Dysmenorrhea Patients’ Experience with Work Productivity Impact and Treatment in Japan

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A survey of Japanese working women found that 44.6% of patients who did not seek treatment did so as they chose to endure the symptoms. We analyzed dysmenorrhea's impact on work productivity and its association with treatments using Japanese survey and claims data. Methods Using an anonymized database consisting of linked Japanese health insurance claims and Work Productivity and Activity Impairment Questionnaire - General Health (WPAI-GH) responses for women aged between 18 and 50 years, we conducted descriptive analyses of dysmenorrhea patients’ WPAI-GH survey responses, and compared dysmenorrhea’s impact with other chronic diseases and across dysmenorrhea patients grouped by treatment. We also analyzed patient-reported coping methods for menstrual pain. Results Among 9,235 individuals in the database, 956 (10.4%) had dysmenorrhea. The WPAI-GH scores for dysmenorrhea patients showed absenteeism at 2.5 ± 0.3% (mean ± standard error) and presenteeism at 26.8 ± 0.9%, comparable to mental disorders, headaches, or low back pain. Within dysmenorrhea patients, the highest rate of absenteeism was observed in patients who received the Kampo medicine (Chinese traditional herbal medicine adopted to and evolved in Japan) alone, followed by analgesic agents alone, and progestin alone. The highest rate of presenteeism was observed in patients with intrauterine devices, followed by analgesic agents alone and progestin alone. Patients who were treated with the most frequently used treatment, LEP (low-dose estrogen–progestin; also known as combined oral contraceptives), experienced second to the lowest absenteeism and presenteeism within treatment groups right above levonorgestrel intrauterine systems and Kampo medicine alone, respectively. Among 5,471 respondents who responded on coping methods for menstrual pain, 2,250 (41.1%) used over-the-counter medications, while only 329 (6.0%) sought medical care. Conclusion Dysmenorrhea’s impact was found to be significant and comparable to other major chronic conditions with high patient burden. We further found correlations between dysmenorrhea’s disease impact and treatment; suggesting the importance of treatment selection and joint decision making between patients and clinicians in promoting evidence-based dysmenorrhea treatment that takes productivity impact into account. Trial registration Not applicable Dysmenorrhea Low-dose estrogen–progestin (LEP) Combined oral contraceptives Work Productivity and Activity Impairment Questionnaire - General Health (WPAI) Menstrual pain Treatment pattern Presenteeism Absenteeism Work productivity loss Activity impairment Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Background Approximately eight million Japanese women are estimated to have dysmenorrhea, and only about 11%-20% receive treatment [ 1 – 4 ]. Despite Japan’s universal health insurance system that provides access to care with limited out-of-pocket expenses for all residents, the vast majority of women live with symptoms without receiving a diagnosis or treatment [ 4 , 5 ]. Dysmenorrhea is a condition that occurs during menstruation, characterized mainly by lower abdominal and back pain, and may include bloating, nausea, headache, fatigue, loss of appetite, irritability, diarrhea, and depressive symptoms [ 6 ]. It affects work productivity, particularly the percentage of reduced work efficiency while present at work due to health reasons (presenteeism) [ 4 , 5 , 7 – 10 ]. Although more than 50% of Japanese women are aware of menstrual abnormalities, the majority remain untreated [ 5 ]. A survey of 3,324 Japanese working women reported that 44.6% of patients who did not seek medical attention did so because they believed menstruation was something that should be endured [ 11 ]. Reasons for not seeking treatment include the idea that women should endure menstrual pain, the low recognition of menstrual-related symptoms, such as menstrual pain and premenstrual syndrome (PMS) as medical conditions, a lack of awareness about treatment’s effectiveness, reluctance to use low-dose estrogen–progestin (LEP, also known as low-dose combined oral contraceptives) and seek treatment from a gynecologist [ 12 – 14 ]. Among patients who regularly visit gynecologists, many began doing so based on recommendations from health check-ups and/or non- gynecologist physicians including occupational health physicians who serve as consultants for employers. The rate of receiving treatment is at an approximately two-fold than patients who initiated visits on their own [ 5 ]. Recommendations from healthcare professionals often serve as a trigger for women to seek care, highlighting the important role that healthcare providers play. In Japan, treatment options for dysmenorrhea include hormonal agents, analgesics, hemostatic agents, Kampo medicine (Chinese traditional herbal medicine adopted to and evolved in Japan), and gynecologic surgery [ 15 ]. Pharmacological treatments, such as levonorgestrel intrauterine system (LNG-IUS), LEP, and oral contraceptive pills, have been reported to improve work productivity in Japanese women [ 16 ]. Therefore, when selecting a treatment for dysmenorrhea, it is important to assess patients’ daily life challenges, work productivity impact. In Japan, the Ministry of Economy, Trade and Industry and the Ministry of Health, Labour and Welfare have also identified the promotion of women’s health in the workplace as a priority issue [ 17 – 19 ]. Evidence that demonstrates the relationship between treatment and work productivity may contribute to better care for women with dysmenorrhea through improved treatment guidelines and medical policies based on scientific evidence. The objective of the current study was to analyze the impact of dysmenorrhea on work productivity and quality of life, and their associations with treatment using large-scale real-world data collected in Japan Materials and methods Study design and ethical approval Data source, study population and inclusion criteria The present study used an existing database that was previously developed by DeSC Healthcare, Inc. (Tokyo, Japan; hereafter referred to as DeSC). This database consists of medical insurance claims data from selected Japanese health insurance societies linked with the results of online surveys conducted via DeSC’s smartphone application “kencom”; survey instruments are discussed in detail later in the Survey items section. The database contained demographic information, such as sex and age, as well as medical insurance claims data, including diagnoses coded according to the International Classification of Diseases, 10th Revision (ICD-10), medical procedures, and prescription drug information. From the database, we included records of individuals who had responded to the questionnaires at least once between July 2020 and July 2022 and were aged 18 to 50 years. Insurance claims of included patients were obtained for the time period between July 1, 2020 and June 30, 2022. Ethics approval The data used in this study were sourced from existing anonymized databases; the authors received a permission for secondary use from the owner of the data. In accordance with the Ethical Guidelines for Life Sciences and Medical Research Involving Human Subjects in Japan [ 20 ], this study was classified as exempt from review and approval by an institutional ethics committee. Survey items Survey items included age, height (cm), weight (kg), body mass index (BMI;kg/m 2 ), occupation, the Work Productivity and Activity Impairment Questionnaire-General Health (WPAI-GH) [ 21 ], EuroQol 5 dimensions 5-level (EQ-5D-5L)[ 22 , 23 ], a custom questionnaire included questions on coping methods for menstrual pain, medical diagnoses for which medical consultations were sought during the study period, prescribed medications, and surgeries. Age was calculated based on the first day of the month of birth, and the participant’s age was defined as that on the date of the questionnaire response. The questionnaire survey (WPAI-GH and EQ-5D-5L) was conducted twice a year, in June and December, with a response deadline extending to the following month (Fig. 1 a). No participant responded twice or more, and individuals who responded at either time point were included in the analysis. WPAI-GH scores were calculated using responses to the questionnaire that asked about the 7 days preceding the survey, and were calculated for the following four domains: 1) the percentage of work time missed due to health reasons (absenteeism), 2) the percentage of reduced work efficiency while present at work due to health reasons (presenteeism), 3) the percentage of overall work productivity loss due to health reasons (work productivity loss), and 4) the percentage of reduced activity due to health reasons (activity impairment) (see Supplementary Material 1 for details). The prescribed medications were identified for each participant as the drug(s) most recently prescribed within the 120 days prior to the questionnaire survey date (see Supplementary Material 2). Patients with any gynecologic surgery procedures for the treatment of dysmenorrhea performed prior to the questionnaire survey date were categorized into the surgery group regardless of concurrent pharmacological treatments. a) We identified the medication(s) prescribed on the date closest to the questionnaire survey date, within the 120 days prior to the survey. Although the questionnaire survey was conducted four times, no participant responded more than once. A survey on coping methods for menstrual pain was conducted in June 2022. The questionnaire asked participants to recall how they had managed menstruation over the one-year period from January to December 2021 (Fig. 1 b). Individuals who had also responded to the questionnaire survey and were aged 18 to 50 years were included in the analysis (not only patients with dysmenorrhea). Figure 1 b b) Timing of the menstrual pain coping questionnaire and its reference period Patients with dysmenorrhea were defined as those who had at least one outpatient visit with an ICD-10 code for primary dysmenorrhea (N944), secondary dysmenorrhea (N945), or unspecified dysmenorrhea (N946) during the study period. The survey identified the following conditions among participants in addition to dysmenorrhea; malignancies, diabetes mellitus, thyroid disorders, cardiovascular diseases, mental disorders, such as depression and schizophrenia, sleep disorders, migraine, non-migraine headaches, allergic rhinitis (including hay fever), low back pain, constipation, collagen diseases (including systemic lupus erythematosus, rheumatoid arthritis, and Sjögren’s syndrome), respiratory diseases, including asthma, and PMS; all defined as having at least one outpatient consultation for the condition during the study period. Detailed definitions are listed in Supplementary Material 3. In addition, complications related to the female reproductive system were recorded. Patients could have multiple conditions. Analytical methods We first identified individuals who had visited outpatient clinic for any condition during the two-year study period and had insurance claims were defined as “individuals with medical records”, whereas those without them were defined as “individuals without medical records”. Participants were classified as having a given condition or not regardless of the presence of other conditions, and mean values were compared between the two groups. In addition, summary statistics were calculated and visualized for each condition including those not explicitly defined in this study, according to the above categories. The number and percentage of patients with dysmenorrhea, categorized by treatment type at the time of the questionnaire response were summarized in pie chart. WPAI-GH and EQ-5D-5L results for the most common treatment types were compared with those of individuals without medical records. Furthermore, we conducted a descriptive analysis of responses between age 18 and 50 years old to a questionnaire on coping methods for menstrual pain. The responders to this previously conducted survey included patients with and without dysmenorrhea. Statistical analysis We conducted statistical analysis using R (version 4.0.3; R Foundation for Statistical Computing, Vienna, Austria [ https://www.R-project.org/ ]). Statistical tests between participants with and without conditions were performed for each WPAI-GH and EQ-5D-5L measure using the Student’s t -test. WPAI-GH and EQ-5D-5L measure in each treatment group of patients with dysmenorrhea were compared with those of individuals without medical records using the Student’s t -test. The t-test was conducted two-sided at the 5% level. Numerical variables are presented as the mean ± standard error, and categorical variables as frequencies (percentages). Results Of the 9,235 participants who met the inclusion criteria and included in the analysis, 956 were diagnosed with dysmenorrhea and had at least one outpatient visit for the purpose of treating dysmenorrhea during the study period (Fig. 2 ). Among all participants, 245 had no medical records from any healthcare providers during the study period (these are referred to as “individuals without medical records”), while 8,279 had medical records for conditions other than dysmenorrhea. The mean age of the participants who met the inclusion criteria was 40.3 ± 0.1 years and that of patients with dysmenorrhea was 37.8 ± 0.3 years (Table 1 ). In the overall study population, we found a higher number of participants in higher age groups. In the dysmenorrhea group, the number was low up to the age of 25 years and showed no significant differences among those aged 26 years or older (Supplementary Material 4). In terms of occupations, clerical work accounted for 4,264 (46.2%) of the overall population and 414 (43.3%) of the dysmenorrhea groups (Table 2 ). Details of the occupations are given in Supplementary Material 5. Regarding comorbidities among patients with dysmenorrhea (n = 956), female reproductive system–related disorders were the most common (804 patients; 84.1%), followed by allergic rhinitis (447; 46.8%) and mental disorders, such as depression and schizophrenia (281; 29.4%) (Table 3 ). Table 1 Participant characteristics Overall (n = 9,235) Dysmenorrhea (n = 956) Item Mean ± SE Median (1st.Q, 3rd.Q) Mean ± SE Median (1st.Q, 3rd.Q) Age (years) 40.3 ± 0.1 42 (35, 47) 37.8 ± 0.3 38 (31, 45) Height (cm) 159.1 ± 0.1 159 (155.4, 162.7) 159.5 ± 0.2 159.6 (156.1, 163.2) Weight (kg) 54.8 ± 0.1 53 (48, 59.4) 54.5 ± 0.4 52.8 (48.4, 59) BMI (kg/m 2 ) 21.7 ± 0.1 20.8 (19.1, 23.3) 21.4 ± 0.1 20.7 (19.2, 22.8) Table 2 Occupations of participants Occupation Overall (n = 9,235) Dysmenorrhea (n = 956) Clerical occupations*1 4,264 (46.2%) 414 (43.3%) Sales/Marketing occupations 1,459 (15.8%) 160 (16.7%) Professional/Technical occupations*2 1,207 (13.1%) 164 (17.2%) Others 2,305 (25.0%) 218 (22.8%) *1: Includes accounting clerks, sales clerks, receptionists, secretaries, and researchers. *2: Includes physicians, nurses, lawyers, engineers, designers, management consultants, interpreters, and editors. Table 3 Comorbidities of participants Overall (n = 9,235) Dysmenorrhea (n = 956) No medical records 245 (2.7%) 0 (0%) Dysmenorrhea 956 (10.4%) 956 (100%) Of which, sought medical intervention/treatment within 120 days before the questioner survey 640 (6.9%) 640 (66.9%) Malignant tumor 287 (3.1%) 24 (2.5%) Diabetes mellitus 135 (1.5%) 18 (1.9%) Thyroid disorder 747 (8.1%) 84 (8.8%) Cardiovascular disease 639 (6.9%) 89 (9.3%) Mental disorders (including depression and schizophrenia) 1,659 (18%) 281 (29.4%) Sleep disorder 692 (7.5%) 137 (14.3%) Migraine 402 (4.4%) 71 (7.4%) Headache (non-migraine) 1,149 (12.4%) 184 (19.2%) Allergic rhinitis (including hay fever) 3,332 (36.1%) 447 (46.8%) Low back pain 1,175 (12.7%) 235 (24.6%) Constipation 1,279 (13.8%) 195 (20.4%) Collagen disease (including systemic lupus erythematosus, rheumatoid arthritis, and Sjögren’s syndrome) 172 (1.9%) 17 (1.8%) Respiratory disease (including asthma) 1,119 (12.1%) 144 (15.1%) Conditions related to premenstrual syndrome 80 (0.9%) 38 (4%) Female reproductive system–related disorders 3,383 (36.6%) 804 (84.1%) The results of the WPAI-GH analysis per condition are shown in Fig. 3 . The Student’s t test was conducted to compare WPAI-GHs between patients with a condition and the rest of the sample without a condition. This analysis was performed for each condition identified in the dataset individually. The Supplementary Material 6 includes further details on our analysis. The highest absenteeism was observed in patients with sleep disorders (6.0 ± 0.8%), whereas dysmenorrhea showed a value of 2.5 ± 0.3% (Fig. 3 a). No significant difference was observed in absenteeism between patients with and without dysmenorrhea. Regarding presenteeism (Fig. 3 b), work productivity loss (Fig. 3 c), and activity impairment (Fig. 3 d), patients with PMS-related conditions had the highest impact at 33.1 ± 3.6%, 34.9 ± 3.6%, and 33.5 ± 3.3%, respectively. In patients with dysmenorrhea, the corresponding scores were 26.8 ± 0.9%, 28.0 ± 1.0%, and 27.5 ± 0.9%, respectively. Significant differences were observed between patients with and without dysmenorrhea in presenteeism, work productivity loss, and activity impairment. The results of the EQ-5D-5L are shown in Supplementary Material 7. Data are presented as the mean ± standard error. *p < 0.05, **p < 0.001 vs. participants without the condition, the Student’s t -test was used. The figure shows participants with conditions, statistical significance of the difference between participants with and without the conditions was tested using the Student’s t -test. See Supplementary Material 6 for detailed scores. Among the dysmenorrhea patients, the most common treatment at the time of the WPAI-GH survey was LEP alone in 269 patients (28.1%), followed by analgesic agents alone in 130 (13.6%) and progestin alone in 94 (9.8%). A total of 251 patients (26.3%) were not receiving any treatment at the time of the WPAI-GH survey (Fig. 4 ). The finding also shows that hormonal therapy (including LEP, progestin, and gonadotropin-releasing hormone analogs), either alone or in combination, was used in 407 cases (42.6%). In contrast, 249 cases (26.0%) received only non-hormonal therapy, limited to analgesic agents, hemostatic agents, or Kampo medicine. In participants with dysmenorrhea included in the analysis, among the medications prescribed within the 120 days prior to the WPAI-GH survey, the prescription closest to the WPAI-GH survey date was used. Participants were categorized into the Mirena or surgery group regardless of any concomitant prescribed medications. One case (0.1%) in which LEP and progestin were prescribed simultaneously was excluded from the analysis. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen–progestin; LNG-IUS: levonorgestrel intrauterine system. The WPAI-GH scores by treatment categories are shown in Fig. 5 . Significant differences were observed in absenteeism between individuals without medical records (control/reference group) and the following dysmenorrhea patient groups; progestin alone, analgesic agents alone, and Kampo medicine alone (Fig. 5 a). We also showed a Breakdown of Absenteeism: By Status (> 0 vs. 0) in Supplementary Material 8. Among subjects treated for dysmenorrhea, the rate of absenteeism = 0 was highest in the LEP group, at 92.1% (220/239). We also found significant differences in presenteeism and work productivity loss between the control/reference group and dysmenorrhea patient groups except for those with Kampo medicine alone (Figs. 5 b and 5 c). The highest rate of presenteeism was observed in the LNG-IUS use group (35.9%), followed by the analgesic agents alone group (29.7%). The rate of presenteeism was lower in the LEP alone group (25.8%) and the progestin alone group (25.9%). Furthermore, significant differences were found in activity impairment between individuals without medical records and dysmenorrhea patient groups except for those with no intervention (Fig. 5 d). The highest shares of patients who experienced presenteeism, work productivity loss, and activity impairment were observed in the LNG-IUS group, followed by analgesic agents alone (Figs. 5 b, 5 c, and 5 d). EQ-5D-5L results by treatment for dysmenorrhea are shown in Supplementary Material 9. Figure 5 a WPAI-GH by Treatment for dysmenorrhea (Control/reference group: individuals without medical records); Absenteeism Data are presented as the mean ± standard error. *p < 0.05, **p < 0.001 vs. individuals without medical records, the Student’s t -test. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen–progestin; LNG-IUS: levonorgestrel intrauterine system. Of the 10,040 respondents to the questionnaire on coping methods with menstrual pain, 5,471 met the inclusion criteria (included 18–50 years old female respondents regardless of a diagnosis of dysmenorrhea). The most common coping method was the use of over-the-counter (OTC) medications, reported by 2,250 respondents (41.1%), followed by taking rest by 731 (13.4%), while only 329 (6.0%) sought clinical intervention/treatment (Fig. 6 ). There were individuals who did not experience menstrual pain (1,625; 29.7%), those who took no action (780; 14.3%), and 3,066 respondents (56.0%) who sought some forms of coping measure. Excluding individuals who did not experience menstrual pain (1,625 people), 8.6% (329/3,846) visited a medical institution, while 91.4% did not. Discussion WPAI-GH in dysmenorrhea Work productivity loss may be divided into two components: absenteeism, which is absence from work, and presenteeism, which is reduced productivity at work due to health issues. Previous studies indicated that approximately 60% of economic losses caused by illness were attributable to presenteeism, making it a serious issue [ 24 , 25 ]. Our finding indicated high presenteeism in patients with dysmenorrhea. The same was also found PMS. These results are supported by previous studies that also reported an association between menstrual-related symptoms and high presenteeism [ 26 ], and our results imply that many individuals continued to work despite feeling unwell. The severity of presenteeism in the dysmenorrhea patient group was similar to that in groups with mental disorders, headaches, or low back pain. In contrast, dysmenorrhea had an impact of 2.5% on absenteeism in our study, the second smallest in the conditions analyzed. This discrepancy between absenteeism and presenteeism, and the findings in productivity loss and activity impairment suggest that many dysmenorrhea patients continue to work despite the sizable impact of the disease. There are a number of previous studies that indicate that Japanese women tend to endure menstrual symptoms; some of the reasons include lack of disease awareness and hesitancy in requesting sick-leave for menstruation-related conditions [ 27 – 30 ], and lack of sympathy from many of those who do not suffer from menstrual symptoms including both women and men [ 31 ]. In the present study, work productivity loss and activity impairment associated with dysmenorrhea were found to be 28.0% and 27.5% according to WPAI-GH results, respectively. These findings suggest that dysmenorrhea have similar sizable effects to both work-related and other daily activities. Our analysis found that conditions with high impact such as those related to premenstrual syndrome, sleep disorders and migraine in these measures also generally showed high presenteeism. Our findings of high presenteeism in conditions such as sleep disorders, migraine, mental disorders, headaches, and low back pain, are consistent with previous findings [ 32 – 35 ]. In sum, our findings demonstrated dysmenorrhea patients’ markable loss of productivity, activity impairment, and presenteeism. More proactive treatment of dysmenorrhea would lessen the disease impact to both employers and employees. We note that the EQ-5D-5L, being a short generalized instrument, was unable to capture differences in disease impact across different conditions. Dysmenorrhea’s impact by treatment as measured in WPAI-GH In our analysis of treatment for dysmenorrhea and WPAI-GH, absenteeism was significantly higher in patients who were treated with the Kampo medicine alone, analgesic agents alone, or progestin alone groups compared to individuals without medical records. In contrast, patients who were treated with LNG-IUS and LEP had lower absenteeism, indicating absenteeism significantly differs across treatment groups. The highest presenteeism, work productivity loss and activity impairment were observed in the LNG-IUS group, followed by the analgesic agents alone and progestin groups, LEP alone, no intervention and Kampo medicine alone groups and all but the Kampo medicine alone groups demonstrated statistically higher presenteeism than the individuals without medical records. A trend and statistical significance similar to presenteeism was observed in work productivity loss with the order of no intervention and Kampo switched, demonstrating consistency between presenteeism and work productivity loss. Our findings demonstrated differences in the productivity impact of dysmenorrhea across treatment groups. We note that the severity of dysmenorrhea at the time of treatment initiation was not available for analysis while treatment choices were likely affected by the severity. Therefore, the effectiveness of treatment options cannot and should not be extrapolated from our findings. However, it is notable that patient groups that used hormonal treatments such as LEP and progestin were consistently between the lowest and third highest groups in all three impact measures among the five treatment groups. This impact of the disease in hormonal therapies, particularly LEP, is consistent with a previous study in which LEP treatment was significantly more effective in improving presenteeism, work productivity loss, and activity impairment. [ 16 ]. Among patients who received treatment, the lowest activity impairment was observed in the LEP group as well. This finding supports the notion that patients who are treated with LEPs tend to experience disease-related impairment in a lesser degree compared to other dysmenorrhea patients. Our findings further support the importance of appropriate treatments to lessen the disease impact on presenteeism, work productivity and the impairment of activities caused by dysmenorrhea. Furthermore, patients with LEP treatment had slightly higher results in the EQ-5D-5L and VAS measures. However, no conclusive findings were drawn from these instruments. Dysmenorrhea and comorbidities In the present study, 29.4% of patients with dysmenorrhea had comorbid mental disorders, such as depression or schizophrenia, and 24.6% had low back pain. This finding is consistent with a study that reported that more than 80% of young women with dysmenorrhea and menorrhagia experienced both physical and psychological issues, including pelvic pain, sleep disorders, mood disorders, diarrhea, and nausea [ 36 ] and with other studies reporting psychological impact such as depression and anxiety and heightened susceptibility to other chronic conditions later in life [ 37 – 39 ]. Our findings along with existing evidence shows dysmenorrhea patients have high burden from diseases beyond dysmenorrhea. Proactive treatment of dysmenorrhea would be important to alleviate some of their increased disease burden. Coping strategy with menstrual pain The questionnaire on coping with menstrual pain was administered to the entire female sample, and we found that 91.4% of respondents appeared to manage their symptoms without seeking medical care. In a previous study that compared women who saw a gynecologist with those who did not, the former group showed a significant reduction in the impact on daily life due to their menstrual symptoms, whereas the latter group showed no change [ 40 ]. This finding yet again highlights the importance of proactive treatment for dysmenorrhea. Not seeking medical care may be attributable to lack of information regarding dysmenorrhea and treatment. A systematic review reported that the majority of women (> 62%) cited their mother as their primary source of information on dysmenorrhea, with friends being a secondary source (10–65%) [ 36 ], suggesting professional sources are not primary. It was reported that women in their 20s to 30s, without a spouse or children and working full-time, showed high expectations for research on both “mental health” and “menstruation” [ 41 ]; by communicating the effectiveness of proactive treatment for dysmenorrhea, more patients would be encouraged to seek treatment; thereby relieving the negative impact of dysmenorrhea. Limitations This study has several limitations. The presence or absence of medical conditions was based solely on diagnoses recorded in health insurance claims data and, the severity was not known. The lack of disease severity in data meant that disease severity was not adjusted across treatment-based sub-groups of dysmenorrhea patients, and our treatment-specific results cannot and should not been seen as effectiveness of treatments. Furthermore, only treatments prescribed by physicians and reimbursed by insurance were included in the analysis; therefore, other treatments such as over-the-counter drugs were not captured. In addition, we might have counted the same patients twice or more when they changed their health insurance plans, which primarily occurred when participants changed their jobs but stayed in the survey. The study population was limited to individuals in Japan who held an account in the kencom platform and were covered by health insurance societies participating in the system. The sample did not include those enrolled in Japan’s national health insurance programs that cover individuals who do not receive insurance through their employers. Additionally, responses to WPAI-GH surveys represented fewer than 10% of the approximately 150,000 users in the kencom users. The questionnaire on coping with menstrual pain relied on retrospective reporting of over a one-year period prior to the survey, which may have compromised accuracy due to participants’ difficulty to remember the distant past. Furthermore, the WPAI-GH survey was self-reported by patients and reflected their health over 7 days preceding the survey. Therefore, it may not have captured most severe dysmenorrhea impact. Given the above, the results of this study cannot be generalized. However, this could serve as a useful benchmark for understanding the current state of dysmenorrhea among health-conscious women who utilize health management applications. Conclusions Dysmenorrhea impairs work productivity and increases presenteeism and activity impairment to a similar degree seen in mental disorders, headaches, and low back pain. However, our analysis of surveys across all female responders (18–50 years old) found that only 6.0% (329/5,471) of affected women seek treatment while 41.1% (2,250/5,471) of individuals reported the use of OTC medications. The correlations that our study found between the disease-related productivity impairment and selected treatment implies the importance of treatment selection in an effort to limit work productivity loss and activity impairment in patients with dysmenorrhea. A further study, perhaps a randomized clinical study, would be needed to confirm the effectiveness of dysmenorrhea treatments in reducing productivity burden. Abbreviations LEP low-dose estrogen–progestin LNG-IUS levonorgestrel intrauterine system OTC over-the-counter PMS premenstrual syndrome WPAI the Work Productivity and Activity Impairment Questionnaire Declarations Ethics approval and consent to participate The data used in the present study consisted solely of anonymized information for which permission for secondary use had been obtained. In accordance with the Ethical Guidelines for Life Sciences and Medical Research Involving Human Subjects in Japan [20], this study was classified as exempt from review and approval by an institutional ethics committee. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from DeSC Healthcare, Inc.; however, these were used under the license for the current study and are therefore not publicly available. Competing interests DG and ST employees of and MU was a former employee of Organon and may hold equity and/or shares. OH and YO are external consultants for Organon and have received consulting fees. OH and YO are former employees of the University of Tokyo, which received research funding from Organon in connection with this study and the development of this publication. Funding This study was supported by funding from Organon. Authors' contributions OH, DG, MU and YO conceptualized and designed the study. MU was responsible for data collection, curation, and data analysis. DG, MU, ST, and OH were responsible for data interpretation. DG and ST drafted the initial manuscript. All authors performed the critical review and final editing. All authors reviewed and approved the final manuscript. Acknowledgements We would like to express our sincere gratitude to Shido Inc. for the data analyses and medical writing support. References Statistics Bureau of Japan. Ministry of Internal Affairs and Communications. Population Estimates / Annual Report, Statistics of Japan, The Portal Site of Official Statistics of Japan. [cited 2025 Nov 16]. Available from https://www.e-stat.go.jp/stat-search/files?stat_infid=000040268910 . Japanese. Obayashi S, Ideno Y, Kubota T, Takamatsu K, Hayashi K. Associations Between Lifestyle Factors and Primary Dysmenorrhea in the Japan Nurses' Health Study. Womens Health Rep (New Rochelle). 2025;6(1):702–10. Koga K, Ishikawa H, Urata Y. Epidemiological study on women's health issues: Survey on the prevalence, medical consultation rate, and information sources regarding dysmenorrhea and premenstrual syndrome among Japanese women. FY2023 Health and Labour Sciences Research Grant, Comprehensive Support Policy Research Project for Women's Health. Ministry of Health, Labour and Welfare, Japan.2023 [cited 2025 Nov 16]. Available from chrome- extension://efaidnbmnnnibpcajpcglclefindmkaj/https://mhlw-grants.niph.go.jp/system/files/download_pdf/2023/202309005A.pdf . Japanese. Tanaka E, Momoeda M, Osuga Y, Rossi B, Nomoto K, Hayakawa M, et al. Burden of menstrual symptoms in Japanese women: results from a survey-based study. J Med Econ. 2013;16(11):1255–66. Health and Global Policy Institute. Survey on Health Promotion and Working Women 2018 [Internet]. Tokyo: Health and Global Policy Institute; 2018 [cited 2025 Nov 25]. Available from: https://hgpi.org/wp-content/uploads/Survey-on-Health-Promotion-and-Working-Women-2018_Final-Report_180810_vFinal.pdf Japan Society of Obstetrics and Gynecology. Glossary of Obstetrics and Gynecology. 5th ed. Tokyo: JSOG. 2025. p.57. Osuga Y, editor. 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Tokyo: Health and Global Policy Institute. 2023 [cited 2025 Nov 25]. Available from: https://hgpi.org/wp-content/uploads/2023_WomensHealthResearchReport_JPN.pdf Uchibori M, Eguchi A, Ghaznavi C, Tanoue Y, Ueta M, Sassa M, et al. Understanding factors related to healthcare avoidance for menstrual disorders and menopausal symptoms: A cross-sectional study among women in Japan. Prev Med Rep. 2023;36:102467. Chinatsu HOKA, Atsuko KASAI, Kazuko TAMAKUMA. Causal Structure Model of Female High School Students’ Hesitancy towards Gynecological Consultations for Menstrual Pain -Influencing Consultation Behavior. ACGU J. 2022;35:115–32. Japanese. Matsubara C, Izumi Kusuki. Relationship between management of menstrual symptoms and health literacy in young women. Bull School Nurs Kyoto Prefectural Univ Med. 2023;33:1–8. Japan Society of Obstetrics and Gynecology. Japan Association of Obstetricians and Gynecologists. Obstetrics and Gynecology Clinical Guidelines: Gynecology Outpatient Edition 2020. Tokyo: Japan Society of Obstetrics and Gynecology; 2020. Yoshino O, Takahashi N, Suzukamo Y, Menstrual Symptoms. Health-Related Quality of Life, and Work Productivity in Japanese Women with Dysmenorrhea Receiving Different Treatments: Prospective Observational Study. Adv Ther. 2022;39(6):2562–77. Initiatives for Women's Health in the Context of Health and Productivity Management. March 2019, Healthcare Industries Division, Ministry of Economy, Trade and Industry. https://www.meti.go.jp/policy/mono_info_service/healthcare/downloadfiles/josei-kenkou.pdf. Accessed 8 August 2025. Japanese. Support Site for the Mind and Body of Working Women. https://www.bosei-navi.mhlw.go.jp/ . Accessed 8 August 2025. Japanese. Women's Health Promotion Office – Healthcare Lab. https://w-health.jp/ . Accessed 8 August 2025. Japanese. Ethical Guidelines for Life Sciences and Medical Research Involving Human Subjects. Ministry of Education, Culture, Sports, Science and Technology (MEXT), Ministry of Health, Labour and Welfare (MHLW), and Ministry of Economy, Trade and Industry (METI). https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hokabunya/kenkyujigyou/i-kenkyu/index.html Accessed 16th of November 2025. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics. 1993;4(5):353–65. van Hout B, Janssen MF, Feng YS, Kohlmann T, Busschbach J, Golicki D, et al. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health. 2012;15(5):708–15. 10.1016/j.jval.2012.02.008 . Ikeda T, Shiraiwa T, Igarashi N, Noto S, Fukuda T, Saito S, et al. Development of a scoring method for the Japanese version of EQ-5D-5L. J Natl Inst Public Health. 2015;64(1):47–55. Japanese. Minami Y, Shiozaki Y, Kato C, Ito M, Takeuchi N, Koyanagi M et al. Japanese cedar pollinosis impact on work productivity, quality of life, and symptoms: 2008 vs. 2009. Nihon Bika Gakkai Kaishi. 2010;49(4):481–9. Japanese. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398–412. Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Nieboer TE. Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ Open. 2019;9(6):e026186. Renske M, van Lonkhuijzen FK, Garcia, Annemarie Wagemakers. The Stigma Surrounding Menstruation: Attitudes and Practices Regarding Menstruation and Sexual Activity During Menstruation. Published online. 2022; 364–84. Cook AS, van den Hoek R. Period pain presenteeism: investigating associations of working while experiencing dysmenorrhea. J Psychosom Obstet Gynaecol. 2023;44(1):2236294. Zainab Doleeb, Liam G, McCoy J, Dada C, Allaire. Underrecognition of Dysmenorrhea Is an Iatrogenic Harm. AMA J Ethics. 2022;24(8):E740–747. Keiko Yamada S, Yamaguchi N, Mizunuma T, Takeda. Analgesic avoidance in Japan: an epidemiological study exploring attitudes toward menstrual pain and medication. Int J Neuropsychopharmacol. 2025;28(Suppl 1):i239–40. Li K, Urteaga I, Wiggins CH, Druet A, Shea A, Vitzthum VJ, et al. Characterizing physiological and symptomatic variation in menstrual cycles using self-tracked mobile-health data. NPJ Digit Med. 2020;3:79. Morse AM, Dauvilliers Y, Arnulf I, Thorpy MJ, Foldvary-Schaefer N, Chandler P, et al. Long-term efficacy and safety of low-sodium oxybate in an open-label extension period of a placebo-controlled, double-blind, randomized withdrawal study in adults with idiopathic hypersomnia. J Clin Sleep Med. 2023;19(10):1811–22. Spierings ELH, Ning X, Ramirez Campos V, Cohen JM, Barash S, Buse DC. Improvements in quality of life and work productivity with up to 6 months of fremanezumab treatment in patients with episodic and chronic migraine and documented inadequate response to 2 to 4 classes of migraine-preventive medications in the phase 3b FOCUS study. Headache. 2021;61(9):1376–86. Baba K, Guo W, Chen Y, Nosaka T, Kato T. Burden of schizophrenia among Japanese patients: a cross-sectional National Health and Wellness Survey. BMC Psychiatry. 2022;22(1):410. Perrot S, Doane MJ, Jaffe DH, Dragon E, Abraham L, Viktrup L, et al. Burden of chronic low back pain: Association with pain severity and prescription medication use in five large European countries. Pain Pract. 2022;22(3):359–71. Pouraliroudbaneh S, Marino J, Riggs E, Saber A, Jayasinghe Y, Peate M. Heavy menstrual bleeding and dysmenorrhea in adolescents: A systematic review of self-management strategies, quality of life, and unmet needs. Int J Gynaecol Obstet. 2024;167(1):16–41. Zhao S, Wu W, Kang R, Wang X. Significant Increase in Depression in Women With Primary Dysmenorrhea: A Systematic Review and Cumulative Analysis. Front Psychiatry. 2021;12:686514. Sahin N, Kasap B, Kirli U, Yeniceri N, Topal Y. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reprod Health. 2018;15(1):13. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762–78. Tanaka E, Momoeda M, Osuga Y, Rossi B, Nomoto K, Hayakawa M, et al. Burden of menstrual symptoms in Japanese women - an analysis of medical care-seeking behavior from a survey-based study. Int J Womens Health. 2013;6:11–23. Sasaki N, Tsuno K, Hidaka Y, Ando E, Asai Y, Sakuraya A, et al. [Expected research in the workplace among Japanese female workers: A cross-sectional online survey based on the framework of patient and public involvement]. Sangyo Eiseigaku Zasshi. 2021;63(6):275–90. Japanese. Additional Declarations Competing interest reported. DG and ST employees of and MU was a former employee of Organon and may hold equity and/or shares. OH and YO are external consultants for Organon and have received consulting fees. OH and YO are former employees of the University of Tokyo, which received research funding from Organon in connection with this study and the development of this publication. Supplementary Files SupplementaryMaterial1.docx SupplementaryMaterial5.docx SupplementaryMaterial8.docx SupplementaryMaterial6.docx SupplementaryMaterial3.xlsx SupplementaryMaterial3.xlsx SupplementaryMaterial9.pptx SupplementaryMaterial2.xlsx SupplementaryMaterial7.pptx SupplementaryMaterial4.pptx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 12 Mar, 2026 Reviews received at journal 11 Mar, 2026 Reviews received at journal 05 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers agreed at journal 28 Feb, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers invited by journal 25 Feb, 2026 Editor invited by journal 14 Jan, 2026 Editor assigned by journal 13 Jan, 2026 Submission checks completed at journal 13 Jan, 2026 First submitted to journal 12 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8587407","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":598433045,"identity":"50b04c24-a55e-44b7-960a-b09f0eeb6d09","order_by":0,"name":"Osamu Hiraike","email":"","orcid":"","institution":"Nippon Medical School Hospital","correspondingAuthor":false,"prefix":"","firstName":"Osamu","middleName":"","lastName":"Hiraike","suffix":""},{"id":598433046,"identity":"c075c7d5-6ecb-4264-8d4c-6f174d84f4e4","order_by":1,"name":"Daisuke Goto","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYDCCA4wNQALKSaggTQszA8ODM0RpgRPMDIwP24jQwXf8cPNnnjM2DPLu/QcfJM6zyZd3P3vwcQGDnZxuA3YtkmcS26R5bqQxGJ45zGyQuC3NcuOZvGTjGQzJxmYHsGsxOJDYxszz4TCD4YxkNonEbYcNDBtyzKR5GA4kbsOl5fxDoMM+/IdqmQPU0v+GgJYbiQ1Ahx1gkJcAaWk4bCAvQcAWyRsP2yTnnEnmMeA5bGyQcCzNwEDijbExjwFuv/CdT3/84c0xOzn59saHD3/U2BjI9+cYPuapsJPDpQUGeAxgCiAMA/zKwUC+AZ0xCkbBKBgFowAKALyYX64wI8C6AAAAAElFTkSuQmCC","orcid":"","institution":"Organon","correspondingAuthor":true,"prefix":"","firstName":"Daisuke","middleName":"","lastName":"Goto","suffix":""},{"id":598433047,"identity":"dc5d7652-3e4e-4401-9bab-4c9c26fecd30","order_by":2,"name":"Masahiko Uchiyama","email":"","orcid":"","institution":"Organon","correspondingAuthor":false,"prefix":"","firstName":"Masahiko","middleName":"","lastName":"Uchiyama","suffix":""},{"id":598433048,"identity":"5e8dcdba-59b2-40c5-afd9-6772cbfd8e01","order_by":3,"name":"Shoko Takahashi","email":"","orcid":"","institution":"Organon","correspondingAuthor":false,"prefix":"","firstName":"Shoko","middleName":"","lastName":"Takahashi","suffix":""},{"id":598433049,"identity":"832ba42e-00b3-4c17-9052-2ca656fe4b41","order_by":4,"name":"Yutaka Osuga","email":"","orcid":"","institution":"Teikyo University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yutaka","middleName":"","lastName":"Osuga","suffix":""}],"badges":[],"createdAt":"2026-01-13 05:08:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8587407/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8587407/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104403934,"identity":"5d4b572b-6a88-42dc-b58a-a703845ef3b8","added_by":"auto","created_at":"2026-03-11 12:19:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":138084,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1a) Timing of WPAI administration and period for prescription data inclusion\u003c/p\u003e\n\u003cp\u003ea) We identified the medication(s) prescribed on the date closest to the questionnaire survey date, within the 120 days prior to the survey. Although the questionnaire survey was conducted four times, no participant responded more than once.\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/b6a8cadb960abf09dc976aff.png"},{"id":104169571,"identity":"6b09ee2e-098f-4c4f-9b97-936ebcb1aac8","added_by":"auto","created_at":"2026-03-08 14:39:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":213979,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1b) Timing of the menstrual pain coping questionnaire and its reference period\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/add7087d0bb22756ecda21bb.png"},{"id":104169592,"identity":"e8b73d68-9138-4324-96ce-e7f9b052a9bf","added_by":"auto","created_at":"2026-03-08 14:39:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":892199,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2 Flow of Participants Included in the Analysis\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/c40ed34f35c5cf023c97671c.png"},{"id":104169624,"identity":"ce9c2c55-6ac5-44c1-a10f-6a85cc776cd4","added_by":"auto","created_at":"2026-03-08 14:40:05","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1528973,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3a Absenteeism\u003c/p\u003e\n\u003cp\u003eData are presented as the mean ± standard error.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05, **p\u0026lt;0.001 vs. participants without each condition, the Student’s t-test.\u003c/p\u003e\n\u003cp\u003eThe figure shows only participants with each condition, with symbols indicating the results of comparisons with participants without each condition. In all conditions, scores were higher in participants with the condition.\u003c/p\u003e\n\u003cp\u003eRegarding detailed scores, see Supplementary Material 4.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/ffd49b5a62b38238311d3a5f.png"},{"id":104169677,"identity":"49a592d0-522f-4629-88f1-1ddbb16d3404","added_by":"auto","created_at":"2026-03-08 14:40:16","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1603088,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3b Presenteeism\u003c/p\u003e\n\u003cp\u003eData are presented as the mean ± standard error.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05, **p\u0026lt;0.001 vs. participants without each condition, the Student’s t-test.\u003c/p\u003e\n\u003cp\u003eThe figure shows only participants with each condition, with symbols indicating the results of comparisons with participants without each condition. In all conditions, scores were higher in participants with the condition.\u003c/p\u003e\n\u003cp\u003eRegarding detailed scores, see Supplementary Material 4.\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/746aea2605fc6e7faa5d7d6e.png"},{"id":104169603,"identity":"43a3c110-ff16-4f2a-acf0-a87d160d0d51","added_by":"auto","created_at":"2026-03-08 14:40:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1627573,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3c Work Productivity Loss\u003c/p\u003e\n\u003cp\u003eData are presented as the mean ± standard error.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05, **p\u0026lt;0.001 vs. participants without each condition, the Student’s t-test.\u003c/p\u003e\n\u003cp\u003eThe figure shows only participants with each condition, with symbols indicating the results of comparisons with participants without each condition. In all conditions, scores were higher in participants with the condition.\u003c/p\u003e\n\u003cp\u003eRegarding detailed scores, see Supplementary Material 4.\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/940c0656dbd48391029d16dc.png"},{"id":104169637,"identity":"6096f7da-2a84-421d-b555-625e4e3dc659","added_by":"auto","created_at":"2026-03-08 14:40:08","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1626379,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3d Activity Impairment\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/2ba8a9249fb073ad175ae08a.png"},{"id":104169674,"identity":"b5b532f2-06dd-4b5c-9cb6-9d25976ac158","added_by":"auto","created_at":"2026-03-08 14:40:15","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":284428,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4 Concurrent use of medications or other treatments at the time of the WPAI response\u003c/p\u003e\n\u003cp\u003eIn participants with dysmenorrhea included in the analysis, among the medications prescribed within the 120 days prior to the WPAI survey, the prescription closest to the WPAI survey date was used. Participants were categorized into the Mirena or surgery group regardless of any concomitant prescribed medications. One case (0.1%) in which LEP and progestin were prescribed simultaneously was excluded from the analysis. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen–progestin; LNG-IUS: levonorgestrel intrauterine system.\u003c/p\u003e","description":"","filename":"image8.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/3bd5791c3880fdea88eaf8c3.png"},{"id":104169620,"identity":"ad4beb4f-dfbe-4c84-bd69-50b6e0057382","added_by":"auto","created_at":"2026-03-08 14:40:03","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":1029764,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 5a WPAI-GH by Treatment for dysmenorrhea (Control/reference group: individuals without medical records); Absenteeism\u003c/p\u003e\n\u003cp\u003eData are presented as the mean ± standard error.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05, **p\u0026lt;0.001 vs. individuals without medical records, the Student’s t-test. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen–progestin; LNG-IUS: levonorgestrel intrauterine system.\u003c/p\u003e","description":"","filename":"image9.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/d204df92260cd2bde38309ec.png"},{"id":104169608,"identity":"4f5f2ba1-253c-4dc2-8595-28ad56e79bc5","added_by":"auto","created_at":"2026-03-08 14:40:02","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":1115471,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 5b WPAI-GH by Treatment (Control/reference group: individuals without medical records); Presenteeism\u003c/p\u003e\n\u003cp\u003eData are presented as the mean ± standard error.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05, **p\u0026lt;0.001 vs. individuals without medical records, the Student’s t-test. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen–progestin; LNG-IUS: levonorgestrel intrauterine system.\u003c/p\u003e","description":"","filename":"image10.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/72542847a5a098868aef5983.png"},{"id":104169569,"identity":"349775b0-86ba-4448-9a1f-b699e8326d63","added_by":"auto","created_at":"2026-03-08 14:39:49","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":1172922,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 5c WPAI-GH by Treatment (Control/reference group: individuals without medical records); Work Productivity Loss\u003c/p\u003e\n\u003cp\u003eData are presented as the mean ± standard error.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05, **p\u0026lt;0.001 vs. individuals without medical records, the Student’s t-test. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen–progestin; LNG-IUS: levonorgestrel intrauterine system.\u003c/p\u003e","description":"","filename":"image11.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/164866961369efacb0b29b7c.png"},{"id":104169704,"identity":"350e4ddb-7015-4a5b-8f79-7fd60e849fed","added_by":"auto","created_at":"2026-03-08 14:40:18","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":1137032,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 5d WPAI-GH by Treatment (Control/reference group: individuals without medical records); Activity Impairment\u003c/p\u003e\n\u003cp\u003eData are presented as the mean ± standard error.\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05, **p\u0026lt;0.001 vs. individuals without medical records, the Student’s t-test. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen–progestin; LNG-IUS: levonorgestrel intrauterine system.\u003c/p\u003e","description":"","filename":"image12.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/6b3e1dc1bd27c084615ea66e.png"},{"id":104169681,"identity":"3d26fb27-7b6b-478d-b2e5-ab82c443e92c","added_by":"auto","created_at":"2026-03-08 14:40:17","extension":"png","order_by":13,"title":"Figure 13","display":"","copyAsset":false,"role":"figure","size":221667,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 6 Coping with Menstrual Pain\u003c/p\u003e\n\u003cp\u003e(Multiple responses allowed)\u003c/p\u003e","description":"","filename":"image13.png","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/2956b203be44797d848449e4.png"},{"id":104408944,"identity":"f515d830-3f16-47f4-bbd3-1d754c0c8a70","added_by":"auto","created_at":"2026-03-11 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14:40:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26190,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial5.docx","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/1ef31807bba5673fc499bfde.docx"},{"id":104169507,"identity":"f971ca6a-a8ce-46bc-be91-21887b1ffab9","added_by":"auto","created_at":"2026-03-08 14:39:40","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":30167,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial8.docx","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/b98a4eb789579db09adabb5f.docx"},{"id":104169614,"identity":"8778363f-79fe-46c8-8b61-f87cb6a15008","added_by":"auto","created_at":"2026-03-08 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14:40:14","extension":"pptx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":61637,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial4.pptx","url":"https://assets-eu.researchsquare.com/files/rs-8587407/v1/9582f642daca7b5bb3ee67ba.pptx"}],"financialInterests":"Competing interest reported. DG and ST employees of and MU was a former employee of Organon and may hold equity and/or shares. OH and YO are external consultants for Organon and have received consulting fees. OH and YO are former employees of the University of Tokyo, which received research funding from Organon in connection with this study and the development of this publication.","formattedTitle":"Dysmenorrhea Patients’ Experience with Work Productivity Impact and Treatment in Japan","fulltext":[{"header":"Background","content":"\u003cp\u003eApproximately eight million Japanese women are estimated to have dysmenorrhea, and only about 11%-20% receive treatment [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Despite Japan\u0026rsquo;s universal health insurance system that provides access to care with limited out-of-pocket expenses for all residents, the vast majority of women live with symptoms without receiving a diagnosis or treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDysmenorrhea is a condition that occurs during menstruation, characterized mainly by lower abdominal and back pain, and may include bloating, nausea, headache, fatigue, loss of appetite, irritability, diarrhea, and depressive symptoms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It affects work productivity, particularly the percentage of reduced work efficiency while present at work due to health reasons (presenteeism) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although more than 50% of Japanese women are aware of menstrual abnormalities, the majority remain untreated [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A survey of 3,324 Japanese working women reported that 44.6% of patients who did not seek medical attention did so because they believed menstruation was something that should be endured [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Reasons for not seeking treatment include the idea that women should endure menstrual pain, the low recognition of menstrual-related symptoms, such as menstrual pain and premenstrual syndrome (PMS) as medical conditions, a lack of awareness about treatment\u0026rsquo;s effectiveness, reluctance to use low-dose estrogen\u0026ndash;progestin (LEP, also known as low-dose combined oral contraceptives) and seek treatment from a gynecologist [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Among patients who regularly visit gynecologists, many began doing so based on recommendations from health check-ups and/or non- gynecologist physicians including occupational health physicians who serve as consultants for employers. The rate of receiving treatment is at an approximately two-fold than patients who initiated visits on their own [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recommendations from healthcare professionals often serve as a trigger for women to seek care, highlighting the important role that healthcare providers play.\u003c/p\u003e \u003cp\u003eIn Japan, treatment options for dysmenorrhea include hormonal agents, analgesics, hemostatic agents, Kampo medicine (Chinese traditional herbal medicine adopted to and evolved in Japan), and gynecologic surgery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Pharmacological treatments, such as levonorgestrel intrauterine system (LNG-IUS), LEP, and oral contraceptive pills, have been reported to improve work productivity in Japanese women [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therefore, when selecting a treatment for dysmenorrhea, it is important to assess patients\u0026rsquo; daily life challenges, work productivity impact. In Japan, the Ministry of Economy, Trade and Industry and the Ministry of Health, Labour and Welfare have also identified the promotion of women\u0026rsquo;s health in the workplace as a priority issue [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Evidence that demonstrates the relationship between treatment and work productivity may contribute to better care for women with dysmenorrhea through improved treatment guidelines and medical policies based on scientific evidence.\u003c/p\u003e \u003cp\u003eThe objective of the current study was to analyze the impact of dysmenorrhea on work productivity and quality of life, and their associations with treatment using large-scale real-world data collected in Japan\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and ethical approval\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eData source, study population and inclusion criteria\u003c/h2\u003e \u003cp\u003eThe present study used an existing database that was previously developed by DeSC Healthcare, Inc. (Tokyo, Japan; hereafter referred to as DeSC). This database consists of medical insurance claims data from selected Japanese health insurance societies linked with the results of online surveys conducted via DeSC\u0026rsquo;s smartphone application \u0026ldquo;kencom\u0026rdquo;; survey instruments are discussed in detail later in the Survey items section. The database contained demographic information, such as sex and age, as well as medical insurance claims data, including diagnoses coded according to the International Classification of Diseases, 10th Revision (ICD-10), medical procedures, and prescription drug information.\u003c/p\u003e \u003cp\u003eFrom the database, we included records of individuals who had responded to the questionnaires at least once between July 2020 and July 2022 and were aged 18 to 50 years. Insurance claims of included patients were obtained for the time period between July 1, 2020 and June 30, 2022.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003eThe data used in this study were sourced from existing anonymized databases; the authors received a permission for secondary use from the owner of the data. In accordance with the Ethical Guidelines for Life Sciences and Medical Research Involving Human Subjects in Japan [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], this study was classified as exempt from review and approval by an institutional ethics committee.\u003c/p\u003e\n\u003ch3\u003eSurvey items\u003c/h3\u003e\n\u003cp\u003eSurvey items included age, height (cm), weight (kg), body mass index (BMI;kg/m\u003csup\u003e2\u003c/sup\u003e), occupation, the Work Productivity and Activity Impairment Questionnaire-General Health (WPAI-GH) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], EuroQol 5 dimensions 5-level (EQ-5D-5L)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], a custom questionnaire included questions on coping methods for menstrual pain, medical diagnoses for which medical consultations were sought during the study period, prescribed medications, and surgeries. Age was calculated based on the first day of the month of birth, and the participant\u0026rsquo;s age was defined as that on the date of the questionnaire response.\u003c/p\u003e \u003cp\u003eThe questionnaire survey (WPAI-GH and EQ-5D-5L) was conducted twice a year, in June and December, with a response deadline extending to the following month (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). No participant responded twice or more, and individuals who responded at either time point were included in the analysis. WPAI-GH scores were calculated using responses to the questionnaire that asked about the 7 days preceding the survey, and were calculated for the following four domains: 1) the percentage of work time missed due to health reasons (absenteeism), 2) the percentage of reduced work efficiency while present at work due to health reasons (presenteeism), 3) the percentage of overall work productivity loss due to health reasons (work productivity loss), and 4) the percentage of reduced activity due to health reasons (activity impairment) (see Supplementary Material 1 for details).\u003c/p\u003e \u003cp\u003eThe prescribed medications were identified for each participant as the drug(s) most recently prescribed within the 120 days prior to the questionnaire survey date (see Supplementary Material 2). Patients with any gynecologic surgery procedures for the treatment of dysmenorrhea performed prior to the questionnaire survey date were categorized into the surgery group regardless of concurrent pharmacological treatments.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003ea) We identified the medication(s) prescribed on the date closest to the questionnaire survey date, within the 120 days prior to the survey. Although the questionnaire survey was conducted four times, no participant responded more than once.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eA survey on coping methods for menstrual pain was conducted in June 2022. The questionnaire asked participants to recall how they had managed menstruation over the one-year period from January to December 2021 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eb). Individuals who had also responded to the questionnaire survey and were aged 18 to 50 years were included in the analysis (not only patients with dysmenorrhea).\u003c/p\u003e \u003cp\u003eFigure\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eb\u003c/p\u003e \u003cp\u003eb) Timing of the menstrual pain coping questionnaire and its reference period\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients with dysmenorrhea were defined as those who had at least one outpatient visit with an ICD-10 code for primary dysmenorrhea (N944), secondary dysmenorrhea (N945), or unspecified dysmenorrhea (N946) during the study period. The survey identified the following conditions among participants in addition to dysmenorrhea; malignancies, diabetes mellitus, thyroid disorders, cardiovascular diseases, mental disorders, such as depression and schizophrenia, sleep disorders, migraine, non-migraine headaches, allergic rhinitis (including hay fever), low back pain, constipation, collagen diseases (including systemic lupus erythematosus, rheumatoid arthritis, and Sj\u0026ouml;gren\u0026rsquo;s syndrome), respiratory diseases, including asthma, and PMS; all defined as having at least one outpatient consultation for the condition during the study period. Detailed definitions are listed in Supplementary Material 3. In addition, complications related to the female reproductive system were recorded. Patients could have multiple conditions.\u003c/p\u003e\n\u003ch3\u003eAnalytical methods\u003c/h3\u003e\n\u003cp\u003eWe first identified individuals who had visited outpatient clinic for any condition during the two-year study period and had insurance claims were defined as \u0026ldquo;individuals with medical records\u0026rdquo;, whereas those without them were defined as \u0026ldquo;individuals without medical records\u0026rdquo;. Participants were classified as having a given condition or not regardless of the presence of other conditions, and mean values were compared between the two groups. In addition, summary statistics were calculated and visualized for each condition including those not explicitly defined in this study, according to the above categories.\u003c/p\u003e \u003cp\u003eThe number and percentage of patients with dysmenorrhea, categorized by treatment type at the time of the questionnaire response were summarized in pie chart. WPAI-GH and EQ-5D-5L results for the most common treatment types were compared with those of individuals without medical records.\u003c/p\u003e \u003cp\u003eFurthermore, we conducted a descriptive analysis of responses between age 18 and 50 years old to a questionnaire on coping methods for menstrual pain. The responders to this previously conducted survey included patients with and without dysmenorrhea.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe conducted statistical analysis using R (version 4.0.3; R Foundation for Statistical Computing, Vienna, Austria [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.R-project.org/\u003c/span\u003e\u003cspan address=\"https://www.R-project.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e]). Statistical tests between participants with and without conditions were performed for each WPAI-GH and EQ-5D-5L measure using the Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. WPAI-GH and EQ-5D-5L measure in each treatment group of patients with dysmenorrhea were compared with those of individuals without medical records using the Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. The t-test was conducted two-sided at the 5% level. Numerical variables are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error, and categorical variables as frequencies (percentages).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 9,235 participants who met the inclusion criteria and included in the analysis, 956 were diagnosed with dysmenorrhea and had at least one outpatient visit for the purpose of treating dysmenorrhea during the study period (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among all participants, 245 had no medical records from any healthcare providers during the study period (these are referred to as \u0026ldquo;individuals without medical records\u0026rdquo;), while 8,279 had medical records for conditions other than dysmenorrhea.\u003c/p\u003e\u003cp\u003eThe mean age of the participants who met the inclusion criteria was 40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 years and that of patients with dysmenorrhea was 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the overall study population, we found a higher number of participants in higher age groups. In the dysmenorrhea group, the number was low up to the age of 25 years and showed no significant differences among those aged 26 years or older (Supplementary Material 4). In terms of occupations, clerical work accounted for 4,264 (46.2%) of the overall population and 414 (43.3%) of the dysmenorrhea groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Details of the occupations are given in Supplementary Material 5. Regarding comorbidities among patients with dysmenorrhea (n\u0026thinsp;=\u0026thinsp;956), female reproductive system\u0026ndash;related disorders were the most common (804 patients; 84.1%), followed by allergic rhinitis (447; 46.8%) and mental disorders, such as depression and schizophrenia (281; 29.4%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOverall (n\u0026thinsp;=\u0026thinsp;9,235)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDysmenorrhea (n\u0026thinsp;=\u0026thinsp;956)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (1st.Q, 3rd.Q)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian (1st.Q, 3rd.Q)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (35, 47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (31, 45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159 (155.4, 162.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e159.6 (156.1, 163.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (48, 59.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.8 (48.4, 59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003cp\u003e(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.8 (19.1, 23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.7 (19.2, 22.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOccupations of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall (n\u0026thinsp;=\u0026thinsp;9,235)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDysmenorrhea (n\u0026thinsp;=\u0026thinsp;956)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClerical occupations*1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,264 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e414 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSales/Marketing occupations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,459 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional/Technical occupations*2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,207 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,305 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*1: Includes accounting clerks, sales clerks, receptionists, secretaries, and researchers.\u003c/p\u003e \u003cp\u003e*2: Includes physicians, nurses, lawyers, engineers, designers, management consultants, interpreters, and editors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComorbidities of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall (n\u0026thinsp;=\u0026thinsp;9,235)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDysmenorrhea (n\u0026thinsp;=\u0026thinsp;956)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo medical records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e245 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e956 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e956 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOf which, sought medical intervention/treatment within 120 days before the questioner survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e640 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e640 (66.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignant tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e287 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e747 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e639 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental disorders (including depression and schizophrenia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,659 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e281 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e692 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e402 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache (non-migraine)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,149 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAllergic rhinitis (including hay fever)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,332 (36.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e447 (46.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow back pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,175 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,279 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollagen disease (including systemic lupus erythematosus, rheumatoid arthritis, and Sj\u0026ouml;gren\u0026rsquo;s syndrome)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory disease (including asthma)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,119 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConditions related to premenstrual syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale reproductive system\u0026ndash;related disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,383 (36.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e804 (84.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the WPAI-GH analysis per condition are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e test was conducted to compare WPAI-GHs between patients with a condition and the rest of the sample without a condition. This analysis was performed for each condition identified in the dataset individually. The Supplementary Material 6 includes further details on our analysis. The highest absenteeism was observed in patients with sleep disorders (6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8%), whereas dysmenorrhea showed a value of 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3% (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e3\u003c/span\u003ea). No significant difference was observed in absenteeism between patients with and without dysmenorrhea. Regarding presenteeism (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e3\u003c/span\u003eb), work productivity loss (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e3\u003c/span\u003ec), and activity impairment (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e3\u003c/span\u003ed), patients with PMS-related conditions had the highest impact at 33.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6%, 34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6%, and 33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3%, respectively. In patients with dysmenorrhea, the corresponding scores were 26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9%, 28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0%, and 27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9%, respectively. Significant differences were observed between patients with and without dysmenorrhea in presenteeism, work productivity loss, and activity impairment. The results of the EQ-5D-5L are shown in Supplementary Material 7.\u003c/p\u003e\u003cp\u003eData are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error.\u003c/p\u003e \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 vs. participants without the condition, the Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test was used. The figure shows participants with conditions, statistical significance of the difference between participants with and without the conditions was tested using the Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. See Supplementary Material 6 for detailed scores.\u003c/p\u003e \u003cp\u003eAmong the dysmenorrhea patients, the most common treatment at the time of the WPAI-GH survey was LEP alone in 269 patients (28.1%), followed by analgesic agents alone in 130 (13.6%) and progestin alone in 94 (9.8%). A total of 251 patients (26.3%) were not receiving any treatment at the time of the WPAI-GH survey (Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The finding also shows that hormonal therapy (including LEP, progestin, and gonadotropin-releasing hormone analogs), either alone or in combination, was used in 407 cases (42.6%). In contrast, 249 cases (26.0%) received only non-hormonal therapy, limited to analgesic agents, hemostatic agents, or Kampo medicine.\u003c/p\u003e\u003cp\u003eIn participants with dysmenorrhea included in the analysis, among the medications prescribed within the 120 days prior to the WPAI-GH survey, the prescription closest to the WPAI-GH survey date was used. Participants were categorized into the Mirena or surgery group regardless of any concomitant prescribed medications. One case (0.1%) in which LEP and progestin were prescribed simultaneously was excluded from the analysis. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen\u0026ndash;progestin; LNG-IUS: levonorgestrel intrauterine system.\u003c/p\u003e \u003cp\u003eThe WPAI-GH scores by treatment categories are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Significant differences were observed in absenteeism between individuals without medical records (control/reference group) and the following dysmenorrhea patient groups; progestin alone, analgesic agents alone, and Kampo medicine alone (Fig.\u0026nbsp;\u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003ea). We also showed a Breakdown of Absenteeism: By Status (\u0026gt;\u0026thinsp;0 vs. 0) in Supplementary Material 8. Among subjects treated for dysmenorrhea, the rate of absenteeism\u0026thinsp;=\u0026thinsp;0 was highest in the LEP group, at 92.1% (220/239). We also found significant differences in presenteeism and work productivity loss between the control/reference group and dysmenorrhea patient groups except for those with Kampo medicine alone (Figs.\u0026nbsp;\u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003eb and \u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003ec).\u003c/p\u003e \u003cp\u003eThe highest rate of presenteeism was observed in the LNG-IUS use group (35.9%), followed by the analgesic agents alone group (29.7%). The rate of presenteeism was lower in the LEP alone group (25.8%) and the progestin alone group (25.9%).\u003c/p\u003e \u003cp\u003eFurthermore, significant differences were found in activity impairment between individuals without medical records and dysmenorrhea patient groups except for those with no intervention (Fig.\u0026nbsp;\u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003ed). The highest shares of patients who experienced presenteeism, work productivity loss, and activity impairment were observed in the LNG-IUS group, followed by analgesic agents alone (Figs.\u0026nbsp;\u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003eb, \u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003ec, and \u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003ed). EQ-5D-5L results by treatment for dysmenorrhea are shown in Supplementary Material 9.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig19\" class=\"InternalRef\"\u003e5\u003c/span\u003ea WPAI-GH by Treatment for dysmenorrhea (Control/reference group: individuals without medical records); Absenteeism\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eData are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error.\u003c/p\u003e \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 vs. individuals without medical records, the Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. Kampo medicine: Chinese traditional herbal medicine adopted to and evolved in Japan; LEP: low-dose estrogen\u0026ndash;progestin; LNG-IUS: levonorgestrel intrauterine system.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the 10,040 respondents to the questionnaire on coping methods with menstrual pain, 5,471 met the inclusion criteria (included 18\u0026ndash;50 years old female respondents regardless of a diagnosis of dysmenorrhea). The most common coping method was the use of over-the-counter (OTC) medications, reported by 2,250 respondents (41.1%), followed by taking rest by 731 (13.4%), while only 329 (6.0%) sought clinical intervention/treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig21\" class=\"InternalRef\"\u003e6\u003c/span\u003e). There were individuals who did not experience menstrual pain (1,625; 29.7%), those who took no action (780; 14.3%), and 3,066 respondents (56.0%) who sought some forms of coping measure. Excluding individuals who did not experience menstrual pain (1,625 people), 8.6% (329/3,846) visited a medical institution, while 91.4% did not.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eWPAI-GH in dysmenorrhea\u003c/p\u003e \u003cp\u003eWork productivity loss may be divided into two components: absenteeism, which is absence from work, and presenteeism, which is reduced productivity at work due to health issues. Previous studies indicated that approximately 60% of economic losses caused by illness were attributable to presenteeism, making it a serious issue [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur finding indicated high presenteeism in patients with dysmenorrhea. The same was also found PMS. These results are supported by previous studies that also reported an association between menstrual-related symptoms and high presenteeism [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and our results imply that many individuals continued to work despite feeling unwell. The severity of presenteeism in the dysmenorrhea patient group was similar to that in groups with mental disorders, headaches, or low back pain. In contrast, dysmenorrhea had an impact of 2.5% on absenteeism in our study, the second smallest in the conditions analyzed.\u003c/p\u003e \u003cp\u003eThis discrepancy between absenteeism and presenteeism, and the findings in productivity loss and activity impairment suggest that many dysmenorrhea patients continue to work despite the sizable impact of the disease. There are a number of previous studies that indicate that Japanese women tend to endure menstrual symptoms; some of the reasons include lack of disease awareness and hesitancy in requesting sick-leave for menstruation-related conditions [\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and lack of sympathy from many of those who do not suffer from menstrual symptoms including both women and men [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, work productivity loss and activity impairment associated with dysmenorrhea were found to be 28.0% and 27.5% according to WPAI-GH results, respectively. These findings suggest that dysmenorrhea have similar sizable effects to both work-related and other daily activities. Our analysis found that conditions with high impact such as those related to premenstrual syndrome, sleep disorders and migraine in these measures also generally showed high presenteeism. Our findings of high presenteeism in conditions such as sleep disorders, migraine, mental disorders, headaches, and low back pain, are consistent with previous findings [\u003cspan additionalcitationids=\"CR33 CR34\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In sum, our findings demonstrated dysmenorrhea patients\u0026rsquo; markable loss of productivity, activity impairment, and presenteeism. More proactive treatment of dysmenorrhea would lessen the disease impact to both employers and employees. We note that the EQ-5D-5L, being a short generalized instrument, was unable to capture differences in disease impact across different conditions.\u003c/p\u003e \u003cp\u003eDysmenorrhea\u0026rsquo;s impact by treatment as measured in WPAI-GH\u003c/p\u003e \u003cp\u003eIn our analysis of treatment for dysmenorrhea and WPAI-GH, absenteeism was significantly higher in patients who were treated with the Kampo medicine alone, analgesic agents alone, or progestin alone groups compared to individuals without medical records. In contrast, patients who were treated with LNG-IUS and LEP had lower absenteeism, indicating absenteeism significantly differs across treatment groups.\u003c/p\u003e \u003cp\u003eThe highest presenteeism, work productivity loss and activity impairment were observed in the LNG-IUS group, followed by the analgesic agents alone and progestin groups, LEP alone, no intervention and Kampo medicine alone groups and all but the Kampo medicine alone groups demonstrated statistically higher presenteeism than the individuals without medical records. A trend and statistical significance similar to presenteeism was observed in work productivity loss with the order of no intervention and Kampo switched, demonstrating consistency between presenteeism and work productivity loss.\u003c/p\u003e \u003cp\u003eOur findings demonstrated differences in the productivity impact of dysmenorrhea across treatment groups. We note that the severity of dysmenorrhea at the time of treatment initiation was not available for analysis while treatment choices were likely affected by the severity. Therefore, the effectiveness of treatment options cannot and should not be extrapolated from our findings. However, it is notable that patient groups that used hormonal treatments such as LEP and progestin were consistently between the lowest and third highest groups in all three impact measures among the five treatment groups. This impact of the disease in hormonal therapies, particularly LEP, is consistent with a previous study in which LEP treatment was significantly more effective in improving presenteeism, work productivity loss, and activity impairment. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong patients who received treatment, the lowest activity impairment was observed in the LEP group as well. This finding supports the notion that patients who are treated with LEPs tend to experience disease-related impairment in a lesser degree compared to other dysmenorrhea patients.\u003c/p\u003e \u003cp\u003eOur findings further support the importance of appropriate treatments to lessen the disease impact on presenteeism, work productivity and the impairment of activities caused by dysmenorrhea. Furthermore, patients with LEP treatment had slightly higher results in the EQ-5D-5L and VAS measures. However, no conclusive findings were drawn from these instruments.\u003c/p\u003e \u003cp\u003eDysmenorrhea and comorbidities\u003c/p\u003e \u003cp\u003eIn the present study, 29.4% of patients with dysmenorrhea had comorbid mental disorders, such as depression or schizophrenia, and 24.6% had low back pain. This finding is consistent with a study that reported that more than 80% of young women with dysmenorrhea and menorrhagia experienced both physical and psychological issues, including pelvic pain, sleep disorders, mood disorders, diarrhea, and nausea [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and with other studies reporting psychological impact such as depression and anxiety and heightened susceptibility to other chronic conditions later in life [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Our findings along with existing evidence shows dysmenorrhea patients have high burden from diseases beyond dysmenorrhea. Proactive treatment of dysmenorrhea would be important to alleviate some of their increased disease burden.\u003c/p\u003e \u003cp\u003eCoping strategy with menstrual pain\u003c/p\u003e \u003cp\u003eThe questionnaire on coping with menstrual pain was administered to the entire female sample, and we found that 91.4% of respondents appeared to manage their symptoms without seeking medical care. In a previous study that compared women who saw a gynecologist with those who did not, the former group showed a significant reduction in the impact on daily life due to their menstrual symptoms, whereas the latter group showed no change [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This finding yet again highlights the importance of proactive treatment for dysmenorrhea.\u003c/p\u003e \u003cp\u003eNot seeking medical care may be attributable to lack of information regarding dysmenorrhea and treatment. A systematic review reported that the majority of women (\u0026gt;\u0026thinsp;62%) cited their mother as their primary source of information on dysmenorrhea, with friends being a secondary source (10\u0026ndash;65%) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], suggesting professional sources are not primary. It was reported that women in their 20s to 30s, without a spouse or children and working full-time, showed high expectations for research on both \u0026ldquo;mental health\u0026rdquo; and \u0026ldquo;menstruation\u0026rdquo; [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]; by communicating the effectiveness of proactive treatment for dysmenorrhea, more patients would be encouraged to seek treatment; thereby relieving the negative impact of dysmenorrhea.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. The presence or absence of medical conditions was based solely on diagnoses recorded in health insurance claims data and, the severity was not known. The lack of disease severity in data meant that disease severity was not adjusted across treatment-based sub-groups of dysmenorrhea patients, and our treatment-specific results cannot and should not been seen as effectiveness of treatments. Furthermore, only treatments prescribed by physicians and reimbursed by insurance were included in the analysis; therefore, other treatments such as over-the-counter drugs were not captured. In addition, we might have counted the same patients twice or more when they changed their health insurance plans, which primarily occurred when participants changed their jobs but stayed in the survey. The study population was limited to individuals in Japan who held an account in the kencom platform and were covered by health insurance societies participating in the system. The sample did not include those enrolled in Japan\u0026rsquo;s national health insurance programs that cover individuals who do not receive insurance through their employers. Additionally, responses to WPAI-GH surveys represented fewer than 10% of the approximately 150,000 users in the kencom users. The questionnaire on coping with menstrual pain relied on retrospective reporting of over a one-year period prior to the survey, which may have compromised accuracy due to participants\u0026rsquo; difficulty to remember the distant past. Furthermore, the WPAI-GH survey was self-reported by patients and reflected their health over 7 days preceding the survey. Therefore, it may not have captured most severe dysmenorrhea impact. Given the above, the results of this study cannot be generalized. However, this could serve as a useful benchmark for understanding the current state of dysmenorrhea among health-conscious women who utilize health management applications.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDysmenorrhea impairs work productivity and increases presenteeism and activity impairment to a similar degree seen in mental disorders, headaches, and low back pain. However, our analysis of surveys across all female responders (18\u0026ndash;50 years old) found that only 6.0% (329/5,471) of affected women seek treatment while 41.1% (2,250/5,471) of individuals reported the use of OTC medications. The correlations that our study found between the disease-related productivity impairment and selected treatment implies the importance of treatment selection in an effort to limit work productivity loss and activity impairment in patients with dysmenorrhea. A further study, perhaps a randomized clinical study, would be needed to confirm the effectiveness of dysmenorrhea treatments in reducing productivity burden.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elow-dose estrogen\u0026ndash;progestin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLNG-IUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elevonorgestrel intrauterine system\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eover-the-counter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epremenstrual syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWPAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe Work Productivity and Activity Impairment Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in the present study consisted solely of anonymized information for which permission for secondary use had been obtained. In accordance with the Ethical Guidelines for Life Sciences and Medical Research Involving Human Subjects in Japan [20], this study was classified as exempt from review and approval by an institutional ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from DeSC Healthcare, Inc.; however, these were used under the license for the current study and are therefore not publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDG and ST employees of and MU was a former employee of Organon and may hold equity and/or shares. OH and YO are external consultants for Organon and have received consulting fees. OH and YO are former employees of the University of Tokyo, which received research funding from Organon in connection with this study and the development of this publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by funding from Organon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOH, DG, MU and YO conceptualized and designed the study. MU was responsible for data collection, curation, and data analysis. DG, MU, ST, and OH were responsible for data interpretation. DG and ST drafted the initial manuscript. All authors performed the critical review and final editing. All authors reviewed and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to Shido Inc. for the data analyses and medical writing support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStatistics Bureau of Japan. Ministry of Internal Affairs and Communications. Population Estimates / Annual Report, Statistics of Japan, The Portal Site of Official Statistics of Japan. [cited 2025 Nov 16]. Available from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.e-stat.go.jp/stat-search/files?stat_infid=000040268910\u003c/span\u003e\u003cspan address=\"https://www.e-stat.go.jp/stat-search/files?stat_infid=000040268910\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Ministry of Education, Culture, Sports, Science and Technology (MEXT), Ministry of Health, Labour and Welfare (MHLW), and Ministry of Economy, Trade and Industry (METI). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hokabunya/kenkyujigyou/i-kenkyu/index.html\u003c/span\u003e\u003cspan address=\"https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hokabunya/kenkyujigyou/i-kenkyu/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 16th of November 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics. 1993;4(5):353\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Hout B, Janssen MF, Feng YS, Kohlmann T, Busschbach J, Golicki D, et al. 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Japanese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398\u0026ndash;412.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Nieboer TE. Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ Open. 2019;9(6):e026186.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenske M, van Lonkhuijzen FK, Garcia, Annemarie Wagemakers. The Stigma Surrounding Menstruation: Attitudes and Practices Regarding Menstruation and Sexual Activity During Menstruation. Published online. 2022; 364\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook AS, van den Hoek R. Period pain presenteeism: investigating associations of working while experiencing dysmenorrhea. J Psychosom Obstet Gynaecol. 2023;44(1):2236294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZainab Doleeb, Liam G, McCoy J, Dada C, Allaire. Underrecognition of Dysmenorrhea Is an Iatrogenic Harm. AMA J Ethics. 2022;24(8):E740\u0026ndash;747.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeiko Yamada S, Yamaguchi N, Mizunuma T, Takeda. Analgesic avoidance in Japan: an epidemiological study exploring attitudes toward menstrual pain and medication. Int J Neuropsychopharmacol. 2025;28(Suppl 1):i239\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi K, Urteaga I, Wiggins CH, Druet A, Shea A, Vitzthum VJ, et al. Characterizing physiological and symptomatic variation in menstrual cycles using self-tracked mobile-health data. NPJ Digit Med. 2020;3:79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorse AM, Dauvilliers Y, Arnulf I, Thorpy MJ, Foldvary-Schaefer N, Chandler P, et al. Long-term efficacy and safety of low-sodium oxybate in an open-label extension period of a placebo-controlled, double-blind, randomized withdrawal study in adults with idiopathic hypersomnia. J Clin Sleep Med. 2023;19(10):1811\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpierings ELH, Ning X, Ramirez Campos V, Cohen JM, Barash S, Buse DC. Improvements in quality of life and work productivity with up to 6 months of fremanezumab treatment in patients with episodic and chronic migraine and documented inadequate response to 2 to 4 classes of migraine-preventive medications in the phase 3b FOCUS study. Headache. 2021;61(9):1376\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaba K, Guo W, Chen Y, Nosaka T, Kato T. Burden of schizophrenia among Japanese patients: a cross-sectional National Health and Wellness Survey. BMC Psychiatry. 2022;22(1):410.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerrot S, Doane MJ, Jaffe DH, Dragon E, Abraham L, Viktrup L, et al. Burden of chronic low back pain: Association with pain severity and prescription medication use in five large European countries. Pain Pract. 2022;22(3):359\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePouraliroudbaneh S, Marino J, Riggs E, Saber A, Jayasinghe Y, Peate M. Heavy menstrual bleeding and dysmenorrhea in adolescents: A systematic review of self-management strategies, quality of life, and unmet needs. Int J Gynaecol Obstet. 2024;167(1):16\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao S, Wu W, Kang R, Wang X. Significant Increase in Depression in Women With Primary Dysmenorrhea: A Systematic Review and Cumulative Analysis. Front Psychiatry. 2021;12:686514.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahin N, Kasap B, Kirli U, Yeniceri N, Topal Y. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reprod Health. 2018;15(1):13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanaka E, Momoeda M, Osuga Y, Rossi B, Nomoto K, Hayakawa M, et al. Burden of menstrual symptoms in Japanese women - an analysis of medical care-seeking behavior from a survey-based study. Int J Womens Health. 2013;6:11\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki N, Tsuno K, Hidaka Y, Ando E, Asai Y, Sakuraya A, et al. [Expected research in the workplace among Japanese female workers: A cross-sectional online survey based on the framework of patient and public involvement]. Sangyo Eiseigaku Zasshi. 2021;63(6):275\u0026ndash;90. Japanese.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dysmenorrhea, Low-dose estrogen–progestin (LEP), Combined oral contraceptives, Work Productivity and Activity Impairment Questionnaire - General Health (WPAI), Menstrual pain, Treatment pattern, Presenteeism, Absenteeism, Work productivity loss, Activity impairment","lastPublishedDoi":"10.21203/rs.3.rs-8587407/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8587407/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNearly 50% of Japanese women report impaired work performance due to menstrual symptoms. A survey of Japanese working women found that 44.6% of patients who did not seek treatment did so as they chose to endure the symptoms. We analyzed dysmenorrhea's impact on work productivity and its association with treatments using Japanese survey and claims data.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing an anonymized database consisting of linked Japanese health insurance claims and Work Productivity and Activity Impairment Questionnaire - General Health (WPAI-GH) responses for women aged between 18 and 50 years, we conducted descriptive analyses of dysmenorrhea patients\u0026rsquo; WPAI-GH survey responses, and compared dysmenorrhea\u0026rsquo;s impact with other chronic diseases and across dysmenorrhea patients grouped by treatment. We also analyzed patient-reported coping methods for menstrual pain.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 9,235 individuals in the database, 956 (10.4%) had dysmenorrhea. The WPAI-GH scores for dysmenorrhea patients showed absenteeism at 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3% (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error) and presenteeism at 26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9%, comparable to mental disorders, headaches, or low back pain. Within dysmenorrhea patients, the highest rate of absenteeism was observed in patients who received the Kampo medicine (Chinese traditional herbal medicine adopted to and evolved in Japan) alone, followed by analgesic agents alone, and progestin alone. The highest rate of presenteeism was observed in patients with intrauterine devices, followed by analgesic agents alone and progestin alone. Patients who were treated with the most frequently used treatment, LEP (low-dose estrogen\u0026ndash;progestin; also known as combined oral contraceptives), experienced second to the lowest absenteeism and presenteeism within treatment groups right above levonorgestrel intrauterine systems and Kampo medicine alone, respectively. Among 5,471 respondents who responded on coping methods for menstrual pain, 2,250 (41.1%) used over-the-counter medications, while only 329 (6.0%) sought medical care.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDysmenorrhea\u0026rsquo;s impact was found to be significant and comparable to other major chronic conditions with high patient burden. We further found correlations between dysmenorrhea\u0026rsquo;s disease impact and treatment; suggesting the importance of treatment selection and joint decision making between patients and clinicians in promoting evidence-based dysmenorrhea treatment that takes productivity impact into account.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Dysmenorrhea Patients’ Experience with Work Productivity Impact and Treatment in Japan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 14:38:22","doi":"10.21203/rs.3.rs-8587407/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-12T10:42:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T03:51:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T18:59:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64371569078950784521483512263821651066","date":"2026-03-05T01:20:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126057402488705122560988904513692813632","date":"2026-03-03T08:30:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227695519650278484466812878597283191594","date":"2026-02-28T07:18:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144360396570428809407428486363941397988","date":"2026-02-27T18:36:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-26T02:55:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-14T11:22:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-13T06:49:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-13T06:46:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-01-13T04:53:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"631078cd-ea30-48af-b5a2-05c56d50ed51","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T12:55:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 14:38:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8587407","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8587407","identity":"rs-8587407","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}