theendopedia

Dienogest for endometriosis

Pharmaceutical

Last reviewed

Dienogest is a daily 2 mg progestin tablet developed specifically for endometriosis and licensed for that purpose across Europe, Japan, much of Asia, Latin America, and (since 2024) Australia. The evidence base for pain reduction is among the strongest of any endometriosis treatment, but a meaningful minority of people stop because of mood changes, irregular bleeding, or other progestin side effects.

Research status

Well Studied

Endo-specific

Yes

Community signal

Mixed

How does Dienogest work?

Dienogest is a fourth-generation progestin — a synthetic version of progesterone — that works on endometriosis through two routes at once. By binding strongly to progesterone receptors, it suppresses ovulation and lowers oestrogen production by the ovaries to a low-but-physiological range, which starves endometriosis lesions of the oestrogen they depend on to grow. It also acts directly on the lesions themselves, reducing the proliferation of endometrial-like cells and dampening the local inflammatory response. Unlike GnRH agonists, it does not produce a deep menopause-like state, which is why hot flushes and severe bone loss are less common, though some bone density loss can still occur with long-term use. It has anti-androgenic activity (rather than the androgenic effects of older progestins), which means it tends not to cause acne or hirsutism. It is not a contraceptive in the conventional sense — pregnancy can still occur, so a non-hormonal method is needed if pregnancy is to be avoided.

What does the research show about Dienogest for endometriosis?

Below are studies linked to this intervention in our database, with design, quality, and outcomes summarised for quick scanning. Endo-specific evidence in this entry: Yes.

23 studies

  • Dienogest vs. combined oral contraceptive: A systematic review and meta-analysis of efficacy and side effects to inform evidence-based guidelines

    Vannuccini S et al. · 2025

    Meta-analysisEndometriosis-specificQuality: High

    No statistical difference in pelvic pain reduction between dienogest and COC; dyspareunia was significantly better controlled by COC; tolerability profiles differed.

    View publication

  • GnRH analogues and dienogest for second line treatment of endometriosis-associated pain: a systematic review, meta-analysis, and network meta-analysis

    Abou-Setta AM et al. · 2025

    Meta-analysisEndometriosis-specificQuality: High

    Network meta-analysis: oral GnRH antagonists were most effective for dysmenorrhoea, but dienogest had the best safety/tolerability profile and was more beneficial for dyspareunia.

    View publication

  • A systematic review and Bayesian analysis of the adverse effects of dienogest

    Zhang L et al. · 2024

    Systematic reviewEndometriosis-specificQuality: Medium

    39 publications; adverse drug reactions are mostly common and non-serious, but identified depression, asthenia, and serious abnormal uterine bleeding as uncommon serious events warranting attention.

    View publication

  • The Efficacy of Dienogest in Reducing Disease and Pain Recurrence After Endometriosis Surgery: a Systematic Review and Meta-Analysis

    Vignali M et al. · 2023

    Meta-analysisEndometriosis-specificQuality: High

    9 studies (n=1668); dienogest reduced both disease and pain recurrence after surgery vs alternatives, with different side-effect profile than GnRH agonists.

    View publication

  • ESHRE guideline: endometriosis (2022)

    Becker CM et al. · 2022

    SurveyEndometriosis-specificQuality: High

    Recommends progestogens (including dienogest) as first-line hormonal therapy for endometriosis pain, alongside combined hormonal contraceptives.

    View publication

What do people in online endo communities say about Dienogest?

Community signals are indicative only — they reflect informal conversation in endometriosis-focused spaces. People posting may or may not have a formal diagnosis; this is not a substitute for clinical evidence or care.

Reddit

Mixed · 500 mentions

HealthUnlocked

Mixed · 200 mentions

  • “Visanne stopped my periods and gave me my life back — pain went from 9/10 to 2/10 within 3 months”

    — Reddit

  • “I made it two months before the mood swings made me unrecognisable to my partner, had to come off”

    — Reddit

  • “First few months were brutal with the irregular bleeding but it eventually settled and I haven't had a bad pain day in a year”

    — Reddit

  • “It's been a long bumpy road but Visanne is the most manageable hormonal I've tried from a mental health view”

    — HealthUnlocked

  • “I was miserable all the time on it, didn't even last two months — went back to the progesterone-only pill”

    — HealthUnlocked

  • “Hair thinning, half a stone of weight I can't shift, but only a few days of spotting all year — it's helping me function while I wait for surgery”

    — HealthUnlocked

How is Dienogest typically used?

Practical notes

Standard dose is 2 mg once daily, taken at roughly the same time each day, continuously without a break between packs. It can be started on any day of the cycle and can be taken with or without food. Most people develop irregular bleeding or spotting in the first 3–6 months that often settles into amenorrhoea or light bleeding; the bleeding pattern is the most common reason for early discontinuation alongside mood effects. Common side effects include headache, breast discomfort, depressed mood, acne, weight gain, decreased libido, and bleeding irregularities — each typically reported in under 10% of users in trials, though real-world rates are often higher. Bone mineral density may drop modestly with long-term use, particularly in adolescents, where partial recovery is seen after stopping. Contraindications include active venous thromboembolism, severe liver disease, undiagnosed vaginal bleeding, and hormone-sensitive cancers. CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John's wort) lower its effectiveness. Dienogest is not approved by the US FDA as a stand-alone product (it is sold in the US only combined with estradiol valerate for contraception/heavy bleeding), which is why much of the English-language patient literature uses the brand name Visanne and refers to non-US prescribing.

What should you know before trying Dienogest?

Case reports of dienogest-induced major depression with suicidal ideation in people without prior psychiatric history have prompted post-2020 expert commentary recommending more cautious screening and monitoring of mood, particularly in the first three months. The large VIPOS real-world study (n=27,840) is examining this prospectively against other treatments.

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