Dienogest, a fourth-generation progestogen used for endometriosis, acts by which primary mechanism?

• A GnRH receptor agonism causing pituitary downregulation
• B Selective progesterone receptor activity causing local decidualization, anti-proliferative effect, suppression of local estrogen production, and anti-inflammatory action on endometriotic implants ✓
• C Aromatase inhibition reducing local and systemic estrogen
• D Anti-androgenic action reducing VEGF and endometriotic angiogenesis

Explanation

Dienogest (2 mg/day) is a selective progestogen without androgenic or glucocorticoid activity that acts on progesterone receptors in endometriotic tissue to induce decidualization, inhibit cell proliferation, reduce local aromatase activity (lowering intraperitoneal estradiol), and suppress pro-inflammatory cytokines such as IL-1β and TNF-α. It creates a 'pseudo-decidualization' effect without the systemic hypo-estrogenic side effects of GnRH agonists. It is approved for long-term use (>6 months) unlike GnRH analogues.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.