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Progestogen (selective) — endometriosis

Dienogest

Brand names: Zalkya, Visanne

Dienogest is a progestogen used in the management of endometriosis-associated pelvic pain.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It produces a hypo-oestrogenic, hyper-progestogenic environment that induces decidualisation and subsequent atrophy of endometriotic lesions, reducing associated pain.

Prescribing in practice

  • Exclude pregnancy before starting and counsel that, although ovulation is often suppressed, it is not licensed as a contraceptive, so a non-hormonal method should be used.
  • Changes in menstrual bleeding pattern, including spotting or amenorrhoea, are very common during treatment.
  • Use with caution in women with a history of depression, as mood changes can occur.

Monitoring

Monitor blood pressure and review bleeding pattern and symptom control; assess bone health considerations with prolonged use.

Counselling the patient

  • Take the tablet at the same time each day, including through any bleeding.
  • Use a non-hormonal contraceptive method, as this is not a contraceptive.
  • Report persistent low mood or significant changes in mood.

Evidence & guidelines

Dienogest is recommended in NICE guidance on endometriosis as a hormonal treatment option for managing endometriosis-related pain.

Reference: NICE NG73; RCOG endometriosis; ESHRE; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways