International Medical Conference Endometriosis 2025:
Endometriosis 2025: Your Mother Should Know, Your Doctor Should Know Better!
A Multidisciplinary Approach to Severe Dysmenorrhea in Young Females - Sylvia Mechsner, MD
Alright, our next speaker is Dr. Sylvia Messner. She is a professor of endometriosis research at Chaite University Hospital in Berlin where she leads the endometriosis research Center. Her work focuses on the pathogenesis and pain mechanisms of endometriosis advancing both scientific understanding and patient care. In recognition of her contributions, Dr. Messner has received the Freedman Newman Prize from the Sharing Foundation in 2012 and the Endometriosis Foundation of America's prestigious Harry Rich Award in 2023. Welcome.
Thank you so much for this kind introduction and also from me a great thank you to you for the invitation. It's a pleasure for me to be here and I enjoy this meeting very much, so many interesting talks. Yes. I have no conflict of interest for this talk. Yes, we heard a lot about endometriosis. It's a big challenge. One of the main problems is dysmenorrhea. We have to detect endometriosis earlier to avoid chronification of disease. So I think we agree all about this, but the big challenge is that more than 70% of all menstruating women suffer from dysuria. So this systematic revenue shows us very precisely that more than 70% suffer, as I told before from dysmenorrhea, but also from bloating, from breast pain and pre menstrual syndrome and so on. So the cycle is a every month challenge for every woman. And now the big problem is that we now have within all these people, the people who develop endometriosis, this is all the good survey done in Australia.
They did an accurate questionnaire about the pain severity about the DYS area and they agreed. So the study population was more than 4,000 young women from 13 to 25 and 92% suffer from dysmenorrhea. So in agreement with the previous data. And yes, two third of them suffer from very severe dysuria over six on the visual analog scale. And that is really heart pain for nearly 50 have also icic pain or sick notes or have other discomfort so that they have problems to concentrate. And that is a big problem because one, we look and that is a really big gender gap. I think what is then the result or the problem of dysuria, the recurrent parent menstrual, excuse me, pain is a problem for the brain because we have all this recurrent information on the spinal cord and the brain and then the central centralization started and pain induced, then the neuroplastic changes in the spinal cord in the brain.
That is a big problem and I think that is a very important research area that we have to focus on because patients suffering from dys areaa have a higher risk also for other pain conditions like chronic pelvic pain independent from endometriosis. We know also other symptoms like colitis ulcer, oid arthritis and so on. And that is also big issue. And we know that also a lot of people have more severe pain during the menstruation when they have other pain conditions. And that is really, really important. We need to focus on this research too. So yes, we know patients with endometriosis suffer from prim dysmenorrhea many years before the diagnosis has to be confirmed. We have this lack of diagnosis that is a big problem present in 2025. So I think we need to focus more on this situation of the adolescents with the primary dysmenorrhea.
We need to catch them up in this area maybe to avoid the ification of pain, the development of endometriosis. Maybe it's possible, I dunno. But at the moment we have a big lack of healthcare in this area. So in Germany it's exactly the a big problem because nobody wants to talk with young people about menstrual pain. And there's also a big problem, a lack of knowledge about the cycle. So I'm doing also student lecturing and that are smart people In Germany, it's really hard to get a place in the medical school. So they have a high degree, they finish the school with high degrees. But when I'm asking them what is the cycle? What is ovulation, what is menstruation, they're looking to me with a big questionnaire in their eyes they have no idea. I dunno, I'm really interested to ask you what is going on in your countries.
But in Germany it's a nightmare. It's a really nightmare. And that are smart people want to become a physician. And what is with the young ladies, very young people, they have no teaching about this problem. So there's a big lack of knowledge about the cycle. How many cycles are normal? Why is menstruation painful and what can they do? They have no advice in this situation. And that is because we know when we don't catch it early, the endometrial. And we have not only the endometriosis symptoms, we have the peripheral sensitization, the central sensitization and all the other comorbidities. So it's a big, big problem for so many million people. But the big challenge is now who is suffering from a normal menstrual pain and what is now a pathological menstrual pain that is created by my experience, I think we can all be agree that on the visual analog scale, four is of over six is not.
Six is not normal severe pain, but they often are also unable to go to school to go to work. Pain is always a subjective impression. So we need to talk about the young ladies about the severity of pain and when we are asking them how strong is the pain, in most cases they say, oh no, it's 10 I'm dying. But then when you have to explain the scale, so from three on you want to take a painkiller, 10 is a much the worst pain you ever can expect. And then they have to think about it in a normal situation they say, okay, three, I want to take a painkiller. Then it's five or six. So you need to talk to them when you want to have a valid answer about the severity of pain. Another point is I think often we have a therapy resistant situation with the painkillers and we often have cond, vegetative reaction, vomiting, MSS diarrhea and so on.
And we have also a treatment resistant dysmenorrhea under oral contraception when they have the withdrawal bleeding. It's also painful in this situation, but as I told you, it's difficult to speak about all the stuff. And in Germany we are lucky, we have a really good health system, really good. Every single woman has access to a gynecologist. So they can have the pap smear, they have to talk to them about contraception and can go with acute problems to the granite colleges. But they have only five to eight minutes and that is not enough to distinguish the staff with the dysmenorrhea. It's unbelievable. It's a situation that is a problem. There's no budget for more. And for this we created the idea how can we treat menstrual pain in young women. We created the idea of an app, app-based supported strategy. What did, we did a prospective study included 16 to 24 years old women.
So it is created for young women. We did stakeholder meetings and so on. We created the information and worked out the information, especially for young people with dysmenorrhea. For of thick without pain medication or for with pain medication. We excluded patients with known endometriosis because we don't want it to have them in the study. And the first step of the trial is then using the app. I will show you the content of the app that has a low threshold access to medical information treatment and treatment expertise is everything is included in this app. The idea was a pain reduction in prevention of complications and early intervention and they can use it later on. And we wanted to have a selection of patients maybe with a pathological dysmenorrhea. And then we have a second step of this trial with a multimodal approach that is the app. So at the moment we included 3,400 young ladies using the app. Now today we stopped the recruitment and they use it for 12 weeks. And when they have ongoing pain, they can in our new multimodal intensive care medical care with a gynecologist. And we included also multimodal treatment strategies with six appointments, with a few therapist, with a nutritionist, and also with a psychologist in this setting.
This is the idea. So they step in with the app, they use the app for 12 weeks. We have a population with a low risk, they can go on with the app. And we selected a population with a high risk for endometriosis. And so we have two arms AWAI group coming later. So we can compare the groups with each other and one group going into the multimodal treatment approach. And our primary endpoints are to reduce the number of pain days but also to reduce the intensity of pain, quality of life, self efficacy and so on. And we want to know how other people, we would like to have a characterization of this population. A couple of information about this app, as I told you, we created this app focused on this young group of patients. We give a lot of information about the cycle. What is normal, what is the cycle, what is normal, what is not normal?
They can track the menstruation, but they can put in also the severity of pain and they give also an overview. This app gives also an overview and we have a lot of information about self-care offers, yoga, aromatherapy, acupressure, all the scientific knowledge we put together about treatment of dysmenorrhea and what else. So we give also information about hygiene products, menstrual products, what else? A lot of, so there are 60 or more information units in this app and they should use it by themselves. So we give no advice, but we explained everything. What is the menstrual pain, how is the uterus cramping and what they need to do, how painkillers are available, how should they use painkillers? The lows, dosage, but they have to use it because that is another big problem in Germany. They don't want to use hormones at the moment, but they also decline to use painkillers.
They are very afraid about painkillers. So often there is more the situation. No, I live with my pain. I avoid to take a painkiller or I take it only in a situation I can't go on without. And that is not right. They have to learn, they need to get the knowledge to how to use the painkillers. That I think is very important. We give all this advice in this app also about exercises, self-care, nutrition, we bring everything together in this app. Anatomy is also a big part of this app. The anatomy about the pelvic pelvis, about the uterus, about the ovaries. We created videos, whatever our ideas. We had a lot of ideas and everything came together. And then the second part of this study is then the extended medical consultation. So a gynecological examination is included and also an extended ultrasound as you showed us. I think also that is very important because we can detect everything without, or we only peritoneal lesions are very difficult to detect. But that is also not the point at this stage of disease. But we have a good view on the uterus and of the sliding of the organs and everything. And then we speak again with the people about the severity of pain, how to go on it makes it sense to go on without hom treatment or is it possible?
Is it more sensible to use pulmonary treatment to use nonstop treatment? How is the risk if they have signs for of adenomyosis for example, it makes more sense to stop the bleeding because maybe they are of risk for endometriosis or is it enough to take only pain medication. But then we check again the advice, how they can use the pain medication that they have and good overview what they should do. And then they have two appointments with the nutritional counseling. Two, also psychological treat or counselings about behavioral therapy counseling because we can tell them a lot, but they need to change their life and that is also very important. And we give advice for this. And also six units with a physiotherapist. And we defined this lack of healthcare and we have a possibility in Germany to apply then for new idea of healthcare servers.
And we did it. And we have gotten the founding from the joint federal committees covered by the government. 6 million euros we have gotten for it. Yes. Yeah, I'm very proud about this project at the moment. Yes, the evaluating is going on, but the first preliminary results show an improvement of symptoms. They are very happy about this options. The young ladies, they don't want the, so our first experience with the app, they, it's not enough to have only an app. They want to have a good talk to the physician with time. And our physicians have one hour. And that is also the idea to bring this a screening program or something like that back into the healthcare system of course. Because I think with this we can have an early detection of endometriosis, maybe we can avoid progression of disease. We have maybe an early secondary prevention and hopefully we can avoid chronic pelvic pain syndromes and so on. Because I think it's very important to catch these people, to find the people with a risk. And I think a key point is aia, thank you so much. Tomorrow I give another talk about this study and show you first data about 10 of our patients with different colleagues.
