Background

Progesterone is essential for menstrual regulation, implantation, and maintaining pregnancy by supporting endometrial transformation, immune modulation, and reduced uterine contractility. Low progesterone leads to irregular menstruation, endometrial risks, infertility, miscarriage, and preterm labour. Various progestogens—oral, vaginal, IM, and sustained‑release forms—address these deficiencies, each with differing bioavailability and side‑effect profiles. Dydrogesterone (DYD) is highly selective, orally effective, and well tolerated, making it suitable for reproductive disorders and luteal phase support. However, there is no clear understanding on the different forms of progesterone prescribed in various conditions, the dosage regimen, duration, etc.

Objective

To assess the prescribing patterns of Indian gynaecologists regarding progesterone supplements and identify the key factors influencing their clinical choices.

Methods

• This cross‑sectional digital survey of Indian gynaecologists used a validated questionnaire (Nov 2022–Aug 2023) to assess patterns in prescribing progesterone preparations such natural micronized progesterone-sustained release (NMP-SR), oral NMP and DYD, including usage, duration, preferences, side effects, and criteria for selection
• The questionnaire also aimed at understanding the treatment regimens for preterm birth (PTB), luteal phase support (LPS) in assisted reproductive technology (ART), threatened abortion (TA), and recurrent abortion (RA)
• Ethical approval and digital consent were obtained
• Data were analysed descriptively using frequencies, percentages, tables, and graphs

Results

• A total of 513 gynecologists participated in the survey 
• The percentage of patients who are prescribed the different progesterone supplements is shown in figure 1.

Figure 1. % of patients prescribed different progesterone supplements

Figure 2. Preferred progesterone supplementation for each indication

• For PTB
  1. DYD 10 mg twice daily (bid), NMP-SR 200 mg bid and NMP vaginal capsule 200 mg vaginal capsule bid was preferred by 75.8%, 63.9% and 62.6% of gynecologists respectively
  2. About 49.1% prescribed progesterone supplements upto 34 weeks
• For LPS in ART
  1. DYD 10 mg twice daily (bid), NMP-SR 200 mg bid and NMP vaginal capsule 200 mg vaginal capsule bid was preferred by 74.1%, 54.8% and 50.3% of gynecologists respectively
  2. About 55.2% prescribed progesterone supplements upto 12-13 weeks
• For TA
  1. DYD 10 mg twice daily (bid), NMP-SR 200 mg bid and NMP vaginal capsule 200 mg vaginal capsule bid was preferred by 65.3%, 56.3% and 48% of gynecologists respectively
  2. About 46.8% prescribed progesterone supplements upto 12-13 weeks
• For RA
  1. DYD 10 mg twice daily (bid), NMP-SR 200 mg bid and NMP vaginal capsule 200 mg vaginal capsule bid was preferred by 70.8%, 51.5% and 47.6% of gynecologists respectively
  2. About 56.1% prescribed progesterone supplements upto 20 weeks
• Common side effects associated with oral progesterone were drowsiness or giddiness, nausea/vomiting, migraine/headache and abdominal pain/bloating
• Side effects with vaginal progesterone included vaginal irritation or dryness, soreness and skin rashes
• The key factors that influenced the prescription of progesterone supplements were patient’s obstetrics history (26.2%), indication (18.6%), and route of administration / efficacy (12.2% each)
• About 67.8% gynaecologists prescribed multiple progesterone preparations in combination and of these 38.7% combined DYD + NMP-SR, 28.2% NMP vaginal capsule + DYD, 21.4% DYD + Injectable, 10.8% NMP-SR + NMP vaginal capsule
• In TA, DYD 40 mg was prescribed immediately followed by 30mg/day for 7 days by 43.5%
• About 35.8% preferred DYD 10 mg thrice daily to prevent preterm labour in case of twin pregnancy
• Serum progesterone levels are not measured before starting the therapy by 69.4%

Conclusion

• Progesterone and dydrogesterone are widely used to manage high‑risk pregnancies, supporting luteal phase supplementation, preventing preterm birth, and reducing miscarriage risk
• Dydrogesterone emerged as a crucial component in the realm of pregnancy care due to its strong receptor affinity, minimal side effects, and proven efficacy in preventing miscarriage making it a preferred option for managing pregnancy‑related conditions

Int J Reprod Contracept Obstet Gynecol. 2024 Jul;13(7):1805-1811.