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Updated: Apr 26, 2026

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
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Subarachnoid haemorrhage during premenopausal dienogest therapy in a patient with multiple risk factors

Toshiyuki Kojima1, Shigen Kasakura2, Hideto Gomibuchi3

  • 1Obstetrics and Gynecology, Muse Ladies Clinic, Fujimino, Saitama, Japan toxoplasma1111@gmail.com.

BMJ Case Reports
|April 24, 2026
PubMed

Insights

Dienogest (DNG) therapy may increase subarachnoid hemorrhage (SAH) risk due to a hypooestrogenic state. Screening for SAH risk factors and magnetic resonance angiography are recommended before initiating DNG treatment.

Area of Science:

  • Neurology
  • Endocrinology
  • Vascular Surgery

Background:

  • Subarachnoid hemorrhage (SAH) is a rare but serious complication.
  • Dienogest (DNG) is a progestin used for gynecological conditions.
  • A hypooestrogenic state induced by DNG may affect vascular health.

Purpose of the Study:

  • To report a third case of SAH during DNG therapy in Japan.
  • To investigate the potential link between DNG and increased risk of cerebral aneurysm rupture.
  • To propose revised screening protocols for patients on DNG therapy.

Main Methods:

  • Case report of a woman in her 40s diagnosed with SAH during DNG therapy.
  • Angiography revealed a ruptured anterior communicating artery aneurysm.
  • Implementation of a revised protocol including SAH risk factor screening and magnetic resonance angiography (MRA) for high-risk patients.

Main Results:

  • A 9.4 mm anterior communicating artery aneurysm was successfully treated with a Woven EndoBridge.
  • DNG therapy led to a significant drop in serum oestradiol levels.
  • Screening of 120 patients identified 10 with a family history of SAH; MRA detected one unruptured aneurysm in this group.

Conclusions:

  • Dienogest therapy may be associated with an increased risk of cerebral aneurysm rupture.
  • Pre-treatment assessment of cerebral aneurysm risk factors is crucial for patients considering DNG therapy.
  • Revised screening protocols, including MRA for those with a family history, can aid in early detection and prevention.

Keywords:
EstrogensInterventional radiologyMenopause (including HRT)NeurosurgeryObstetrics, gynaecology and fertility

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