The effect of dydrogesterone on the mid-cycle gonadotrophin surge in regularly cycling women

The natural menstrual cycle revisited - can natural cycle be trusted

BACKGROUND

The serum progesterone (P4) level during the luteal phase (LP) plays a crucial role in the initiation and maintenance of pregnancy. However, it is unclear whether the natural cycle consistently provides the best endocrine profile and whether mid-luteal serum P4 levels are always sufficient to support implantation and early pregnancy. The question has become more relevant in relation to fertility treatment, as more frozen embryo transfer cycles are performed in the natural cycle. Moreover, can serum hormone levels and covariates measured during the follicular phase (FP), such as Follicle Stimulation Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Anti-Mullerian Hormone (AMH) and Antral Follicle Count (AFC), be used to predict P4 levels during the luteal phase (LP)?

RESULTS

This observational prospective cohort study analysed 26 healthy women with a cycle length between 21-35 days and a body mass index (BMI) < 30 kg/m2. Blood sampling started on the fifth day of the menstrual cycle and continued every fifth day until the next cycle. The procedure was repeated for a total of three cycles. The study found that only ten women had a P4 level greater than 30 nmol/L on cycle day 20 or 25 in all three cycles. In total, only 45 cycles out of 77 cycles had serum P4 levels ≥ 30 nmol/L. The E2 level ≥ 345 pmol/L on cycle day 10 proved to be predictive of a P4 level of ≥ 30 nmol/L on either day 20 or day 25 with a sensitivity of 57% and a specificity of 89%. No other covariates, including the FSH level cycle day 5, LH levels during the follicular phase, age, weight, AFC and AMH cycle day 5 correlated with LP P4 levels.

CONCLUSIONS

A significant correlation between FP E2 levels cycle day 5 (> 131pmol/L) and cycle day 10 (> 345pmol/L) and a LP P4 level ≥ 30 nmol/l was found; thus, the FP E2 level is a predictor of corpus luteum competence. Our findings highlight the existence of suboptimal P4 levels during the LP and a significant inter-individual and intra-cycle variation in P4 levels during the LP in regular menstruating women.

Dydrogesterone: pharmacological profile and mechanism of action as luteal phase support in assisted reproduction

The pharmacological and physiological profiles of progestogens used for luteal phase support during assisted reproductive technology are likely to be important in guiding clinical choice towards the most appropriate treatment option. Various micronized progesterone formulations with differing pharmacological profiles have been investigated for several purposes. Dydrogesterone, a stereoisomer of progesterone, is available in an oral form with high oral bioavailability; it has been used to treat a variety of conditions related to progesterone deficiency since the 1960s and has recently been approved for luteal phase support as part of an assisted reproductive technology treatment. The primary objective of this review is to critically analyse the clinical implications of the pharmacological and physiological properties of dydrogesterone for its uses in luteal phase support and in early pregnancy.

A randomized, double-blind, placebo-controlled study of luteal phase dydrogesterone (Duphaston) in women with minimal to mild endometriosis

OBJECTIVE

To compare dydrogesterone with placebos in the treatment of minimal to mild endometriosis.

DESIGN

Prospective, double-blind, randomized study.

SETTING

Three Obstetrics and Gynaecology Departments in the United Kingdom.

PATIENTS

Sixty-two premenopausal women with complaints of pain (n = 12) and infertility with or without pain (n = 50) with minimal to mild endometriosis diagnosed at laparoscopy. Thirty-nine women had a laparoscopy after treatment and 56 women were followed up 12 months after treatment.

INTERVENTIONS

Two high doses of dydrogesterone (either 40 or 60 mg) or a placebo, which was given for 12 days, beginning 2 days after the LH surge for a treatment period of 6 months.

MAIN OUTCOME MEASURES

Change between before and after treatment endometriosis scores, pregnancy rates (PRs), and pain.

RESULTS

Treatment with dydrogesterone did not alter the natural history of endometriosis or PRs when compared with placebo. Pain was reduced significantly during treatment with 60 mg dydrogesterone and this improvement still was evident at 12-month follow-up.

CONCLUSION

Luteal phase dydrogesterone reduces pain associated with endometriosis.

Premenstrual syndrome

The term premenstrual syndrome is often used to describe several clinical conditions. Only a full history covering not only reproductive but also psychological and social factors, combined with daily diaries which are kept prospectively for at least two months, can help clarify the problems the patient experiences. As it is the timing rather than the type of symptoms which is essential to a diagnosis, diaries are used to assess symptoms, make a diagnosis and monitor the effectiveness of therapy. Patients with premenstrual syndrome should therefore always keep a diary and bring it to every consultation. We do not know if patients complaining of premenstrual syndrome are at one extreme of a spectrum disorder or if they are a 'specific group'. Such patients may have classical premenstrual syndrome, perimenstrual distress, benign idiopathic oedema, dysmenorrhoea, cyclical benign breast disease or mood symptoms which are not significantly related to the menstrual cycle. There are many aetiological theories--biological, psychological, environmental and social, the syndrome being a complex psychosomatic disorder. For appropriate management an accurate diagnostic formation is required. Reassurance, stress management techniques, an improvement in general mental and physical well-being, information and education are the mainstays of therapy. Symptomatic relief of symptoms is often helpful. Many other managements have been tried with the aim of correcting the underlying aetiological case. These include vitamins, prostaglandin inhibitors and endocrine therapies. As the disorder is long-term, the safety of treatments should be carefully considered.

Premenstrual syndrome. A double-blind cross-over study of treatment with dydrogesterone and placebo

A double-blind, cross-over, placebo-controlled study of dydrogesterone (10 mg b.d.) in the treatment of premenstrual syndrome is described. Two groups of women were studied: secondarily referred hospital clinic patients, and self-referred patients. Only one-third of patients screened completed the study. All patients showed significant improvements in symptom scores during the course of the study, the only significant difference between placebo- and dydrogesterone-treated patients being an increase in frequency of breast tenderness and a decrease in pain with menstrual bleeding in the latter.