This tool helps clinicians and patients choose the most appropriate progestogen based on clinical indication, side-effect profile, and cost considerations.
Select your criteria and click 'Compare Agents' to see recommendations.
Quick Take:
Duphaston is a synthetic progestogen (dydrogesterone) that closely matches the activity of natural progesterone, designed to treat luteal‑phase deficiency, endometriosis, recurrent miscarriage, and support hormone‑replacement therapy (HRT). It is available in 10mg tablets, with a bioavailability of about 80% and a half‑life of 12‑16hours.
Below are the most commonly prescribed alternatives, each with distinct pharmacologic traits.
Micronized progesterone is a bioidentical form of natural progesterone, micronized to improve oral absorption. It is sold under brand names such as Prometrium and is typically taken in 100‑200mg doses. Medroxyprogesterone acetate (MPA) is a synthetic progestin with strong glucocorticoid activity, often prescribed as 10mg oral tablets (Provera) for abnormal uterine bleeding or as an injectable for contraception. Norethisterone acetate is a synthetic progestin derived from 19‑nor testosterone, commonly used in 5‑10mg daily regimens for dysmenorrhea and secondary amenorrhea. Estradiol is a potent estrogen often combined with progestins in HRT and contraceptive pills. While not a progestogen, its interaction with progesterone agents shapes clinical decisions.Doctors prefer Duphaston for conditions where a "pure" progestogenic effect is needed without androgenic or glucocorticoid spill‑over. Typical scenarios include:
Because dydrogesterone binds selectively to progesterone receptors, side‑effects such as mood swings, bloating, and weight gain are often milder than with MPA or norethisterone.
| Agent | Dosage Form | Typical Daily Dose | Bioavailability | Half‑Life | FDA Status (US) | Primary Clinical Use |
|---|---|---|---|---|---|---|
| Duphaston | 10mg tablet | 10-20mg | ~80% | 12-16h | Approved in EU, not FDA‑approved (compounded) | Luteal‑phase support, HRT, miscarriage prevention |
| Micronized progesterone | Capsule 100mg | 100-200mg | ~50% | 24h | FDA‑approved | HRT, luteal support, infertility |
| Medroxyprogesterone acetate | 10mg tablet / 150mg injection | 10mg (oral) or 150mg IM q3mo | ~79% | ~13h | FDA‑approved | Contraception, endometrial cancer, abnormal bleeding |
| Norethisterone acetate | 5mg tablet | 5-10mg | ~70% | ~12h | FDA‑approved | Menstrual disorders, endometriosis, hormonal therapy |
| Estradiol | Patch, tablet, gel | 0.5-2mg (oral) | ~30-40% | ~12h | FDA‑approved | Estrogen component of HRT, contraception |
Mechanistic nuances drive side‑effect profiles. Dydrogesterone (Duphaston) mimics the natural progesterone receptor (PR‑B) without activating androgen receptors. In contrast, MPA binds both progesterone and glucocorticoid receptors, raising concerns about weight gain, lipid changes, and rare thrombotic events. Norethisterone carries modest androgenic activity, which can cause acne or hirsutism in sensitive patients.
Micronized progesterone, being bioidentical, offers the most “natural” hormone exposure but its oral absorption is erratic; food can increase bioavailability by up to 30%. This variability sometimes necessitates split dosing or vaginal administration for IVF cycles.
Safety highlights:
Cost considerations vary by market. In Europe, a month’s supply of Duphaston costs roughly €30‑40, while a comparable dose of micronized progesterone is €20‑25. In the United States, the lack of FDA approval makes Duphaston a compounded product, often priced at $80‑120 per month, whereas FDA‑approved alternatives are covered by most insurance plans.
Below is a practical flow to help clinicians and patients match the right progestogen to their condition.
In the United States, Duphaston has not received FDA approval; it is available only through compounding pharmacies under a physician’s prescription. The European Medicines Agency (EMA) approved it in 1975, and it remains a first‑line progestogen in many European guidelines. Micronized progesterone, MPA, and norethisterone are all FDA‑approved, allowing pharmacists to dispense them directly.
Regulatory status influences prescribing habits. For example, a US‑based OB‑GYN might default to MPA for endometriosis because insurance coverage is straightforward, while a European counterpart would likely start with Duphaston due to guideline preference.
Choosing the wrong progestogen can lead to therapeutic failure or unwanted side‑effects. Common mistakes include:
Regular follow‑up labs (serum progesterone, liver enzymes) and symptom tracking can catch issues early.
There is no one‑size‑fits‑all answer. Duphaston shines when selectivity, minimal androgenicity, and a clean side‑effect slate are paramount, especially for luteal‑phase deficiencies, early pregnancy support, and HRT in women at risk for mood swings. Micronized progesterone remains the go‑to bioidentical option when FDA approval and insurance coverage dictate the choice. MPA offers powerful progestogenic action but carries a higher metabolic burden, making it suited for contraception or specific oncologic protocols. Norethisterone balances efficacy and oral convenience, though its modest androgenic tone can be a drawback for acne‑prone patients.
By weighing indication, safety profile, cost, and regulatory realities, clinicians can match the right progestogen to each patient’s unique health story.
Clinical trials and observational studies show that Duphaston (dydrogesterone) does not increase the risk of congenital anomalies when used in the first trimester for luteal‑phase support. It is considered safe under physician supervision, especially for women with documented progesterone deficiency.
Duphaston is a synthetic progestogen that selectively binds progesterone receptors without androgenic or glucocorticoid activity. Micronized progesterone is a bioidentical hormone that can be converted to other steroid metabolites, leading to a broader effect profile and more variable absorption when taken orally.
Yes, many European guidelines recommend Duphaston as first‑line therapy for endometriosis‑related pain because it offers symptom relief with fewer metabolic side‑effects compared to MPA. However, insurance coverage in the US may limit access, so discuss alternatives with your provider.
The standard regimen is 10mg taken twice daily (total 20mg) from ovulation or embryo transfer until about 10weeks gestation. Some clinicians start at 10mg once daily and increase based on serum progesterone levels.
Dydrogesterone is metabolized primarily by CYP3A4. Strong CYP3A4 inhibitors such as clarithromycin or fluconazole can raise its plasma concentration, potentially increasing side‑effects. Always inform your doctor about any concurrent medications.
The manufacturer never submitted a New Drug Application to the FDA, opting to market the drug in Europe and other regions where regulatory pathways differ. Consequently, U.S. patients obtain it via compounding pharmacies under a prescriber’s order.
Clarise Wheller
September 25, 2025 AT 22:24Thanks for breaking down the options, the side‑effect matrix really helps clinicians narrow down the best fit. For patients with low androgenic tolerance, Duphaston’s selective profile is a solid pick. When insurance coverage is tight, micronized progesterone often becomes the more accessible route. I also appreciate the note on MPA’s glucocorticoid activity-it’s something we have to monitor in long‑term users. Your table makes the comparison crystal clear, especially for those juggling IVF timing and HRT considerations.
Riley Fox
September 25, 2025 AT 23:47Interestingly-while the data suggests Duphaston boasts “minimal side‑effects,” one could argue that the very absence of robust FDA‑approval introduces an unseen risk; after all, compounding pharmacies are not immune to variability, are they?; moreover, the article glosses over potential drug‑drug interactions with CYP3A4 inhibitors-an oversight that could prove clinically significant 😏.
David Stephen
September 26, 2025 AT 01:10From a mentorship perspective, it’s helpful to remind patients that serum progesterone levels can guide dosing, especially when switching between oral micronized progesterone and Duphaston. Encourage them to track mood changes and weight trends, as these are practical signals of tolerability. A gentle reminder: always discuss any new supplements with the prescribing provider before making adjustments.
Roberta Giaimo
September 26, 2025 AT 02:34One grammatical nuance that often slips by readers is the distinction between “bioidentical” and “synthetic”; the former refers to molecular identity with endogenous hormones, while the latter describes structural analogs such as dydrogesterone. Clarity on this point can prevent misconceptions about safety profiles. 😊
Tom Druyts
September 26, 2025 AT 03:57Let’s keep the momentum going! If you’re looking for a regimen that won’t break the bank, check your insurance formulary for micronized progesterone-many plans cover it under the generic label. For those who prioritize a clean side‑effect slate, Duphaston remains a top contender, especially in IVF cycles where precise luteal support matters.
Julia C
September 26, 2025 AT 05:20It’s almost theatrical how the pharmaceutical market hides the truth behind “compounded” labels, isn’t it? While Duphaston dazzles on paper with its selective binding, the lack of FDA scrutiny feels like a backstage conspiracy-who’s really guaranteeing batch consistency? Still, the pharmacokinetic data are solid, and for patients wary of androgenic side‑effects, it does shine. Just remember, every miracle drug carries its own drama.
Matthew Marshall
September 26, 2025 AT 06:44Duh, MPA is a nightmare.
Lexi Benson
September 26, 2025 AT 08:07Oh sure, another hormone showdown-because what we really needed was extra drama in our medication cabinet.
Amanda Devik
September 26, 2025 AT 09:30Empowering patients with clear decision trees drives adherence; leveraging risk‑benefit profiling and cost‑effectiveness analytics streamlines personalized care without the jargon overload
Mr. Zadé Moore
September 26, 2025 AT 10:54The ethical imperative demands we prioritize agents with proven safety data-choose FDA‑approved options over speculative compounds.
Brooke Bevins
September 26, 2025 AT 12:17I hear the frustration about insurance hurdles; let’s cut through the red tape and push for formulary inclusion of Duphaston where evidence supports its superiority.
John Magnus
September 26, 2025 AT 13:40When evaluating progestogenic therapy, it is essential to adopt a multidimensional framework that incorporates pharmacodynamics, pharmacokinetics, regulatory status, and health‑economic considerations. Dydrogesterone, the active moiety of Duphaston, exhibits high affinity for the progesterone receptor isoform B while sparing androgen and glucocorticoid receptors, a property that translates into a lower incidence of metabolic side‑effects compared with medroxyprogesterone acetate. However, the lack of FDA approval in the United States means that the product is typically compounded, introducing variability in excipient composition and potential stability issues that are not encountered with FDA‑cleared micronized progesterone. Micronized progesterone, by contrast, is a bioidentical molecule with a well‑characterized oral absorption profile, albeit one that is highly food‑dependent and subject to first‑pass metabolism, which can necessitate dose splitting or alternative routes such as vaginal administration in assisted reproductive technology cycles. From a cost perspective, compounded Duphaston often exceeds $100 per month in the U.S. market, whereas generic micronized progesterone is frequently covered under Medicare Part D and commercial formularies, resulting in out‑of‑pocket expenses that are a fraction of the compounded product. Clinical efficacy data suggest comparable luteal‑phase support outcomes between Duphaston and micronized progesterone when serum progesterone levels are maintained above 10 ng/mL, yet head‑to‑head trials remain limited. Endometriosis management further illustrates the divergence: dydrogesterone demonstrates superior pain reduction with fewer androgenic sequelae, while medroxyprogesterone acetate, though effective, is associated with weight gain and mood disturbances that may compromise quality of life. In hormone‑replacement therapy, the combination of estradiol with Duphaston offers a more physiologic estrogen‑progestogen balance, reducing breast tenderness and endometrial hyperplasia risk relative to regimens incorporating MPA. Nonetheless, the decision algorithm must account for patient‑specific factors such as comorbid depression, cardiovascular risk, and personal preference regarding route of administration. Moreover, drug–drug interaction potential, particularly via CYP3A4 inhibition, warrants vigilance when co‑prescribing antifungals or macrolide antibiotics with any progestogen. Ultimately, a nuanced, patient‑centered approach that weighs clinical indication, side‑effect tolerance, insurance coverage, and regulatory environment will optimize therapeutic outcomes across the spectrum of progesterone‑based therapies.