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

Abstract

Introduction

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).

Material and Methods

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.

Results

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.

Conclusion

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.

Zusammenfassung

Einleitung

Dysmenorrhö ist eine häufige und belastende Erkrankung bei Frauen. Ziel dieser Studie war es, die Prävalenz endokriner Therapien der Dysmenorrhö (EDT) sowie den Einsatz von Analgetika bei Patientinnen mit Dysmenorrhö ohne chirurgisch behandelte Endometriose (no-STE) zu untersuchen.

Material und Methoden

Es wurde eine multizentrische Querschnittsstudie an 2 deutschen universitären Endometriosezentren durchgeführt. Zusätzliche Teilnehmerinnen wurden mit Unterstützung der Endometriose-Vereinigung Deutschland rekrutiert. Insgesamt wurden 821 prämenopausale Frauen mit Dysmenorrhö eingeschlossen, darunter 266 Patientinnen ohne STE, von denen 42 eine operative Diagnostik oder Therapie erhielten.

Ergebnisse

Ziel war die Erfassung realer Behandlungsstrategien bei Dysmenorrhö ohne chirurgisch behandelte Endometriose. Lediglich 35,7% der No-STE-Patientinnen (n = 95) erhielten aktuell eine EDT, während 241 Patientinnen (90,6%) Analgetika zur Schmerztherapie einnahmen. Trotz Schmerzmedikation blieb die menstruelle Schmerzintensität hoch (VAS 5,06 [95%-KI 4,58–5,55] vs. 4,63 [95%-KI 4,29–4,98] bei Patientinnen mit bzw. ohne EDT; F = 2,073; p > 0,05). Von den Patientinnen ohne EDT unterzogen sich 149 (87,1%) auch keiner operativen Diagnostik oder Therapie hinsichtlich der Dysmenorrhö. Kombinierte orale Kontrazeptiva wurden als EDT zyklisch von 14 (14,7% der EDT-Anwenderinnen) und im Langzyklus/kontinuierlich von 27 Patientinnen (28,4% der EDT-Anwenderinnen) eingesetzt. Eine Langzeiteinnahme von Gestagenmonopräparaten erfolgte bei 38 Patientinnen (40% der EDT-Anwenderinnen). Die Gründe für eine Ablehnung der EDT wurden detailliert analysiert.

Schlussfolgerung

Viele Patientinnen lehnen eine EDT insbesondere im Langzeitzyklus ab, wobei die angegebenen Gründe häufig keine leitliniengemäßen Kontraindikationen sind. Ärztinnen und Ärzte sollten ihre Patientinnen umfassender über Nutzen und Risiken sowohl der EDT als auch chirurgischer Verfahren in der Diagnostik und Therapie endometrioseassoziierter Symptome aufklären.

Keywords

dysmenorrhea - dienogest - endometriosis - migraine disorders - combined oral contraceptives

Schlüsselwörter

Dysmenorrhö - Dienogest - Endometriose - Migräne - kombinierte orale Kontrazeptiva

Publication History

Received: 10 May 2025

Accepted after revision: 27 September 2025

Article published online:
17 November 2025

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