Background/Aims: Threatened miscarriage, marked by vaginal bleeding during the first 20 weeks of pregnancy, is a frequent complication with potential adverse outcomes. Dydrogesterone and micronized progesterone are commonly prescribed to manage this condition, yet their comparative efficacy remains under debate. This study aims to evaluate the effectiveness and safety of dydrogesterone versus micronized progesterone in treating threatened miscarriage. Methods: A retrospective case-control study was conducted at Our Hospital, including 123 pregnant women aged 6 to 20 weeks presenting with uterine bleeding. Participants were divided into two groups based on receiving either dydrogesterone (n=56) or micronized progesterone (n=67). Pregnancy outcomes, including miscarriage rates, preterm labor, and mode of delivery, were recorded and analyzed using SPSS software. Results: The miscarriage rate was slightly higher in the dydrogesterone group (9.6%) compared to the progesterone group (5.9%), though this difference was not statistically significant (p=0.729). Both groups exhibited high rates of successful delivery, with no significant difference between them (p>0.05). Additionally, no significant differences were observed in the incidence of pregnancy complications or mode of delivery between the two groups. Conclusion: Both dydrogesterone and micronized progesterone are effective in managing threatened miscarriage, with no significant differences in pregnancy outcomes. Further large-scale, randomized trials are needed to confirm these findings and refine treatment guidelines.