How We Can Optimize Dysmenorrhea Treatment: Real-World Results from a Cross-Sectional, Multi-Center Study

Dysmenorrhea is a common and disabling condition in women. We investigate the prevalence of endocrine dysmenorrhea treatment (EDT) and the use of pain medication in dysmenorrhea patients without surgically treated endometriosis (no-STE).

Patients were recruited for a cross-sectional multicenter study from two German university hospital endometriosis centers. Additional participants were enrolled with support of the German Endometriosis Association. A total of 821 premenopausal women with dysmenorrhea were examined. 266 had no STE, 42 of whom underwent surgery.

The study aimed to assess real-world treatment patterns for dysmenorrhea in women without surgically treated endometriosis. Only 35.7% of the no-STE patients (n = 95) were currently receiving EDT and 241 (90.6%) were taking pain medication for dysmenorrhea. Menstrual pain remained high even under pain medication (5.06 [95% CI 4.58-5.55] visual analogue scale [VAS] vs. 4.63 [95% CI 4.29-4.98] in patients with and without EDT; F = 2.073 p > 0.05). 149 (87.1%) of the patients who did not take EDT also did not undergo surgery for diagnosis and treatment of dysmenorrhea. Combined oral contraceptives as EDT were utilized cyclically by 14 (14.7% of EDT users) and in an extended/continuous use by 27 patients (28.4% of EDT users). Long term intake of progestin only preparations was utilized by 38 patients (40% of EDT users). The reasons for refusing EDT were analyzed in detail.

Many patients refuse to undergo long-term EDT. The reasons for refusal are often not in line with current guidelines. Clinicians should better inform their patients about the advantages and disadvantages of EDT and surgery in the diagnosis and treatment of endometriosis related symptoms.