":false}