International Medical Conference Endometriosis 2025:
Endometriosis 2025: Your Mother Should Know, Your Doctor Should Know Better!
Pain Perception in Young Women With Dysmenorrhea: Observations in a Novel Multiprofessional Treatment Setting - Sylvia Mechsner, MD
Sylvia Ner is a professor of endometriosis research at Charity 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. And in recognition of her contributions, she has received the treatment Newmann Prize from she foundation in 2012 and she is also received the Endometriosis Foundation of America's prestigious Harry Rich Award in 2023.
What is the cycle? What is normal, what is not normal? What is menstrual pain, how to treat pain, medication, self-management, food changes, exercises, whatever we found in the literature we put together and gave them the chance to handle the menstrual pain by themselves. And when the pain is not resolved, they are not able to go or the pain is going on. Then we invited them to come to an extended medical care. In our outpatient clinic we have a smaller group that is a waiting group without extended treatment. So we can compare later on the efficacy of our recommendations, the extended medical care included in gynecological examination. Also the extended ultrasound so that we can see maybe early signs of endometriosis. Endometriosis is not the idea to treat here. We want to treat the menstrual pain, but we want to distinguish the pathological dysmenorrhea from the non-pathological dysmenorrhea and we hopefully see in this medical care, special medical care, the ones with the higher risk for a later development of endometriosis. And of course we give advice what to do now and yes, I will show you later. Another point of this treatment strategy is to offer them two appointments with a nutritional counseling, two behavioral, another appointment to another appointments with a psychologist specialized on behavioral therapy and also we offer them six units of physiotherapy.
Yes, the gynecological colleague is doing then a reassessment looking for the severity of dysmenorrhea, looking for all the other stuff, what is going together with the pathological dysmenorrhea. Then she's doing and she's trained very well. We learned yesterday also how important an extended ultrasound is that we are able to see endometriosis and of course we pay fully attention on early signs of adenomyosis because we think also the uterus is a key factor in this disease. And of course the other stuff we hopefully not see in this group of patients. And then yes, we give recommendation how to go on because in case of treatment resistant dysmenorrhea, when nothing is working, then the next step is of course, and I fully agree with Professor Vini that we have to start with pulmonary treatment and nonstop mod dose. So let's have a deeper look in the first 10 patients, which finished completed the study.
As you can see here, a young patient group, severe dysmenorrhea, we are asking with or without pain medication without pain medication. It was severe dysmenorrhea and also with pain medications they suffer also from dysmenorrhea exceptional, this one, but maybe she's wrong. So the recruitment strategy is based on the app and maybe she gave some other wrong information that she was now here. But anyway, we gave her advice also that's clear. So some of them suffer also from Dysen and dys, uria and dys, some of them used already oral contraceptions in cyclical manner. And the ultrasound showed that we had three with early signs of adenomyosis. The other scans were negative and that is what we recommended. In the other cases we recommended to EPT and optimizing of the pain medication and in some cases we say of course oral contraception should be now used in a nonstop modes and in another patient with sign here with sea symptoms.
We gave also the recommendation now to go on with pulmonary treatment. So that is a physiotherapeutic assessment. It's done by Sonia Zda. Sonia Zda is a really highly educated physiotherapist. She has a master of science and she's highly specialized in pelvic floor physiotherapy. I really like amazing what she is thinking about the pelvic floor and what she is knowing about the function of the pelvic floor and so on. So she did also then clinical assessment of all the interesting symptoms the patient could have, especially also low back pain. So she did a very extensive anamnesis about all the staff also in regard to the muscle hypotonus in general and in the pelvic floor muscles. But she looked also or asked also for limited rage, motion of the hip joints, lumbar spine and other stuff, which is often also involved when patients have a higher hypotonus in the pelvic floor. The temporal modular joint dysfunction for example on the cervical spine and neck. Also, she's looking for breathing and relaxing and yes, she is doing also a survey for secondary diagnosis like surgeries, accidents, braces, medications, survey of limitations of complaints, quality of life, collections of hobbies, sport activities, menstrual symptoms. So she has a lot to ask and to do with the patients. And then she has six units, she has time to see the patients.
She is doing everything online. So with video tools and self palpation and pelvic floor, Anna to me, she figured out the symptoms and so on together with the patients. And then she give advice for special exercises with videos and she has done other appointments together with the patients to check if they are doing well, what else they need and so on. So six units of physiotherapy, the results of her first appointment. I was really a little bit shocked when I saw this result because yeah, it's interesting that patients have so many symptoms. Yes here, abdominal pain and dys hernia. It's also very interesting that reported more frequent the DYS hernia. Then with our gynecological call that is interesting. Also, low back pain is often sometimes fatigue, but as we expected, the pelvic floor is also very important cause of pelvic pain and we see a lot of changes here, hypo muscles but also hypot tone, muscles and dis balances of the pelvic floor.
Also problems with joints and also the temporal mandibula one is not, excuse me, not seldom affected neck and shoulder issues breathing and relaxing. So really interesting how many problems the patients have with the musculoskeletal system. And after six units of physiotherapy it looks completely different. So pain relief is present in or nearly all patients. Also DYS hernia was much better or not existent anymore. Yes, they feel much better from the subjective point of view of the patients. Of course also the pelvic floor changes were more normal and everything was better. Another point is the in badly and the gastrointestinal symptoms. So our nutritionist is doing this. She is also highly experienced. She is postdoc, so she did a lot of research in this field, not in this field. She's new in the field of endometriosis but in the field of nutrition. So I'm really happy to have such a highly educated team.
She asked for nausea, hunger attacks, fullness, feeling, loss of appetite, the end belly vomiting, diarrhea, constipation, and abnormal pain. Also, she did also a big assessment for these patients. And then our idea here was to give some advices for the food. More plant-based diet. Nutrition high in fiber should be the patients should reduce the meat intake. They should reduce wet intake because a lot of patients with endometriosis suffer from such a gluten sensitivity. We know that seafood intake should be increased, antioxidants should be increased reduction of histamine and painful periods and yes, consideration of individual intolerances because we know a lot of them have lactase intolerances and so on. And then she gives also an individual recommendation for each of them here, her results and the first consultation, a lot of patients suffer from the typical symptoms. The endo belly, she has finished already 12 patients, so 10 of the 12 suffer from this endo belly.
A lot of them have a loss of appetite, diarrhea, abdominal pain, and also nausea. That is a typical profile of patients with endometriosis. And after this more or less individual recommendation to change the diet, there is in most here and a lot here in 100% of the patients a complete reduction of the symptoms. Also here 100% are now better. Now here Bel is in 90% better. Loss of appetite was in 75% better. So also nausea was much better. So in only rare cases the symptoms were unchanged or some were unchanged and a lot of them were then without symptoms. So I think very interesting data from this preliminary first results of the study, she gave me two case reports to show you because it's really individual here.
This patient has digestive problems after consuming lactose rich products. So then she has diarrhea. So she recommended not to eat lactose rich product of course, but also there was almost a complete absence of fruits and vegetables in the nutrition of this patient. So she recommended diet increased in fibers and also that was very effective for this patient. So healthy food is also something we have to keep in mind in these patients. And another one here, she said, or she had the impression that histamine has a great impact in the pain modulation. So it was an anti-inflammatory diet for this patient and also a lot of the symptoms improved. Then another point is that this is very important that we have this psychological support in these patients and our psychologist has two consultations for each one hour that is also good. So her goal was to do a screening of psychopathology and this young wang because we wanted to exclude some patients with deep depression or anorexia or what else.
So that was also very important. And then she did a planning in supporting the implementation of the new self-care habits together with patients. So yoga for example, yoga for dealing with pain and stress and recommendations from the other professions to include all the stuff in the daily life because for young ladies it's not so easy to change everything, to do the physical activity, to keep in mind the diet and so on. And at the end she offered also psychological support because that is very difficult in Germany to get a place for psychological support. Also after the study, here are her results. What she is doing at the consultation, the first consultation she do the psychological evaluation. She plans the implementation of the new self-care habits. She support individual problems and coping. And the second consultation then that she looked that the implementation of the self-care habits were successful and were not why?
And she give recommendation for future psychological treatment if needed or support lacing transfer to a new knowledge from nutrition, psychotherapy and medical advice. And she discussed the experience in this study and here for the assessment of psychotherapy. So yes, she found within this 10 people, three, which were suspected for panic disorders, we heard also about this or social anxiety disorder. And also one had a depression and a fourth of them had already a diagnosed and were under treatment. It was also very good to see that in the, excuse me, during the second consultation, there was an improvement of panic attacks here present or a slightly improvement or it was untrained because they had no problems. But then another point is that they used the self-care strategies more frequent, so they were able to adapt in this situation that they also have to do something to get healthy and to stay healthy.
That is very interesting. Yes, that are the first observations and results here. And to conclude in the psychological assessment, she had three of 10 patients showed the previous untreated and undiagnosed clinical relevance psychological symptoms. One of 10 patients was already in one of the 10 patients was already in psychotherapy. And the self-care strategies were more frequent used and all 10 patients were highly satisfied with the study program as a whole and that they benefit from it. That was also good to see, to summarize the study is ongoing and that our preliminary data, normally I am not going around the world. It shows such preliminary data. But in regard to the motto of this meeting, I thought it was possible this chunks to show, but of course we have to be careful with the results now. But the screening of pathological disin was successful in this case. So in nine of 10 cases we had a pathological dysmenorrhea. In three of 10 we have signs for adenomyosis.
It was really interesting. We asked also what is helpful or not, and it was a little bit surprised that they don't use all units in the apps. That is something we have to improve. They prefer the personal mentoring with the gynecologist. Interestingly, they reported different complaints and pain levels to the different professions. A lot of they suffer a lot of muscle skeletal complaints resolve with exercises and a lot of the gastrointestinal symptoms improve with food changes. So this is for, in my knowledge, the first interdisciplinary approach for the treatment of menstrual pain care is very important and all of them have an improvement of symptoms. So hopefully the idea becomes true that onset of early treatment can prevent chronic pelvic pain and reduces the risk of progression of endometriosis. And hopefully I will report after end of the study maybe next year. That is the team, highly educated, specialized team and I'm very thankful that they are doing such a great work. Thank you.
