Gynaecological uses of dienogest alone and in combination with oestrogens

Dienogest is a hybrid synthetic gestagen which shares characteristics with 19-nortestosterone and progesterone derivatives, and also has advantageous substance specific pharmacological features. These include a high oral bioavailability, strong suppressive effect on the endometrium, lack of oestrogenic and androgenic effects, with a significant antiandrogenic efficacy component. Due to its reliable ovulation inhibiting effect, dienogest is a part of oral contraceptives in combination with ethinyl estradiol (Valette®, Maxim®) or is a part in a 4-phasic drug (Qlaira®) with dynamic dosage in combination with estradiol valerate (Qlaira®). Due to the specific efficacy profile of dienogest, Valette® and Maxim® can also be used for the treatment of moderate forms of acne, whereas Qlaira® is especially suitable for use as a contraceptive for women with heavy menstrual bleeding (hypermenorrhea). In the dosage of 2 mg in combination with estradiol valerate 1 or 2 mg a day (Lafamme® 1/2 mg or 2/2 mg), dienogest is tried and tested as a continuous hormone replacement therapy for postmenopausal women. During the therapy, the climacteric complaints improve quickly, with a positive impact especially on mood, sleep and mental functioning. As monotherapy (Visanne®), dienogest is used for the treatment of endometriosis. In terms of pain reduction, it was shown to be equal to the GnRH analogue leuprorelin acetate, but with a better tolerability. The lower abdominal pain typical for endometriosis, receded quickly and laparoscopies showed a clear regression of endometriosis lesions. Gynaecological uses of dienogest alone and in combination with oestrogens V. Bartsch With a comment by Prof. Dr. med. Thomas Römer