A systematic review of the efficacy and safety of dydrogesterone in the treatment of menstrual disorders in young patients, including early reproductive age
Khashchenko E.P., Alekseeva M.N., Pavlovich S.V., Uvarova E.V.
Objective: To conduct a systematic review of recent publications on the mechanisms of action, clinical efficacy, and safety of dydrogesterone in patients of reproductive age, including early reproductive years.
Materials and methods: The literature search was conducted in the following databases: eLibrary, PubMed, ClinicalTrials.gov, ICTRP, Cochrane Library and Google Scholar for the period 2016-2025. A total of 927 publications were identified, resulting in the exclusion of duplicate articles (n=95), articles that did not meet the inclusion criteria (n=789), and those with insufficient data (n=17). The selection was carried out according to certain criteria of relevance: clinical studies, study design, reported endpoints, dydrogesterone therapy, and patients of reproductive age and patients aged 18 years and younger, post-menarche.
Results: There was a full-text analysis of 43 articles, 12 of them met the inclusion criteria with a total number of observations of 2,817 patients. A summary of the data showed high efficacy of dydrogesterone in regulating the menstrual cycle, reducing the frequency of abnormal uterine bleeding, relieving the severity of dysmenorrhea and chronic pelvic pain in patients of the early reproductive period. The review describes pathogenetic mechanisms of action of dydrogesterone, including an immunomodulatory effect mediated by the suppression of the NF-kB/COX-2 pathway, synthesis of proinflammatory cytokines, and activation of anti-inflammatory mediators. These mechanisms help to restore endometrial receptivity, reduce the recurrence of abnormal uterine bleeding and the severity of pelvic pain.
Conclusion: This systematic review confirms the pathogenetic and clinical significance of dydrogesterone as an effective and safe therapeutic option for menstrual cycle disorders (irregular menstruation, abnormal uterine bleeding, dysmenorrhea) in patients of reproductive age, including early reproductive years. The use of dydrogesterone is characterized by good tolerability and high levels of patient satisfaction with the therapy.
Authors’ contributions: Khashchenko E.P., Alekseeva M.N., Pavlovich S.V., Uvarova E.V. – developing the concept and design of the study, collecting and processing the material, writing the text, editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The article was prepared with the support of Binnopharm Group LLC. The sponsor has no influence on the choice of material for publication, analysis and interpretation of data.
For citation: Khashchenko E.P., Alekseeva M.N., Pavlovich S.V., Uvarova E.V. A systematic review of
the efficacy and safety of dydrogesterone in the treatment of menstrual disorders in
young patients, including early reproductive age.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (8): 57-68 (in Russian)
https://dx.doi.org/10.18565/aig.2025.220
Keywords
dydrogesterone
early reproductive age
menstrual disorders
abnormal uterine bleeding
dysmenorrhea
chronic pelvic pain
immunomodulation
NF-kB
COX-2
endometriosis
endometrial receptivity
systematic review
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Received 19.08.2025
Accepted 28.08.2025
About the Authors
Elena P. Khashchenko, PhD, Senior Researcher at the 2nd Gynecological Department (Pediatric and Adolescent Gynecology), V.I. Kulakov NMRC for OG&P, Ministry of Health Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, khashchenko_elena@mail.ru, https://orcid.org/0000-0002-3195-307XMaria N. Alekseeva, student of the Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, alekseevamarydubai14@mail.ru,
https://orcid.org/0000-0001-9795-0587
Stanislav V. Pavlovich, PhD, Academic Secretary, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Professor, Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University),
119991, Russia, Moscow, Trubetskaya str., 8-2, s_pavlovich@oparina4.ru, https://orcid.org/0000-0002-1313-7079
Elena V. Uvarova, Corresponding Member of the RAS, Dr. Med. Sci., Professor, Head of the 2nd Gynecological Department (Pediatric and Adolescent Gynecology),
V.I. Kulakov NMRC for OG&P, Ministry of Health Russia, 117997, Russia, Moscow, Ac. Oparina str., 4; Professor at the Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2; President of the Interregional Public Organization “Association of Pediatric and Adolescent Gynecologists”; Chief Freelance Specialist in Pediatric and Adolescent Gynecology, Ministry of Health of the Russian Federation, elena-uvarova@yandex.ru, https://orcid.org/0000-0002-3105-5640
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