Evaluation of the Analgesic Effect of Intramyometrial Botulinum Toxin Injection Via Hysteroscopy in Severe Primary Dysmenorrhea (HYSTEROXINE)

Nantes University Hospital (NUH)

Status and phase: Not yet enrolling; Phase 3

Conditions: Chronic Pelvic Pain; Primary Dysmenorrhea

Treatments: Drug: Placebo; Drug: Xeomin

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT06995287

2025-520638-53-00 (EU Trial (CTIS) Number)

RC24_0428

Details and patient eligibility

About

The objective of the study is to evaluate the global impression of improvement at 3 months following intramyometrial botulinum toxin injections via hysteroscopy in women with severe primary dysmenorrhea who have failed first-line medical treatment, compared to intramyometrial placebo injections.

Full description

This trial is multicenter, placebo-controlled, randomized with center-based stratification, double-blind and prospective. The treatment consists of a single injection follow by 6 months of follow-up.

Enrollment: 222 estimated patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult women who are not menopausal,
• Experiencing severe dysmenorrhea, defined as an average pain intensity score ≥ 6/10 on a Numerical Rating Scale (NRS) over the past 3 months at the inclusion visit,
• Having failed optimal first-line medical treatment combining hormonal therapy and appropriate analgesics (Level I and II analgesics, and NSAIDs),
• Having undergone a pelvic MRI within 6 months prior to the inclusion visit that shows no evidence of deep infiltrating endometriosis or endometrioma, following systematic review by radiologists from the expert center managing the patient (if the pelvic MRI is deemed of insufficient quality for interpretation, a new MRI will be performed at the center),
• Using a highly effective method of contraception (failure rate <1%) for the entire duration of the follow-up period. Highly effective contraception methods are defined as one of the following: combined hormonal contraception (containing estrogen and progestin) with ovulation inhibition (oral, vaginal, or transdermal), progestin-only hormonal contraception with ovulation inhibition (oral, injectable, or implantable), intrauterine device (IUD), intrauterine hormonal system (IUS), condoms, bilateral tubal occlusion, vasectomized partner, or sexual abstinence,
• Having a negative urine pregnancy test on the day of the procedure,
• Having signed the informed consent form for the study at the M-1 visit.

Exclusion criteria

• Pregnant or planning a pregnancy during the entire study period,
• Currently breastfeeding,
• Refusal to use effective contraception during the study and for 6 months after its completion,
• Contraindications to botulinum toxin, including:
• Generalized disorders of muscular activity (e.g., myasthenia gravis, Lambert-Eaton syndrome),
• Ongoing treatment with aminoglycosides, peripheral muscle relaxants, or amino-4-quinolines,
• Hypersensitivity to the active substance, human albumin, or sucrose,
• Bleeding disorders or current treatment with anticoagulants,
• Ongoing vaginal or upper genital tract infection,
• Participation in another interventional clinical trial,
• Inability to cooperate or understand the study requirements in a way that would allow strict adherence to the protocol,
• Subject to legal protection measures (e.g., guardianship, curatorship, or judicial protection),
• Not affiliated with the French social security system,
• Unable to access the internet to complete questionnaires at Month 1 and Month 6.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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222 participants in 2 patient groups, including a placebo group

Botulinum toxin type A

Experimental group

Description:

One injection will be performed via hysteroscopy under local anesthesia. The patient will be followed up remotely at M1 and M6 to complete questionnaires, and will be seen in site at M3 for a postoperative consultation and to complete questionnaires.

Treatment:

Drug: Xeomin

Placebo

Placebo Comparator group

Description:

One injection will be performed via hysteroscopy under local anesthesia. The patient will be followed up remotely at M1 and M6 to complete questionnaires, and will be seen in site at M3 for a postoperative consultation and to complete questionnaires.

Treatment:

Drug: Placebo