Metrissa (Dienogest)

Dienogest is used in hormonal therapies that target estrogen‑driven gynecological conditions.

• Endometriosis: reduces pelvic pain and suppresses lesion growth.
• Combined oral contraception (with estrogen): provides effective birth control by inhibiting ovulation.
• Abnormal uterine bleeding: helps regulate menstrual flow and reduce heavy bleeding.

• Dienogest binds selectively to progesterone receptors, exerting a strong progestogenic effect that antagonises estrogen‑mediated proliferation of endometrial tissue. It also suppresses gonadotropin release, leading to decreased ovarian estrogen production and inhibition of ovulation when combined with estrogen in contraceptive formulations.

Dienogest may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Headache: mild to moderate intensity.
• Nausea: transient gastrointestinal discomfort.
• Breast tenderness: occasional swelling or soreness.
• Weight gain: modest increase in body weight.
• Irregular menstrual bleeding: spotting or breakthrough bleeding.
• Acne: mild skin eruptions.

Serious or Rare Side Effects

• Venous thromboembolism: deep vein thrombosis or pulmonary embolism.
• Severe liver dysfunction: jaundice or elevated transaminases.
• Depression or mood changes: new or worsening psychiatric symptoms.
• Allergic reactions: rash, pruritus, or anaphylaxis.
• Uterine rupture (very rare): especially in women with prior uterine surgery.

Before initiating therapy, clinicians should evaluate individual risk factors and monitor patients regularly.

• Medical history review: assess for liver disease, clotting disorders, or hormone‑sensitive cancers.
• Bleeding risk evaluation: monitor for abnormal uterine bleeding or spotting.
• Drug interaction check: avoid concomitant use with strong CYP3A4 inducers.
• Pregnancy avoidance: advise effective contraception during treatment.
• Breastfeeding consideration: discuss potential risks with healthcare provider.
• Store at ambient temperature: keep in the original packaging, protect from moisture and direct sunlight.

Dienogest can interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine): may markedly reduce plasma levels.
• Anticoagulants (e.g., warfarin): increased risk of bleeding.
• HIV protease inhibitors: unpredictable hormonal effects.
• St. John’s wort: may diminish contraceptive effectiveness.

Moderate Interactions (Monitor Closely)

• Antifungal agents (e.g., ketoconazole): may increase drug exposure.
• Macrolide antibiotics (e.g., erythromycin): potential modest increase in levels.
• Selective serotonin reuptake inhibitors: may enhance bleeding tendency.
• Other hormonal therapies: assess additive progestogenic effects.
• Herbal supplements (e.g., ginseng): possible alteration of metabolism.