Progestogen (selective) — endometriosis

Dienogest

Brand names: Zalkya, Visanne

Adult dose

Dose: 2mg PO OD continuously

Route: Oral

Frequency: OD

Clinical pearls

NICE NG73: medical management of endometriosis
RCOG endometriosis guidance / ESHRE
Highly selective progestogen with low androgenic activity; not licensed as standalone contraceptive

Contraindications

Active VTE / arterial events
Active or past sex steroid-dependent malignancy
Undiagnosed vaginal bleeding
Severe hepatic impairment
Pregnancy
Hypersensitivity

Side effects

Menstrual irregularity (amenorrhoea common)
Headache
Mood change
Acne
Weight change
Reduced bone mineral density (long-term)
Liver dysfunction

Interactions

Enzyme inducers (carbamazepine, rifampicin, St John's wort)

Monitoring

Bleeding pattern
BP
Mood
BMD if long-term

Reference: BNF; NICE NG73; RCOG endometriosis; ESHRE; https://bnf.nice.org.uk/drugs/dienogest/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways