Duphaston: what is this medicine prescribed for? Side effects, indications for prescribing Duphaston

Indications for use

The drug Duphaston is prescribed to compensate for the lack of progesterone in the treatment of:

Endometriosis
Threats of premature termination of pregnancy (with progesterone deficiency)
Infertility caused by luteal phase deficiency
Dysmenorrhea and menstrual irregularities
PMS
Secondary amenorrhea (treatment in combination with estrogen-containing drugs)
Uterine bleeding caused by hormonal disorders.

Duphaston hormonal tablets are used for replacement therapy to stop the proliferative effect of the hormone estrogen on the endometrial layer of the uterus during menopause or with an intact uterus. This is discussed in more detail in the article:

Duphaston during pregnancy

A frequent cause of infertility, miscarriages and threats of termination of pregnancy is a lack of hormones in the female body. For this reason, doctors often prescribe Duphaston in such situations.

The composition and principle of action of the drug is such that it restores the lack of hormones with its structure. It is necessary in preparation for pregnancy.

The active component of the drug, entering the body, completely replaces the female hormone. It is identical in molecular structure to progesterone.

The female hormone is produced by the work of the ovaries and by estrogen, which makes up the lining of the uterus. In the first days of the cycle, there is less progesterone in the blood than estrogen, which causes the cells lining the uterus to grow.

During ovulation, the egg leaves the ovary and in its place a corpus luteum is formed, which produces the female sex hormone progesterone. When the amount of this hormone changes under the influence of certain factors, the uterine mucosa becomes porous and loose.

Medicinal properties

Dydrogesterone contained in Duphaston is a synthetic analogue of the natural hormone progesterone. Therefore, when asked whether Duphaston is hormonal or not, we can say with confidence that it belongs to hormonal drugs.

Under the influence of a synthetic analogue of progesterone, no significant changes are observed in the process of thermogenesis, therefore, when measuring basal temperature, its values are reliable and will indicate the onset of ovulation. The hormonal drug does not have a pronounced effect on metabolic processes and liver activity. Dydrogesterone shows similarities to natural progesterone. But, along with this, it does not cause the development of the same side reactions that are characteristic of other synthetically produced progesterones. The description of the drug indicates that during menopause, the hormonal drug provides a positive effect of estrogen hormones on the blood lipid profile.

How Duphaston works

The action of Duphaston consists of a selective effect on the endometrial layer of the uterus, thereby reducing the likelihood of hyperplasia or carcinogenesis caused by excessive estrogen synthesis. At the same time, the hormonal drug does not have a contraceptive effect, since it does not in any way affect ovulatory function. Menstrual flow continues as usual. It is worth noting that pregnancy may occur while taking hormonal pills. With the use of the drug, it is possible to maintain the normal development and growth of the emerging embryo. How does Duphaston work? It has a specific effect on receptors located on top of the uterine mucosa.

Dydrogesterone helps to reduce the excitability of the myometrium itself, which significantly reduces uterine contraction.

By reducing the influence of natural estrogens on the functioning of the internal genital organs, infertility, PMS, acute manifestations of menopause, and recurrent miscarriage are successfully treated. This reduces the likelihood of fetal death in the early stages of pregnancy.

The annotation contains information that the absorption of dydrogesterone by the mucous membranes of the gastrointestinal tract occurs quite quickly. After 2 hours, the highest level of synthetic progesterone in the blood is observed. The connection with albumin reaches 97%. A significant part of the metabolites is excreted by the renal system. A day after using the tablets, 85% of the main component is eliminated, and it is finally completed after 72 hours. The presence of metabolites, which are represented by glucuronic acid conjugates, is observed in the urine.

Pharmacological action and pharmacokinetics

Dydrogesterone is a synthetic analogue of gesterone, a natural hormone responsible for the normal course of the menstrual cycle, conception and fetal development. Despite the similar composition, the active substance of Duphaston is not a derivative of testosterone, but only an artificially created structural analogue. This eliminates the list of negative effects inherent in progesterone: anabolic (tissue growth in the body), sedative, anxiolytic (tranquilizer effect), antipsychotic and some other types.

The principle of operation of dydrogesterone is based on a selective effect on the endometrium, which reduces the risk of hyperplasia of the uterine mucosa (pathological tissue proliferation) and carcinogenesis (the initial stage of tumor formation). Such conditions develop when there is excess estrogen in the blood. Dydrogesterone controls the activity of the female hormone, which prevents its trophic effects.

Another advantage of the drug is the absence of a detrimental effect on the blood clotting process, which strongly depends on the amount of estrogen, and does not affect the processing of substances in the liver.

Dydrogesterone does not disrupt the menstrual cycle in any way, does not affect ovulation and therefore is not an oral contraceptive, unlike many hormonal drugs.

It is absorbed very quickly in the stomach and intestines, the maximum amount in the blood is detected within 2 hours after the start of administration. 97% bound to plasma proteins.

Bioavailability indicator - 28%.

Completely recyclable. When removed from the body, no traces of unprocessed substance were found. Inactive metabolites are present in the urine (about 60–70%), indicating their elimination by the kidneys.

Mode of application

Price from 450 to 950 rubles

Hormones are taken orally. The tablet should be taken with a sufficient volume of liquid so that it can begin to act faster. Use of hormonal tablets for severe signs of endometriosis: a dose of the drug of 10 mg twice or three times a day from 5 days. MC for 25 days. MC without interruption.

Take synthetic progesterone in the treatment of infertility associated with luteal insufficiency, according to the following scheme: the medicine in a daily dose of 10 mg is used from 5 days. MC for 25 days. MC. Duphaston therapy is carried out for six months; it is necessary to continue this treatment during pregnancy (for the first months, tablets are taken as for a regular abortion).

PMS (premenstrual syndrome): a dosage of 20 mg per day is prescribed (two tablets contain 10 mg). Women with premenstrual syndrome use progesterone in the morning and evening from 11 a.m. MC for 25 days. MC. The duration of treatment for premenstrual syndrome is determined individually and is determined by the attending physician. After the characteristic symptoms disappear, treatment for PMS is usually not prescribed.

Duphaston should be used for dysmenorrhea as follows: drink one tablet twice a day, according to the instructions this should happen from 5 days onwards. MC for 25 days. MC. To enhance the effect of hormonal therapy, the drug is prescribed in injections from domestic manufacturers.

In case of irregular painful periods, progesterone is used as follows: the medicine in a dosage of 10 mg should be taken twice a day from the 11th day. MC for 25 days. MC. This amount of hormones will be quite enough to eliminate painful periods and correct the cycle.

The method of use for amenorrhea is slightly different from the standard one. First, the attending physician prescribes an estrogen-containing medicine; its use is carried out once per day from 1 day. MC for 25 days. MC. After this, it is recommended to take a hormonal medication with the active ingredient progesterone. In accordance with the instructions, you need to take a tablet with a dosage of 10 mg twice a day from 11 days. MC for 25 days. MC. In some cases, progesterone injections are given into the muscle instead of Duphaston therapy. Whether to use an injection drug or not is determined only by a gynecologist.

Instructions for use for dysfunctional vaginal bleeding: to stop bleeding you will need to drink 2 tablets. per day over the next 5-7 days, after how many days you can evaluate the result of treatment with hormonal drugs, check with your gynecologist. To prevent blood loss, it is recommended to start taking 1 tablet. twice a day in the middle of the cycle - from 11 days. MC for 25 days. MC.

Progesterone can be used for HGS. What does the drug do? Creates an artificial hormonal background, due to which the symptoms of postmenopause and menopause are completely relieved. Taking drugs based on dydrogesterone is carried out according to the following scheme: 1 tablet. once per day for 14 days. at MC at 28 days. The cyclic regimen when taking estrogen-containing drugs is 10 mg per day for 12-14 days. use of estrogens.

If a biopsy or ultrasound reveals pregesterone deficiency, you will need to add another 10 mg to the doses used. It is preferable for a woman to use a daily dosage of 20 mg.

When is therapy needed?

Insufficient production of progesterone leads to serious changes in a woman’s body. Basically, the functions of the reproductive system are disrupted: disruptions in the menstrual cycle appear, endometriosis develops. Possible consequences are infertility and miscarriages.

Endometriosis

In the first case, the cause is a decrease in the activity of the corpus luteum and a decrease in the synthesis of progesterone. In the second case, there is no opportunity for the development of a fertilized egg. The structure of the medicinal substance dydrogesterone resembles the natural hormone progesterone and has a similar effect on the body.

What is Duphaston prescribed for:

absence of menstruation;
female infertility;
endometriosis;
premenstrual syndrome accompanied by pain;
scanty, rare, irregular menstruation;
miscarriage due to decreased progesterone production;
menopause and menopause;
abnormal bleeding from the uterus.

This drug treats amenorrhea and dysmenorrhea. The main caution is excessive sensitivity to the main and auxiliary components of the drug Duphaston.

It is not recommended to take the drug for those who have lactose intolerance or malabsorption syndrome (malabsorption in the gastrointestinal tract). They also try not to use the product in cases where women had rashes and itchy skin during a previous pregnancy.

At the beginning of treatment with Duphaston, you should carefully read the instructions or annotation attached to the package. Manufacturers of the product must list contraindications and warn about possible side effects.

Previously, the instructions for use mentioned a contraindication such as renal failure. Currently, the negative effect of the active component of the drug on the functioning of the adrenal glands and kidneys is considered unproven.

Today the drug is often prescribed for headaches. PMS is characterized by many unpleasant manifestations. Headache during menstruation occurs for many reasons, not the least of which is hormonal imbalance.

Fluctuations in the level of progesterone and estrogen occur constantly, but changes are especially noticeable before the onset of menstruation and during pregnancy.

If the appearance of migraine is associated with PMS, then non-steroidal anti-inflammatory drugs (NSAIDs) are most often taken: Spazmalgon, Tempalgin, Nurofen. Baralgin injections quickly relieve pain and relieve the tension inherent in PMS. The disadvantage of this treatment is the negative impact on the gastrointestinal tract.

The main causes of migraines during menstruation

Another treatment option is taking synthetic analogues of natural sex hormones. The drug Duphaston belongs to this group. Take it in accordance with the scheme described above. NSAIDs can be used without a doctor's prescription, but hormone therapy requires a doctor's approval.

In addition, the use of such drugs does not provide an immediate analgesic effect. There is a gradual elimination of the hormonal imbalance and associated changes that caused the menstrual headache/migraine.

Use during pregnancy and pregnancy

Pregnancy is not a contraindication to taking this drug. The drug not only treats hormonal disorders, but also has a positive effect on the course of pregnancy.

If a threatened abortion is diagnosed during pregnancy, a one-time dosage of 40 mg is prescribed. Subsequent administration is carried out in a dosage of 10 mg with a time interval of 8 hours until the characteristic symptoms completely disappear.

Progesterone-based drugs are prescribed when recurrent abortion is detected during pregnancy in a standard dose (10 mg twice a day) up to 20 weeks. Then you need to gradually stop taking the medicine during pregnancy.

The use of hormonal therapy with Duphaston 20 during the lactation period is undesirable, since dydrogesterone can pass into breast milk.

General description of Duphaston

By group affiliation, Duphaston belongs to the gestagens, and its active component is dydrogesterone, which, in turn, is quite close in chemical properties and molecular structure to natural progesterone. It has no side effects, and is also not endowed with anabolic, androgenic, glucocorticoid, estrogenic and thermogenic activity. Simply put, Duphaston is an element of hormonal replacement treatment, while dydrogesterone does not affect coagulation parameters. Does not adversely affect carbohydrate metabolism and liver function.

When treated with this drug, the therapeutic effect occurs without disruption of menstrual function or suppression of ovulation, that is, it does not harm the course of pregnancy during the treatment period.

Duphaston is productively absorbed from the gastrointestinal tract, and a couple of hours after application it reaches its maximum concentration. The metabolic process occurs in the liver and is excreted in the urine by the kidneys.

The drug is produced in the form of round white tablets.

A complete analogue of Duphaston is Utrozhestan.

Contraindications and precautions

It is not recommended to start hormonal therapy if excessive sensitivity to synthetic progesterone or other components contained in the drug is detected; tendency to develop itching (diagnosed during pregnancy).

Women may experience bleeding, which can be stopped by increasing the dosage of gestagen taken.

The use of hormonal pills for the purpose of HRT requires a preliminary collection of a complete medical history. During treatment, it is necessary to monitor the tolerability of the prescribed HRT so that it works exclusively for therapeutic purposes.

During the first three months of hormonal treatment, vaginal bleeding is possible, which is normal (the body thus gets used to the hormones). If the same picture is observed after the adaptation period, it is necessary to conduct a gynecological examination and exclude oncological processes within the endometrium.

If a previously hormone-dependent neoplasm is detected and its rapid progression during pregnancy, it is necessary to conduct a thorough examination before taking hormonal medications.

You should not take progesterone tablets if you have malabsorption syndrome or lactose intolerance.

Duphaston®

Before starting treatment with Duphaston® for abnormal uterine bleeding, it is necessary to find out the cause of the bleeding. With prolonged use of the drug, periodic examinations by a gynecologist are recommended, the frequency of which is determined individually, but at least once every six months.

In the first months of treatment for abnormal uterine bleeding, “breakthrough” bleeding or “spotting” may occur. If “breakthrough” bleeding or “spotting” spotting occurs after a certain period of taking the drug or continues after a course of treatment, you should contact your doctor and carry out appropriate additional examination, and, if necessary, do an endometrial biopsy to exclude neoplasms in the endometrium.

If dydrogesterone is prescribed in combination with estrogens for the purpose of hormone replacement therapy (HRT), you should carefully read the contraindications and special instructions associated with the use of estrogens.

HRT should be prescribed to treat menopausal symptoms that adversely affect the patient's quality of life. The benefit/risk ratio of HRT should be assessed annually. Therapy should be continued until the potential benefit outweighs the potential risk.

There is limited data on the risks associated with HRT for the treatment of premature menopause. Due to the low absolute risk in younger women, the benefit/risk ratio for them may be more favorable compared with that for older women.

Medical examination

Before starting the use of a combination of dydrogesterone and estrogen (for HRT), a complete individual and family history should be collected. An objective examination (including examination of the pelvic organs and mammary glands) should be performed to identify possible contraindications and conditions requiring precautions.

During treatment, it is recommended to periodically monitor individual tolerance to HRT. The patient should be informed about what changes in the mammary glands she should report to the doctor. (See breast cancer). Studies including mammography should be carried out in accordance with generally accepted screening, taking into account individual characteristics and the clinical picture.

Hyperplasia and endometrial cancer

In women with an intact uterus, the risk of endometrial hyperplasia and cancer increases with long-term estrogen monotherapy.

Cyclic use of progestogens, including dydrogesterone (at least 12 days of a 28-day cycle) or the use of a sequential combined HRT regimen in women with a preserved uterus may prevent the increased risk of endometrial hyperplasia and cancer with estrogen monotherapy.

Mammary cancer

Available evidence suggests that the risk of breast cancer is increased in women treated with estrogen-progestogen HRT, and possibly also with estrogen monotherapy. The level of risk depends on the duration of HRT. The results of the epidemiological study and the WHI (Women's Health Initiative) study confirm an increased risk of developing breast cancer in women taking drugs containing a combination of estrogen and progesterone as part of HRT. The risk increases after about three years of use, but returns to the mean within a few (usually five) years after the end of therapy.

While taking drugs for HRT, especially with combined therapy with estrogens and progestogens, an increase in the density of breast tissue during mammography may be observed, which can make it difficult to diagnose breast cancer.

Ovarian cancer

Ovarian cancer is much less common than breast cancer.

Epidemiological data from a large meta-analysis suggest a small increase in risk for women receiving HRT as estrogen monotherapy or combination therapy with estrogens and progestogens. An increase in this risk becomes apparent with treatment duration of more than five years, and after its cessation the risk gradually decreases over time. Findings from a number of other studies, including the WHI, indicate that combined HRT is associated with a similar or slightly lower risk of ovarian cancer.

Venous thromboembolism

HRT is associated with a 1.3- to 3-fold increase in the risk of venous thromboembolism (VTE), i.e. deep vein thrombosis or pulmonary embolism. The likelihood is highest in the first year of HRT than in subsequent years. Patients with established thrombophilia have an increased risk of developing venous thromboembolism, and HRT may increase the risk. For this reason, HRT is contraindicated in such patients.

Risk factors for venous thromboembolism include estrogen use, advanced age, major surgery, prolonged immobilization, obesity (BMI > 30 kg/m2), pregnancy, the postpartum period, systemic lupus erythematosus and cancer. There is no clear data on the possible role of varicose veins in the development of venous thromboembolism.

If long-term immobilization after surgery is necessary, you should stop taking HRT medications 4-6 weeks before surgery, resuming the drug is possible after the woman has fully recovered her motor activity.

Women with no history of VTE, but with a family history of thrombosis at a young age in close relatives, may be offered screening after detailed counseling about the possible limitations and disadvantages of therapy (screening reveals only some of the hereditary defects of the hemostatic system) .

If thrombophilia associated with thrombosis is detected in family members or if there is a severe defect (for example, deficiency of antithrombin III, protein C, protein S, or a combination of defects), HRT is contraindicated.

If the patient is taking anticoagulants, the benefits/risks of HRT must be carefully assessed. Until a thorough assessment of the factors for the possible development of thromboembolism or the initiation of anticoagulant therapy is completed, HRT drugs are not prescribed. If thrombosis develops after initiation of therapy, HRT should be discontinued.

You should immediately consult a doctor if any of the symptoms indicating a possible thromboembolism appear (painful swelling of the lower extremities, sudden chest pain, shortness of breath, blurred vision).

Coronary heart disease (CHD)

Data obtained from randomized controlled trials indicate a lack of protective effect against the development of myocardial infarction in women with and without coronary artery disease receiving HRT in the form of combination therapy with estrogens and progestogens or estrogen monotherapy.

The relative risk of developing coronary heart disease increases slightly during combined HRT. The absolute risk of developing CHD depends on age. The incidence of CHD associated with HRT use in healthy women near natural menopause is very low, but the risk increases with age.

Ischemic stroke

Combination therapy with estrogens and progestogens or estrogens alone is associated with a 1.5-fold increase in the risk of ischemic stroke. The relative risk does not change with age and does not depend on the time of menopause. However, the incidence of stroke varies with age, and the overall risk of stroke in women taking HRT will increase with age.

Excipients

The drug contains lactose monohydrate.

Patients with rare hereditary diseases such as galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome should not take the drug.

Side effects

The following side effects may occur while taking hormonal pills:

Hematopoietic system: development of hemolytic type anemia
Immune system: the occurrence of excessive susceptibility
CNS: severe migraine-type headaches
Hepatobiliary system: serious disturbances in the activity of the liver, which is accompanied by painful sensations in the abdomen, yellowness of the skin
Reproductive system: breast engorgement, uterine bleeding
Skin: manifestations of allergies, rashes, severe itching, Quincke's edema.

Peripheral edema is quite rarely recorded.

Drug group

Duphaston contains an active substance from the group of gestagens, dydrogesterone. Synthetic analogues of the natural hormones of the female body are widely used in gynecology. Gestagens are prescribed for ovarian dysfunction. Hormonal drugs eliminate oligemenorrhea, amenorrhea, algomenorrhea and other female problems.

Progestogens or gestagens are hormones that are produced by the corpus luteum of the ovaries, the placenta of pregnant women, and partly by the adrenal glands. This is a large group of active substances of a steroid nature.

Composition of Duphaston tablets

The main function of gestagens is to prepare the female body for conception and support the changes that should occur in the body during pregnancy. Gestagens reduce the sensitivity of tissues to male sex hormones, including testosterone. This is very important for a woman’s well-being, mood and appearance.

Treatment with a progestin drug leads to a decrease in the excitability of the uterine muscles and promotes its relaxation. Spasms of this organ are a common cause of abdominal pain.

Hormonal changes before menstruation often provoke the following symptoms: severe headaches, nausea, and possibly vomiting. In such cases, therapy with progestin drugs relieves pain. In addition, hormonal agents are used to mitigate the effects of menopause on the female body.

Effect of the drug

There are several analogues of Duphaston - these can be both tablets and suppositories. For example, Iprozhin, Prajisan, Progestogel and Progesterone. Combination medications are also produced. With the help of such medications it is possible to treat a large number of gynecological disorders.

The drug Duphaston is an oral tablet. Each of them contains 10 mg of active substance. In addition, the product contains auxiliary components: lactose, corn starch, silicon dioxide and magnesium stearate.

The tablets are white in color and coated. They are round, biconvex, with a notch on one side. In total, one blister contains 20 tablets. This drug is produced by the Dutch company Solvay Pharma.

Analogs

Utrozhestan

Olik Limited, Thailand

Price from 353 to 520 rubles.

Utrozhestan is a progesterone-based drug used to treat hormone-dependent diseases and to support the second phase of the cycle, HRT. Produced in capsule form (can be used as candles). The package contains 30 capsules. dosage 100 mg and 14 caps. at a dose of 200 mg. In addition, instructions are included in the packages.

Pros:

Can be purchased at City Health pharmacies
It is used not only orally, but also intravaginally (as suppositories)
Prescribed for PMS.

Minuses:

During administration, changes in MC may be observed
Available with prescription
It should not be combined with alcohol.

Features of using Duphaston

The drug is approved for use during pregnancy and lactation.

Its use does not affect the ability to drive, therefore, during the treatment period, driving and activities with increased concentration are allowed.

Do not take Duphaston tablets to patients with malabsorption syndrome, lactase deficiency, or hereditary galactose intolerance.

In case of drug interactions, it is important to remember that phenobarbital and rifampicin significantly accelerate the metabolism of dydrogesterone and reduce the effectiveness of the drug itself. No further restrictions are specified.

Contraindications

The instructions for Duphaston state that the drug cannot be used for:

hypersensitivity to dydrogesterone and other drugs that contain progesterone. Allergy to auxiliary components;
irritation and itching of the skin during previous pregnancies;
prescribed with caution for diseases associated with metabolic disorders, epilepsy, kidney disease, migraines;
"Duphaston" is not prescribed to women with galactose intolerance or malabsorption syndrome;
During replacement therapy, ultrasound monitoring of the pelvic organs and mammographic examinations are required.

A separate line is an overdose of Duphaston. Cases of overdose when taking the drug correctly have not been observed. If the tablets are taken accidentally, the treatment is symptomatic.

Side effects of the drug

The instructions state that all side effects of Duphaston are classified as very rare:

• anemia – lack of iron in the blood;

• allergic reactions to the main or auxiliary substances;

• headaches, migraines;

• extremely rarely – liver damage, which may be accompanied by symptoms of jaundice, pain in the epigastric region;

• extremely rarely – breakthrough uterine bleeding. These conditions can be neutralized by increasing the dosage of the drug. Pain and swelling in the chest;

• itching, skin rash, swelling of the lower extremities. In severe cases, Quincke's edema.

How does the drug behave with other drugs?

Be sure to tell your gynecologist if you are taking the following medications:

• rifampicin;

• phenobarbital.

The use of these drugs reduces the effectiveness of dydrogesterone.

Attention! Replacement therapy

In patients who require replacement therapy, it is necessary to exclude all conditions and contraindications associated with taking estrogen-containing drugs.

Before starting treatment, a complete medical history is required. Particular attention should be paid if the medical history indicates progesterone-dependent tumors - for example, meningiomas.

Patients on replacement therapy should undergo regular examinations and have mammograms. The doctor should warn the patient what chest symptoms to pay attention to.

Rules for the sale and storage of Duphaston

The drug is stored indoors at normal temperatures. No refrigerator or other equipment required. Shelf life if stored correctly is 5 years. Duphaston is not a prescription drug. The medicine cannot be used after the expiration date has expired.

Patient reviews

Feedback from girls is mostly positive. When taken, there are practically no side effects. Several times I came across reviews that the drug caused headaches or nausea.

But the situation returned to normal in subsequent cycles. Women note that the pain associated with premenstrual syndrome has decreased. The pain of menstruation decreased.

Reviews from girls who became pregnant and carried babies on Duphaston are also the most positive. For some, 1 cycle was enough, others had to take the use more seriously and continue treatment for 6 months.

Sometimes there are reviews that Duphaston increases weight. But from the personal experience of the author of the article, the drug even contributed to weight loss, skin condition improved, and menstruation was easier. Although pregnancy did not occur.

But reviews are reviews, and you shouldn’t take Duphaston on your own. This drug belongs to hormonal drugs. And taking it without undergoing examination and without a doctor’s prescription is, at the very least, unwise!