Dydrogesterone for HRT: Safer Progestogen Choice?
Menopause can bring hot flashes, night sweats, mood changes, and more. Hormone Replacement Therapy (HRT) is often life-changing—but a big concern for many is the progestogen component, especially its impact on breast cancer risk, side effects, mood, and clotting. One progestogen that increasingly comes up in evidence is dydrogesterone. This blog explores what the research says, how it compares to other progestogens, and how to decide if it might be a right choice for you.
What is Dydrogesterone?
Dydrogesterone is a synthetic progestogen (progestin) structurally very similar to natural progesterone. It has long been used for a variety of gynecological issues (bleeding disorders, PMS, infertility support) and is now being re-introduced into HRT options in the UK.
Until recently in the UK, dydrogesterone was only available as part of a fixed oral combination with estradiol (Femoston). But as of 2025, dydrogesterone has been brought back to the UK market as a standalone progestogen, which means it can now be prescribed with transdermal estradiol (patches, gel or spray)—a combination many women and clinicians prefer for safety and flexibility.
This is an important development because it expands options for women who want:
The benefits of transdermal estradiol (lower blood clots risk vs oral estrogen).
A gentler, well-tolerated progestogen with a favourable risk profile.
More flexibility to personalise their HRT plan, rather than being limited to a single fixed-dose tablet.
Evidence in Favour of Dydrogesterone in HRT
Recent studies and guidelines suggest that dydrogesterone may have a more favourable safety profile compared to more “androgenic” progestogens (like medroxyprogesterone acetate or norethisterone):
A UK study (GM-MMG guidance) notes that dydrogesterone is associated with fewer side effects and lower risk of venous thromboembolism (VTE) than many other oral progestogens. GMMMG
Observational and case-control studies indicate that the breast cancer risk for women using estradiol + dydrogesterone is lower than for those using estradiol + more androgenic progestogens. For example, Schneider et al. (Climacteric, 2009) found that breast cancer incidence among users of estradiol/dydrogesterone was modest, and in some comparisons, lower than with other combined HRT formulas. PubMed
Ultra-low dose estradiol + dydrogesterone (0.5 mg/2.5 mg) has been shown to reduce vasomotor menopausal symptoms (hot flushes etc.) with a favourable side effect profile in recent trials. ScienceDirect
How Dydrogesterone Compares: Pros & Considerations
Pros:
Lower breast cancer risk in some observational data versus other progestogens.
Less androgenic side effects (e.g. less impact on mood, fewer adverse metabolic effects).
Good endometrial protection when used with estradiol (in combined HRT), even in women with intact uterus.
Considerations / Cautions:
As with all HRT, the risk depends on dose, duration of use, timing since menopause onset, and individual risk factors (family history of breast cancer, VTE risk, cardiovascular risk).
Who Might Benefit from HRT with Dydrogesterone
Dydrogesterone might especially appeal to women who:
Are concerned about side effects from “stronger” progestogens.
Have experienced mood impacts with other progestogens.
Have risk factors for VTE or cardiovascular disease and want a safer progestogen option.
Prioritise safer breast cancer risk profile and gentle metabolic effects.
Making the Choice: What to Ask & What to Monitor
If you and your clinician are considering HRT with dydrogesterone, you might discuss:
What estradiol dose will be used (lower doses often have fewer risks).
How long progestogen treatment will be needed.
Monitoring breast health, cardiovascular markers, and symptoms.
Starting timing: earlier in menopause tends to have more benefit vs risk.
FAQ
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Evidence suggests it has a lower risk for breast cancer and VTE compared to more androgenic progestogens, though “safer” does not mean “no risk.”
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Yes, when used appropriately with estrogen (in combined HRT), dydrogesterone provides endometrial protection, reducing the risk of hyperplasia.
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ome women report breast tenderness, mood changes, or breakthrough bleeding, but these tend to be less severe than with other progestogens for many users.
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Duration should be tailored: starting earlier in menopause is preferable; risks and benefits should be reviewed annually. Many guidelines suggest limiting duration where risk factors are high, but with careful monitoring, use beyond 5 years may still be considered in low-risk individuals.
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Potentially yes—it’s one of the options often better tolerated in women with mood sensitivity or moderate risk factors. But full medical assessment is essential, including cardiovascular, breast, VTE risk history.