Dienogest-associated capillaroscopic abnormalities: a case report and narrative review of progestin microvascular effects.

Progestins are widely used for endometriosis with proven efficacy and favorable safety. Their microvascular effects, however, are not fully understood. We report a 35-year-old woman who developed recurrent hand erythema and significant nailfold videocapillaroscopy abnormalities after starting dienogest. This prompted a review of available evidence on the vascular impact of progestins, particularly dienogest. Current data indicate complex, dose-dependent effects on microcirculation. Dienogest appears to have a more favorable profile than other synthetic progestins, with limited impact on endothelial adhesion molecules and preservation of estrogen-induced vasodilation. Nonetheless, progestins can modulate endothelial proliferation, angiogenic factor expression, and vascular tone through genomic and non-genomic mechanisms. While generally safe, individual susceptibility to vascular effects may occur. Clinicians should be aware of potential microvascular manifestations during progestin therapy and consider capillaroscopy in patients presenting with relevant cutaneous changes.