L26/O-080 Predictors of satisfaction regarding hormonal therapy use in women with endometriosis and/or adenomyosis: Dutch results from the international TEPEA-study

Abstract Study question Which clinical, treatment-related and informational factors are associated with satisfaction with hormonal therapies (HTs) in women with endometriosis and/or adenomyosis? Summary answer Satisfaction with HT was low, driven by mood changes, headache and diagnosis, while higher-quality counseling and having tried multiple therapies were associated with higher patient-satisfaction. What is known already HT is the cornerstone of treatment for endometriosis and adenomyosis, yet treatment response and patient satisfaction vary widely. Side effects are common and frequently lead to non-compliance. While most studies focus on pain reduction, patient-reported satisfaction, treatment tolerability and informational needs remain unexplored. Many women seek additional information outside healthcare settings and use alternative therapies, but the impact of these factors on satisfaction with HT is poorly understood. Consequently, it remains unclear which clinical, treatment-related and informational factors influence satisfaction and whether these differ between women with endometriosis, adenomyosis or both conditions. Study design, size, duration This nation-wide cross-sectional observational study is part of an international study conducted in 7 countries. Women with endometriosis and/or adenomyosis in The Netherlands were included. Data were collected through an online, anonymous, survey conducted between September 2024 and January 2025. The final study population comprised 1,191 women. Participants/materials, setting, methods Women aged ≥16 years with endometriosis and/or adenomyosis were included. Data were collected using a self-reported, online multiple-choice survey distributed primarily through the Dutch Endometriosis Foundation. Patient-reported satisfaction was assessed alongside side-effect burden, diagnostic category, information sources, quality of counselling and use of alternative treatments. Associations with satisfaction were examined using univariable and multivariable regression models, with adjustment for potential confounders and assessment of model assumptions. SPSS was used for the statistical analyses. Main results and the role of chance Of the 1,191 women, 43.2% reported endometriosis, 11.8% adenomyosis and 45.0% both conditions. Overall, 1,114 (93.5%) use(d) HT: most commonly combined oral contraceptives or progestogens. Overall satisfaction was low (mean 2.64 ± 1.17; scale 1-5). Side effects were highly prevalent and 78.4% had discontinued at least one therapy due to side effects. In the primary multivariable model, mood changes, headache, decreased libido, weight gain, use of depot injection, hormonal implant or hormonal IUD, younger age (16-20 years) and adenomyosis were independently associated with lower satisfaction (all p < 0.05). Being more content with information provided by healthcare professionals and having tried more HTs were independently associated with higher satisfaction. In subanalyses, among women experiencing vaginal blood loss (n = 573), discontinuation due to side effects showed the strongest negative association with satisfaction, alongside mood changes, decreased libido, heavy bleeding and adenomyosis. A side effects-only model identified mood changes and headache as the strongest predictors of dissatisfaction. Satisfaction differed significantly between diagnostic groups and remained lowest in adenomyosis after multivariable adjustment. Use of alternative therapies (42%) was associated with greater reliance on non-professional information sources and lower satisfaction with healthcare-provided information and overall treatment satisfaction. All reported models were statistically significant. Limitations, reasons for caution Diagnoses were self-reported, which may introduce misclassification. Online recruitment via patient organizations may limit generalizability. The cross-sectional design limits conclusions regarding causality and may cause recall bias. Satisfaction was assessed using a non-validated measure, and since quality-of-life and mental health outcomes were not included, residual confounding cannot be entirely excluded. Wider implications of the findings These findings highlight the need for individualized, communication-focused care and better tolerated, more effective therapies. Strengthening evidence-based information provision, reducing reliance on low-quality online sources and investing in menstrual health education and quality of counselling may improve patient satisfaction and support more effective, patient-centered endometriosis and adenomyosis care pathways. Trial registration number No