Metrius (Dienogest)

• Metrius is a progestin that modulates hormone‑driven conditions affecting the reproductive system.
• Endometriosis: reduces pain and lesion growth by suppressing estrogen‑driven proliferation.
• Menstrual disorders: stabilises irregular bleeding and alleviates dysmenorrhoea.
• Contraception: prevents ovulation and creates an endometrial environment unsuitable for implantation.

• Dienogest acts as a selective progesterone‑receptor agonist. By binding to progesterone receptors it inhibits the mid‑cycle luteinising hormone surge, suppresses ovulation, induces endometrial atrophy and counteracts estrogen‑mediated proliferation of ectopic endometrial tissue, thereby providing therapeutic effects in endometriosis and contraceptive applications.

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Headache: mild to moderate intensity.
• Nausea: occasional gastrointestinal upset.
• Breast tenderness: transient discomfort.
• Weight gain: modest increase in body mass.
• Acne or skin changes: occasional eruptions.
• Mood swings: mild emotional variability.

Serious or Rare Side Effects

• Venous thromboembolism: risk of deep‑vein clot formation.
• Severe depression or mood disorders: may require medical attention.
• Liver dysfunction: abnormal liver enzymes or hepatitis.
• Allergic reactions: rash, pruritus, or anaphylaxis.
• Uterine rupture (very rare): especially in pregnancy, which is contraindicated.

• Before initiating therapy, consider the following safety measures.
• Pregnancy: contraindicated; avoid use in women who are or may become pregnant.
• Liver disease: assess hepatic function; use with caution in impairment.
• Smoking: advise cessation, especially in women over 35, due to cardiovascular risk.
• Cardiovascular risk: evaluate history of thromboembolic events before prescribing.
• Drug interactions: review concomitant medications that affect CYP3A4 metabolism.
• Store at ambient temperature: keep below 25 °C, in the original packaging, protected from moisture and direct sunlight.

Dienogest may interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may increase plasma levels.
• Antifungal agents (e.g., fluconazole): can raise exposure.
• Certain antiretrovirals (e.g., ritonavir): potentiate effects.
• St John’s wort: may reduce effectiveness by inducing metabolism.

Moderate Interactions (Monitor Closely)

• Other hormonal agents (e.g., estrogen‑containing contraceptives): may affect hormonal balance.
• NSAIDs: monitor for increased bleeding risk.
• Antidepressants (SSRIs): observe for mood changes.
• Antiepileptics (e.g., carbamazepine): may lower drug concentration.
• Herbal supplements (e.g., ginseng): assess for additive hormonal activity.