Treatment of heavy menstrual bleeding with a new combination of estradiol valerate and dienogest

Luís Bahamondes, Ilza Monteiro, Arlete Fernandes
In: Open Access Journal of Contraception · 2010 · pp. 119 · doi:10.2147/oajc.s7943 · W2086367824
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Two randomized trials show an estradiol valerate-dienogest combined oral contraceptive is an effective treatment for women with heavy menstrual bleeding, reducing menstrual blood loss.

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This paper reviews evidence on using a new combined oral contraceptive containing estradiol valerate and dienogest in a dynamic 26-day four-phasic regimen to treat heavy menstrual bleeding (menorrhagia). It summarizes results from two large randomized controlled trials reporting that the estradiol valerate–dienogest combination provides effective reduction of menstrual blood loss, with good cycle control and favorable bleeding patterns compared with other combined OCs or placebo. A key limitation noted is that further studies are needed to confirm these data. Relevance to endometriosis: dienogest is a progestin used in endometriosis-related medical therapy, and this paper focuses on heavy menstrual bleeding treatment with estradiol valerate–dienogest rather than on endometriosis itself.

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Abstract

Abstract: The first combined oral contraceptive (OC) was launched in the US 50 years ago and was followed by another formulation introduced in Germany one year later. The most common estrogen component in current formulations is ethinylestradiol; however, many concerns have been raised with respect to this estrogen. Although the natural estrogen produced by the ovary, 17-beta estradiol, is the most potent of the estrogens, it is poorly absorbed orally, and previous attempts to use it in combined OCs have been unsuccessful due to the occurrence of irregular bleeding. Recently, a new combined OC was developed containing a natural estrogen, estradiol valerate, and a new progestin, dienogest, in a dynamic 26-day, four-phasic (estrogen stepdown and progestin stepup) scheme of administration. In clinical trials, its contraceptive performance was excellent, with good cycle control and bleeding patterns compared with other combined OCs or with placebo. This review focuses predominantly on the use of an estradiol valerate-dienogest combined OC for the treatment of heavy menstrual bleeding. The findings of two large, randomized, controlled trials have shown that this combined OC constitutes an effective treatment for women with heavy menstrual bleeding, representing a new therapeutic option to reduce menstrual blood loss. Further studies are necessary to confirm these data. Keywords: dienogest, estradiol valerate, heavy menstrual bleeding, menorrhagia, contraception
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Abstract

The first combined oral contraceptive (OC) was launched in the US 50 years ago and was followed by another formulation introduced in Germany one year later. The most common estrogen component in current formulations is ethinylestradiol; however, many concerns have been raised with respect to this estrogen. Although the natural estrogen produced by the ovary, 17-beta estradiol, is the most potent of the estrogens, it is poorly absorbed orally, and previous attempts to use it in combined OCs have been unsuccessful due to the occurrence of irregular bleeding. Recently, a new combined OC was developed containing a natural estrogen, estradiol valerate, and a new progestin, dienogest, in a dynamic 26-day, four-phasic (estrogen stepdown and progestin stepup) scheme of administration. In clinical trials, its contraceptive performance was excellent, with good cycle control and bleeding patterns compared with other combined OCs or with placebo. This review focuses predominantly on the use of an estradiol valerate-dienogest combined OC for the treatment of heavy menstrual bleeding. The findings of two large, randomized, controlled trials have shown that this combined OC constitutes an effective treatment for women with heavy menstrual bleeding, representing a new therapeutic option to reduce menstrual blood loss. Further studies are necessary to confirm these data.

Keywords

dienogest, estradiol valerate, heavy menstrual bleeding, menorrhagia, contraception © 2010 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms and incorporate the Creative Commons Attribution - Non Commercial (unported, 3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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