Dienogest (Visanne) for Endometriosis: What to Expect and What to Track

Dienogest is a hormone tablet for endometriosis pain. It is a progestogen, which is a medicine that acts like the hormone progesterone, and you take one tablet every day without a break. Visanne is a brand name for dienogest 2 mg.

If your doctor has just prescribed it or offered it to you, this guide covers what the first 3 months can feel like, how long pain relief can take, and what to write down each week. It is general information. Your own doctor decides what is right for you.

For a comparison of all the main treatments, see our guide to endometriosis treatment options. This page is only about dienogest.

What dienogest is and who it is for

The UK Summary of Product Characteristics (SmPC) is the official information for prescribers. It lists one use for dienogest 2 mg tablets: the treatment of endometriosis. It puts the medicine in the group called progestogens. Dienogest lowers the amount of oestrogen (estradiol) that your body makes. Endometriosis tissue needs oestrogen to grow, so with less of it, the tissue shrinks over time (UK SmPC).

Guidelines in Europe and the UK support this kind of treatment. The European Society of Human Reproduction and Embryology (ESHRE) strongly recommends progestogens to reduce endometriosis pain. It also tells doctors to consider the different side effects of each progestogen, and to choose a treatment together with you (ESHRE). NICE in England tells doctors to offer hormone treatment, "for example, the combined oral contraceptive pill or a progestogen", to people with suspected, confirmed or recurrent endometriosis (NICE NG73).

The SmPC lists conditions where dienogest must not be used. Tell your doctor if you have, or have had, any of these:

• A blood clot in a vein now
• Heart or artery disease, such as a heart attack or a stroke
• Diabetes that has damaged your blood vessels
• Severe liver disease, or a liver tumour
• A cancer that is sensitive to sex hormones, or a suspected one
• Vaginal bleeding that has no known cause

Tell your doctor about your other medicines too. Some epilepsy medicines, the antibiotic rifampicin and St John's wort can make dienogest work less well (UK SmPC).

Where dienogest is sold

UK. Dienogest 2 mg tablets have a UK licence. The UK SmPC names the product "Dienogest 2 mg tablets" and "Endovelle 2 mg tablets", so the name on your pack may not be Visanne (UK SmPC).

European Union. Dienogest 2 mg was first launched in Japan in 2008 for endometriosis. It was approved for endometriosis in the European Union in 2009 (Li et al.).

Australia. Dienogest, sold as Visanne, was added to the Pharmaceutical Benefits Scheme (PBS) in December 2024. The listing cut the price by about half, from around $750 a year. It was the first new endometriosis medicine on the PBS in 30 years (newsGP).

United States. Dienogest is not sold on its own in the US. The FDA has approved it only as part of combined birth control pills, such as Natazia (Barbieri, OBG Management). If you live in the US, ask your doctor about the other hormone treatments that ESHRE recommends for endometriosis pain. These include other progestogens, combined hormonal contraceptives, a hormonal IUD and the contraceptive implant (ESHRE). An article in OBG Management, a US journal for gynecologists, points to a study where norethindrone acetate, another progestogen, eased pelvic pain about as well as dienogest. Dienogest caused fewer side effects in that study (Barbieri).

What the first 3 months can feel like

From left to right: early weeks, noting spotting; middle weeks, resting at home; around month three, feeling better outdoors.

The SmPC says side effects are more common in the first months, and they become less common as you keep taking the tablets (UK SmPC).

Bleeding and spotting

A change in your bleeding is the most likely thing you will notice. Most people who take dienogest have a change in their bleeding pattern, such as spotting, irregular bleeding or no bleeding at all. You keep taking the tablets every day, whatever your bleeding does (UK SmPC).

In the trials, people wrote their bleeding in a diary. Here is what the SmPC reports:

One person can have more than one pattern, so each column adds up to more than 100%. The numbers show the usual course. Long and irregular bleeding are common at the start and become less common later, and more people stop bleeding.

A 2024 review pooled 39 studies of dienogest. Abnormal or irregular bleeding was the most common side effect, at 55%. About 17% had no periods (Li et al.). The studies differed a lot, so treat these as rough numbers.

Other side effects

In the main trials, the side effects reported most often were (UK SmPC):

• Headache: 9.0%
• Breast discomfort: 5.4%
• Low mood (depressed mood): 5.1%
• Acne: 5.1%

The SmPC also lists weight gain, hot flushes, trouble sleeping, less interest in sex, hair loss, nausea, belly pain, back pain and ovarian cysts as common side effects. Common means that they affect between 1 and 10 people in every 100.

The 2024 review found similar rates. Bloating or swelling was 13%, headache 8%, and breast tenderness, weight gain, mood changes, hot flushes and lower sex drive were each about 7% (Li et al.).

It is not a contraceptive

The SmPC says dienogest stops ovulation in most people, but it is not a contraceptive. You must stop any hormonal contraception before you start. If you need contraception, use a method without hormones, such as condoms (UK SmPC).

How long until the pain improves

The main trial for the SmPC compared dienogest with a dummy tablet (placebo) for 3 months in 198 people with endometriosis. After 3 months (UK SmPC):

• Pelvic pain went down by an average of 27.4 points on a 0 to 100 scale. That is roughly 2.7 points on a 0 to 10 scale.
• Pain went down by half or more in 37.3% of people on dienogest, and in 19.8% of people on placebo.
• Pain went down by three quarters or more in 18.6% on dienogest, and in 7.3% on placebo.

A follow-on study suggested that pain kept improving for up to 15 months. So 3 months is a fair first check, and it may not be the full effect. Ask your doctor when they want to review how the treatment is going.

A 2025 Cochrane review looked at 33 trials of progestogens. Tablets like dienogest probably reduce overall pain and period pain compared with placebo. Compared with GnRH agonists, pain relief may be about the same, but the tablets probably cause more side effects in total (Cochrane).

Dienogest does not work well for everyone. If your pain has not changed by your review, or the side effects are hard to live with, that is useful information for your doctor. ESHRE tells doctors to take side effects and how well a treatment works for you into account when they choose (ESHRE).

Bone density and mood

Bone density

Dienogest moderately lowers your body's own oestrogen, and oestrogen helps keep bones strong. Here is what the SmPC reports (UK SmPC):

• Adults. In 21 adults, average bone density did not go down after 6 months. There are no long-term data on bone density or fractures in adults.
• Teenagers (12 to 17). After 12 months, bone density in the lower spine went down by 1.2% on average, and about 72% had some decrease. In a smaller group, bone density partly recovered 6 months after they stopped. Nobody knows yet if this changes fracture risk later in life.
• Higher risk of osteoporosis. Doctors should weigh the risks and benefits carefully before they start dienogest.
• Calcium and vitamin D. The SmPC says enough calcium and vitamin D, from food or supplements, is important for bone health at all ages.

ESHRE also notes that some progestogens may decrease bone density in teenagers (ESHRE).

Mood

Low mood is one of the most common side effects, at 5.1% in the trials. The SmPC says people with a history of depression should be watched carefully, and the medicine should be stopped if serious depression comes back. A long-term study followed 3,023 people who started dienogest. It could not rule out a slightly higher risk of depression compared with other endometriosis medicines (UK SmPC).

If you have had depression before, tell your doctor before you start. Our article on endometriosis, depression and anxiety has more on the link between pain and mood.

What to track each week

The first 3 months give you and your doctor the answer to one question: is this medicine worth staying on? A short weekly note puts that answer on paper. NICE tells doctors to let people with endometriosis know that a pain and symptom diary can help their discussions (NICE NG73).

Each week, write down:

• Bleeding days. Which days you had spotting, and which days you had bleeding that needed a pad or tampon.
• Pain score. Your usual pain and your worst pain, from 0 to 10, and what the pain stopped you doing.
• Mood. How many days you felt low, anxious or irritable.
• Sleep. How many nights were poor, and if pain or other symptoms woke you.
• Side effects. Headaches, breast discomfort, acne, bloating, hot flushes or anything new.
• Missed tablets. Any day you missed a tablet, or had vomiting or diarrhoea soon after one.

Before you start, write down one week of your usual symptoms if you can. It gives you something to compare with. For help with the pain score, see how to describe period pain.

Endolog is a pain and symptom diary for endometriosis. You log pain, bleeding, mood, sleep and notes on the days they happen. After 3 months, you have a record to show your doctor at your review. A paper notebook works too. Try to write your note on the same day each week.

When to call your doctor

The SmPC points to these warning signs (UK SmPC).

Get emergency help (999 in the UK, 911 in the US, 000 in Australia) if:

• You think you have a blood clot. The SmPC says to stop treatment at once if a clot is suspected. The leaflet in your pack lists the signs.
• You have severe pain in your upper belly.

Call your doctor soon if:

• Your bleeding is heavy and does not stop. Heavy bleeding over time can cause anaemia.
• Your mood gets low, or depression comes back.
• Your skin or eyes turn yellow, or you get itching all over.
• You get new pelvic pain. Cysts on the ovaries can form while you take dienogest. Most cause no symptoms, but some cause pelvic pain.
• You could be pregnant. Dienogest must not be taken in pregnancy.
• Your blood pressure is high on more than one reading.

Talk to your doctor at your review if:

• Your pain has not improved.
• The side effects make daily life hard.
• The bleeding pattern still bothers you after the first few months.

Talk to your doctor before you stop the tablets, except in an emergency such as a suspected blood clot. Your doctor can help you decide what to do next.

Frequently asked questions

Is Visanne the same as dienogest?

Yes. Visanne is a brand name for dienogest 2 mg tablets (newsGP). In the UK, the same medicine is sold under other names (UK SmPC).

How do I take dienogest?

The SmPC says to take one tablet each day without a break, if possible at the same time each day. You take it whether or not you are bleeding. Follow your prescription and the leaflet in your pack (UK SmPC).

Will dienogest stop my periods?

It can. Only 1.7% of people had no bleeding in the first 90 days. Near the end of the first year, 28.2% had no bleeding (UK SmPC).

Does dienogest cause weight gain?

Weight gain is a common side effect in the SmPC, so it affects between 1 and 10 people in every 100 (UK SmPC). In the 2024 review, weight gain or swelling was about 7% (Li et al.).

Will dienogest affect my fertility later?

NICE says hormone treatment for endometriosis has no permanent negative effect on fertility (NICE NG73). The SmPC says the menstrual cycle usually returns to normal within 2 months after you stop dienogest (UK SmPC).

Can I use dienogest as birth control?

No. It stops ovulation in most people, but the SmPC says it is not a contraceptive. Use a method without hormones, such as condoms, if you need contraception (UK SmPC).

This article is for general information. It does not replace advice from your own doctor, who decides what treatment is right for you. If you think you have an emergency, call 999 in the UK, 911 in the US or 000 in Australia.