Menstrual Distress Beyond Pain in Endometriosis

Menstrual Distress in Endometriosis Extends Beyond Pain to Multidimensional Symptom Burden

Key Points

Highlights: 

• Women with endometriosis experience significantly higher menstrual distress compared with women without the disease. 
• Menstrual distress in endometriosis is multidimensional and associated with urogenital, gastrointestinal, sexual, cognitive, and sleep-related symptoms. 

Importance:

• Systematically assessing menstrual distress and factors affecting it are important, so that women can receive the care they need in a timely manner.

What’s done here:

• In this cross-sectional study, 75 women with surgically or clinically diagnosed endometriosis were compared with 75 age-matched controls. 
• Menstrual distress and associated symptoms were assessed using the validated Menstrual Distress Questionnaire (MEDI-Q)

Key results:

• Women with endometriosis had significantly higher total menstrual distress scores and symptom distress subscale scores compared with controls.
• Higher distress was independently associated with dyspareunia, dyschezia, dysuria, gastrointestinal symptoms, reduced sexual desire, impaired concentration, and sleep disturbances.
• Menstrual bleeding intensity further amplified distress perception, particularly among women with coexisting adenomyosis.

Strengths and Limitations:

• Strengths are: the inclusion of an age-matched control group enhances interpretability of menstrual distress differences; the use of a validated multidimensional questionnaire allows comprehensive symptom assessment.
• Limitations are: the cross-sectional design precludes conclusions about causality between symptom burden and menstrual distress; the reliance on self-reported measures may introduce recall or reporting bias; relatively modest sample size limits generalizability and subgroup analyses.

From the Editor-in-Chief – EndoNews

"The clinical narrative of endometriosis has long been dominated by pain-centric frameworks, with dysmenorrhea frequently regarded as the principal driver of menstrual distress. This study contributes to a growing body of literature suggesting that the symptom burden associated with endometriosis is substantially more complex and multidimensional. By systematically evaluating menstrual distress using a validated instrument, the authors demonstrate that distress perception reflects not only nociceptive symptoms but also urogenital, gastrointestinal, cognitive, sexual, and sleep-related factors.

These findings reinforce the concept that menstrual distress represents a composite experience shaped by the interaction of physical symptoms and functional impairment rather than a single dominant symptom domain. The associations identified in this study underscore the importance of considering endometriosis as a multisystem condition in which symptom clusters may interact and amplify overall disease burden. Importantly, the observation that bleeding characteristics and coexisting adenomyosis further influence distress perception highlights the heterogeneity of clinical presentation and the need for individualized assessment.

From a clinical perspective, the study supports the value of structured symptom evaluation tools in capturing dimensions of disease impact that may otherwise remain underrecognized during routine consultations. Integrating multidimensional assessments into clinical practice may facilitate more comprehensive management strategies that extend beyond analgesic approaches to include interventions targeting sleep disturbance, sexual health, and functional well-being.

At the same time, the cross-sectional design limits the ability to determine causal relationships between symptom clusters and distress severity. Whether the observed associations reflect underlying disease mechanisms, shared pathophysiological pathways, or the cumulative effect of chronic symptom burden remains an open question. Larger longitudinal studies will be needed to clarify temporal relationships and to determine whether targeted management of specific symptom domains can meaningfully reduce overall menstrual distress.

In summary, this work adds important evidence supporting a broader conceptualization of menstrual distress in endometriosis. By emphasizing multidimensional symptom contributors, it encourages clinicians and researchers to move beyond pain-focused paradigms toward more integrated models of disease assessment and patient-centered care."

Lay Summary

Delayed recognition of the full symptom burden of endometriosis remains a challenge, as clinical attention has traditionally focused on pain alone.

A new study published in theEuropean Journal of Obstetrics and Gynecology and Reproductive Biology shows that menstrual distress in women with endometriosis is significantly greater than in women without the disease and is influenced by a broad range of physical and functional symptoms.

To better quantify menstrual distress and identify its determinants, researchers led by Dr. Felice Petraglia at the University of Florence conducted a cross-sectional study including 75 women newly diagnosed with endometriosis and 75 age-matched healthy controls. Participants completed the validated Menstrual Distress Questionnaire (MEDI-Q), which assesses symptom burden across multiple domains.

Women with endometriosis had significantly higher overall menstrual distress scores and higher symptom distress subscale scores than controls. Distress was associated not only with pelvic pain symptoms such as dyspareunia and dyschezia but also with gastrointestinal complaints, urinary symptoms, reduced sexual desire, impaired concentration, and sleep disturbances. Greater bleeding-related discomfort, particularly among women with coexisting adenomyosis, further amplified distress perception.

These findings highlight that menstrual distress in endometriosis reflects a multidimensional experience rather than a single symptom domain. Systematic assessment of distress and its contributing factors may help clinicians adopt more personalized and comprehensive management strategies.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41548348/