{"paper_id":"ca62818a-7182-4aa0-97b8-c03bf7a0c434","body_text":"Continuing Education Column\nഈഥ૑ 53\nۿࢲ\n݅\n੸ ഑਷ ઱ӝ\nա\n੉\nۆ\n૕ജী ੄\n૕ജ হ੉\nׂ\n\u0001\u000f׮ \nThe Management of Chronic Pelvic Pain\nੋҗ ] \u0001Sung\u000eTack Oh, MD\nDepartment of Obstetrics & Gynecology, Chonnam National University College of Medicine\nEĔmail: ohst@chonnam.ac.kr\nJ Korean Med Assoc 2008; 51(1): 53 - 64\nC\nhronic pelvic pain (CPP) is defined as lower abdominal pain lasting for at least 6 months.\nThere are two forms of CPP: cyclic or continuous. The usual cyclic pain is dysmenorrhea.\nDysmenorrhea is classified into primary and secondary. The primary dysmenorrhea is painful\nmenstruation without any other pelvic disease. It can be treated by fat\n\u000efree or omega\u000e3\u000erich\ndiet, quitting of smoking, nonsteroidal antiinflammatory drugs (NSAIDs), oral contraceptive pills,\nand long-acting injectable progestins. The most common origin of secondary dysmenorrhea and\nCPP is endometriosis. The management of pain of endometriosis can be controlled with step\n\u000e\nby\u000estep management of the original lesion by medical and surgical treatment, postoperative\nmedical treatment, trigger point injection, NSAIDs, and immune therapy. Other etiologies of CPP\nare adenomyosis, pelvic congestion syndrome, abnormalities of uterus and ovary, psychological\nproblems, gastrointestinal diseases (e.g. irritable bowel syndrome), urinary diseases (e.g.\ninterstitial cystitis or chronic urethral syndrome), and musculoskeletal diseases. They can be\ntreated by the management of the underlying diseases. The special form of CPP is chronic\nmyofacial syndrome of the abdominal wall, which can be treated by trigger point injection. The\nother supportive treatments for CPP are laparoscopic adhesiolysis, uterine suspension, lapa-\nroscopic uterosacral nerve ablation (LUNA), presacral neurectomy, and hysterectomy. The treat-\nment of CPP is very difficult. Therefore the exact diagnosis of its origin is necessary, and the\ncombination treatment in various aspects is needed.\nKeywords : Dysmenorrhea; Chronic pelvic pain; Endoemetriosis\n೨बਊয \u001bૐ\nAbstract\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0016 \u0014\n\n54ܐ\nOh ST\nೞҊ ૑\n߈\n҃ೱ੉ ੓\nࢤ\n࠙ࠗ؀\n۽ٮ\n\u0001\u000f׮\nܐ\n࢑ߑ\nృ\nࠗ۽\nূ\n੄ ҃਋\t਋\nо\u000eߑ\nо\u000e\u0017\nо\u000eੋ ই\nܨ\nాҗ য়\nౠ൤\n୷\n\u000f׮ػ\nহ\nझఋӖ\n_ \u0014\n\u000f\n૕\nਊ୓о ৉\nࢤࢲ \n௏౟\nח\nೞҊ ੓\nо\n\u000eࢤب \nਘ\n௏౯ী ੄ೠ\n\u000f\n\u0011\u0012\t׮\nܐ\nо\u000eನച૑\n੉ ੸਷\nࠁח׮ \nо\n\u000eܻࢤ\n\u0001\u000f\n\u0013\u0012\t׮\n৏ઁ\n\t/PO\u000e4UFSPJEBM\u0001\"OUJ\u000e*OGMBNNBUPSZ\u0001%SVHT\r\u0001/4\"*%T\nࢿ\nӝաઁ\tDZ\u000e\nਸ\n\u000f׮\n஖\n׮\n_ \u0012\u001a\n\u000f\nغࢿࢤ\n੉ನৠदӝաઁ\tMJQPPYZHFOBTF\nী ੄\n݅\nNFDMPGFOBNBUF\u0001 TP\u000e\nҊী\n؊\nҊ\nܐ\nਸ ઱\n\u000f\n\u0013\u0013\t׮\nࢎח \n૕\n09\n\u000e09\u000e\u000f׮\n09\u000eઑ૒ী\nച\r\u0001੼ঘҗ ઺఍\n੄ ন\nೠ $09\n\u000e৏ઁо ੷೧ೣਵ\n౸ ੘ਊ੉ աఋդ\nী $09\n\u000e੉Ѣա\nઓ੤\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0016 \u0015\n\nഈഥ૑ 55\nThe Management of Chronic Pelvic Pain\n੘ਊ\nೠ $09\u000e۽ܐ\nFMFDPYJC\r\n\u0001\u000f׮\n਽\nח\nৠदӝա\nܻ\nࢸ۽ \n஠झ\nࢤ\n\u000f\n\u0014\u0013\t׮\n۝\n\u0001\u000f׮\nԲѢա ҃ҳਊ\nਊ੉ о੢\nആ੉\n੉\n09\n\u000e\u000f׮\n҃ҳ ೖ੐ઁ\t0SBM\u0001$POUSBDFQUJWF\u00011JMMT\r\u00010$1\nౠ\nബҗ৬\nо૑Ҋ ੓ਵ\nױ\n੢ਸ রઁೞৈ ೐\nр\n࠙\n\u000f׮\n߂\nҊೞҊ\nాী ੄ೠ ాૐ\nחࢲ\nMFWPOPSHFTUSFM\nэ਷ ъ\n׮ࠁ\n۰\nҊೞҊ ੓য\n\u000f׮\n҃ҳ ೖ\n਷ ੓ਵա ъೠ\n৏ઁ৬\nݶ\nݴ\n\u000f׮\n੗Ҿղ ੢஖\nਊ ড\nFQP\u000e1SPWFSB\r\u0001EFQPU\u0001 NFESPYZQSP\u000e\nFQPTVC2\nਸ ೣਬೠ ੗Ҿղ\nա\t.JSFOB\r\u0001-FWPOPSHFTUSFM\u0001 SFMFBTJOH\u0001 JOUSBV\u000e\n੗Ҿ\n؊\n\u000f׮ػ\nܐ\nܻࢤ۽ \nా਷ р೵੸ ഑਷\nҎ\nೠ दӝ੄\nѐ੄ ૕ജ\nਗ\nࢤ۽ \nޙٸ\n١\nҊ ৈӝী ੿न੸ੋ ਗੋ\n਋\n߽\nܻޛ\nബҗ੸ੋ\n\u000f׮\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0016 \u0016\n\n56ܐ\nOh ST\nૐ\n਷ ਗੋ\nૐ੉ ର૑ೞ\n۽\n޷\nয ੓Ҋ\n੻਷ ա੉\nࢿߊࣘ۽ \nػ\nҮాਸ ੌਵః\n\u000f׮ػ\n\u000f׮\n˝ ઑ૒੄\nૐ\n੗ӓী ੄ೠ\nൔ\r\u0001ਤ\nൔ\r\u0001ਤ\nझ৬੄ ਬ଱ী ੄ೠ റҷ ੗Ҿ੄\n੄ Ѿ੺੄ ঑ా ഑਷ Ѽੋী ੄ೠ\n੉\n઱ਤ੄ ৏ૐ\n੷ ੗Ҿղ\nറ ా\nद೯ೞҊ\n\u000f׮\n੉\nѪ੉\n\u000f׮\n഑਷\nܐ\nח\n੘ਊઁ\t(O\u000e\n੸҃ҳೖ੐ઁ\n੉\n\u000f׮\n਋ ബ\n୭Ӕ੄ п ড੄ ਊ\nബҗо\nҊ\n\u000f\n\u0013\u0014\u0001\r\u0012\u0014\t׮ \n۝\nࣄ߬\u0001\u000f׮ \nѲ੉ \u0013\u0011 Ǻ H\u0010\n੘ਊ\nബҗ\n࠺\n࠺بܫߊ \nNH੄ ҃ҳਊ\nFQP\n\u000e߈\n٘٣\nत\n߬۽\n\u000f\n\u0017\u0014\t׮\n٥\u000eറ\nݮ֙\u0013\u0019\u001a\u0012\u0001\u000f\n\u0019\u0014\u0001\r\u0018\u0014\t׮ \nܳ\nܳࣗ\n\u0017ܳ \n٘\n઺ \u0013\u0011\nࢲ\nҕ\nੌद੸\n\u0001\u000f׮\nਸ द೯ೞ\nࠂ\n੸਷ ઑ੘\nӐ х৏੉ա ୹ആ੄\n۽ܐ\nૐ\nо જ\nജ੗\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0016 \u0017\n\nഈഥ૑ 57\nThe Management of Chronic Pelvic Pain\nҮా\n١\n੉੷\nࢲ\n\u0001\u000f\n\u0015\u0015\t׮\nਬ଱\n݅\nী\n۽\nా\n\u0001\u000f׮\nח\nܐ\nਸ\nࣿࣻݶۄ \n\u000f׮\nറী ড \u0012\u0011 _\u0014\u0011\u0006\u0001੿\nറ ాૐ੉\n\u000f׮\n࠺࠙ހܰ \nਸ द೯ೠ Ѿҗ ాૐ੄\nߨ\n਷ \u0014 _ \u0015\nъ\nހܰ\n೤ഋ ҃ҳೖ੐ઁ\tDPNCJOFE\u0001PSBM\nࣿࣻ\nী\nട୓\n҃਋੄\n\u000f׮\nࣿࣻ\nܐ\n5SJHHFS\u00011PJOU\u0001*OKFDUJPO\n૑ х\nాૐী\nਬ\nחܰ\nח\nѼ\nҊо\n޷݈\nبܻ\u0001\u0006\u0012חࢲ \n੼ী\n\u000f׮\nਖ਼ઓೞৈ\nܐ\n\nܐ\nૐ\nചী ੄ೠ ా\nী\n৏ઁ\n\u000f׮\nా੄\n੗Ҿ\n׮ػࢿࢤ۽ب֪ \nਊ੉ ాૐ੄\n݄\nী ੄೧\nஜਮ\nޛ\n۽޲\n૑\nѢ୛\nೠ റ թ\n\u000f׮\n09\n\u000eࢲ\n09\u000eয\n۞\n09\n\u000eח\n09\u000e\u000f׮\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0016 \u0018\n\nࢲ\n҃\nాਸ\n\u000f׮\nాૐী\nNNVOF\u0001.PEVMBUJPO\n5IFSBQZ\n৉೟੸ੋ ӝ੹੉ ઺\nഅ੤ө૑ ঌ\nࢿ\nध\nঌ\nۄפ\n৉೟\n৉೟\n\u000f׮\n߸\nޖ\nࢿ\nആҳ\nૐо\r\u0001$\n\u000eࣁ\nನ\nఠ пઙ\n੗\nਊೣਵ\n߂\nನ\n੓ਸ Ѫ\n\u000f׮ػ\nӔૐ\t\"EFOPNZPTJT\n\u0001\n੗\nӔ\n୷੉ ъ೧૑\nਘ҃җ\nࣿ\n৏\n୭\nࢤ\n੄\n\u000f׮\n਎ആૐ\t1FMWJD\u0001$POHFTJPO\u00014ZOESPNF\nҗ\n৏઱\t1FMWJD\u00017BSJDPTJUZ\n਎\nਤ\nী ੄\nী ాૐਸ\nо\nೞӝ ਤೞৈ ઝஏ\n৻੺ઁ\tFYUSBQFSJUPOFBM\u0001 SFTFDUJPO\nೞӝ\nݶ\n҃਋\n\u000f׮\nా\n੓Ҋ оՔ बೠ ੗Ҿ\n੉ա ੗Ҿ ղ\n੓Ҋ оՔ դҙ Ѿ଴\n੸೤ೠ ஖\nࣻח \nૐറҵ\tPWBSJBO\u0001SFNOBOU\u0001TZOESPNF\n੉\n߈\nо ઱ਤ ઑ૒ਸ ঑\nઑ૒ਸ\n\u000f׮\nా\n਋਎\n\u000f׮\nઁо ೣ\n\u0001\u000f׮\n58ܐ\nOh ST\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0016 \u0019\n\nഈഥ૑ 59\nThe Management of Chronic Pelvic Pain\nా\nѼ\nਤ੢ҙ҅ ૕ജ ઺\n੢ ૐറҵ\t*SSJUBCMF\u0001 CPXFM\u0001 TZOE\u000e\nহҊ ੿\nউबदఃҊ\nਊ੸ ഛ੢ઁ\tCVML\n\u000e\n੄ ೦਋਎\n\u000f׮\nॿ\n૕ജ\t$SPIO’੢৏\tVMDFSBUJWF\u0001DPMJUJT\n\r\u0001х\n੢૕\n۲\nղҗ੸\nઑ\n\u000f׮\nా\n಴੸ੋ ૕ജ\nૐറҵ\tDISP\u000e\nߑ\u0001\rࢳ\nӔ\n١\n\u0001\u000f׮ \nೞ\nܳ\nܻ\nܿ\n\u000eਸ ైৈ\nਸ ైৈೡ\nэ਷ ҎѺӔ ੉\nэ਷ ಣഝ\nܳ\n۽\n\u000f׮\nߑ\nࣗ\n৉\n_ \u0016\u0012\n\u000f \u0001஖\nبࣻחࠁܳ \n೦਋਎ઁ\tUSJDZDMJD\u0001 BOUJEF\u000e\nפ\nҗ ઺୶न҃ ੗ӓਸ ాೞৈ ాૐ\nൃ\n\u000f׮\nࢎ\nೞҊ ҃ೖ ੹ӝ੸ न҃ ੗ӓ\tUSBOTDVUBOFPVT\n\u000f׮\nా\nѪ\nղ\nਤо Ҁ\nࠂ\n߹\nࠂࢲ۰ \n؊ݶ \n૕ജ੉ ӔҎ\nо ੓\nాೞৈ ҙ੺\n߈\nೠ ૕ജ਷ દ੐न҃ૐ\nૐറҵ\tNZPGBDJBM\u0001 TZOE\u000e\n\u0001\u000f׮ \n੺ѐ\tTVQSB\u000e\nन҃੉ Ѿ଴ ഑਷\nೞৈ\nܐ\nೠ\nా ജ੗ী\n؀\n\u000f׮\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0016 \u001a\n\n60ܐ\nOh ST\nా\nై\nೠ Ҏ\nա\n୓੸ਵ\n\u000f׮\n੼\t5 SJHHFS\u00011PJOU\nࢿ݅\nӔਭ\nాૐ ૐറҵ\t$ISPOJD\u0001 NZPGBDJBM\u0001 QBJO\u0001 TZOESPNF\n੉\nӒ\nী\nӒ\nन҃୨\nѼ\n\u0001\u000f׮\n݅ࢲ\nী ੄\nҊ Ӓ\nҊೞҊ ੓\nܲ׮\nઁ৻ೞ\nॄ ӔӔ\n\u000f׮ػܐࢎ۽ \n੗ো\n୷ Ѿ੺\nޛ׳\n੉ ো\nߊ\n\u0001\u000f\n\u0015\u0016\t׮\nઉ\nߊ\nо о੢ ബҗ੸੉Ҋ উ੹ೠ ஖\n൤ Ҵ\n\u000f׮\nѱ੉૑ \u0012\u0010\u0013\nாੋ\tCVQJWB\u000e\n਷\n੹թ\nঀ\n\u000f׮\n഑਷ \u0013\u0014\u0001 ѱ੉૑\nח\n഻ঁ ੸਷ Ҋా\n\u0011\u0014ח \nܿ\n੄\nѱ੉૑ ੉\n\u0001\u000f׮\nܐ\nܻࣿ߅\nాী ബҗ੸ੋ\n۰\nഐ\nറ\nࠁ\n׮\nࣻ\n\u0001\u000f\n\u0019\u0016\t׮ \nࣿ\n੉ ੓\nೡ\n\u000f׮݆\n੗Ҿ Ѧӝ\t6UFSJOF\u00014VTQFOTJPO\nҮా੉ बೠ ҃਋\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0017 \u0011\n\nഈഥ૑ 61\nThe Management of Chronic Pelvic Pain\n૕ध ੹੗Ҿ\nਗೞѢա ഑਷\nࠂߑ \nߨߑח \n\u0001\u000f׮\nъ҃\n؀\n೤ೞৈ ઱\n\u0001\u000f׮\nࣿ\nBQBSPTDPQJD\u00016UFSPTBDSBM\u0001/FSWF\u0001\"CMBUJPO\r\u0001-6/\"\n੉\nबೠ ਘ\n઺ঔ\n\u0001\u000f׮ػ \n੄ ੋ\n਋ ઱੄ೞৈঠ\n\u000f׮\n۽\n൤\nӒ\nࢤ\nחࢲ\n\u0001\u000f׮\n1SFTBDSBM\u0001/FVSFDUPNZ\r\u000114/\nद೯\nই\nࢶ١ \n\u000f׮ػܐࢎ۽ \nࣿ\nਸ द೯ೞৈ\nन઺ೠ\n\u000f\n\u0012\u0017\t׮\nۿ\nױ\n੿न\nਸ ҙ଴\n౱੉ न୓\nೞৈ\n\u000f׮ \n೴\n11. Chan WY, Hill JC, Determination of menstrual prostaglandin\nlevels in nondysmenorrheic and dysmenorrheic subjects.\nProstaglandins 1978; 15: 365-375. \n12. Rees MC, Anderson AB, Demers LM, Turnbull AC. Pros-\ntaglandins in menstrual fluid in menorrhagia and dysmenor-\nrhea. Br J Obstet Gynaecol 1984; 91: 673-680.\n13. Lundstrom V, Green K. Endogenous levels of prostaglandin\nF2? and its main metabolites in plasma and endometrium of\nnormal and dysmenorrheic women. Am J Obstet Gynecol\n1978; 130: 640-646. \n14. Rees MC, Di Marzo V, Tippins JR, Turnbull AC. Leukotriene\nrelease by endometrium and myometrium throughout the\nmenstrual cycle in dysmenorrhea and menorrhagia, J Endo-\ncrinol 1987; 113: 291-295. \n15. Levinson SL. Peptidoleukotriene binding in guinea pig uterine\nmembrane preparations. Prostaglandins 1984; 28: 229-240. \n16. Nigam S, Benedetto C, Zonca M, Leo\n\u000eRosberg I, Lubbert H.\nIncreased concentrations of eicosanoids and platelet \u000eacti-\nvating factor in menstrual blood from women with primary\ndysmenorrhea. Eicosanoids 1991; 4: 137-141. \n17. Harel Z, Lilly C, Riggs S, Drazen J. Urinary leukotriene (LT)\n\u000eE4 in\nadolescents with dysmenorrhea. J Adolesc Health 2000; 27:\n151-154. \n18. Balbi C, Musone R, Menditto A, Di Prisco L, Cassese E,\nD'Ajello M, Ambrosio D, Cardonel A. Influence of menstrual\nfactors and dietary habits on menstrual pain in adolescence\nage. Eur J Obstet Gynecol Reprod Biol 2000; 91 :143-148.\n19. Deutch B. Menstrual pain in Danish women correlated with\nlow n\n\u000e3 polyunsaturated fatty acid intake. Eur J Clin Nutr\n1995; 49: 508-516. \n10. Hornsby PP, Wilcox AJ, Weinber CR. Cigarette smoking and\ndisturbance of menstrual function. Epidemiology 1998; 9:\n193-198. \n11. Barnard ND, Scialli AR, Hurlock D, Bertron P. Diet and sex-\nhormone binding globulin, dysmenorrhea, and premenstrual\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0017 \u0012\n\nsymptoms. Obstet Gynecol 2000; 95: 245-250.\n12. Harel Z, Biro FM, Kotenhahn RK, Rosenthal SL. Supplemen-\ntation with omega\u000e3 fatty acids in the management of dys-\nmenorrhea in adolescents. Am J Obstet Gynecol 1996; 174:\n1335-1338.\n13. Chan WY, Dawood MY. Prostaglandin levels in menstrual fluid\nof nondysmenorrheic and of dysmenorrheic subjects with and\nwithout oral contraceptive or ibuprofen therapy. Adv Pro-\nstaglandin Thromboxane Res 1980; 8: 1443-1447.\n14. Hanson FW, Izu A, Henzyl MR. Naproxen sodium in dys-\nmenorrhea: its influence in allowing work/school activities.\nObstet Gynecol 1978; 52: 583-587. \n15. Budoff PW. Zomepirac sodium in the treatment of primary\ndysmenorrhea syndrome. N Engl J Med 1982; 307: 714-719. \n16. Smith RP, Powell JR. Intrauterine pressure changes during\ndysmenorrhea therapy. Am J Obstet Gynecol 1982; 143: 286-\n292.\n17. Mehlisch DR. Ketoprofen, ibuprofen, and placebo in the\ntreatment of primary dysmenorrhea: a double\n\u000eblind crossover\ncomparison. J Clin Pharmacol 1988; 28: S29-33. \n18. Mehlisch DR. Double\u000eblind crossover comparison of keto-\nprofen, naproxen, and placebo in patients with primary dysme-\nnorrhea. Clin Ther 1990; 12: 398-409. \n19. Marchini M, Tozzi L, Bakshi R, Pistal R, Fedele L. Comparative\nefficacy of diclofenac dispersible 50 mg and ibuprofen 400 mg\nin patients with primary dysmenorrhea. A randomized, double\nblind, within\n\u000epatient, placebo \u000econtrolled study. Int J Clin\nPharmacol Ther 1995; 33: 491-497. \n20. Owen PR. Prostaglandin synthetase inhibitors in the treat-\nment of primary dysmenorrhea. Am J Obstet Gynecol 1984;\n148: 96-103.\n21. Roy S. A double\n\u000eblind comparison of a propionic acid derivative\n(ibuprofen) and a fenamate (mefenamic acid) in the treatment\nof dysmenorrhea. Obstet Gynecol 1983; 61; 628-632.\n22. DuRant RH, Jay MS, Shofitt T, Lider CW, Taylor W. Factors\ninfluencing adolescents' responses to regimens of naproxen\nfor dysmenorrhea. Am J Dis Child 1985; 139: 489-493. \n23. Harel Z, Riggs S, Vaz R, Flanagan P, Harel D. The use of the\nleukotriene receptor antagonist montelukast (Singulair) in the\nmanagement of dysmenorrhea in adolescents. J Pediatr Ado-\nlesc Gynecol 2004; 17: 183-186.\n24. Hauksson A, Akerlund M, Forsling ML, Kindahl H. Plasma\nconcentrations of vasopressin and a prostaglandin F2α meta-\nbolite in women with primary dysmenorrhea before and during\ntreatment with a combined oral contraceptive. J Endocrinol\n1987; 115: 355-361. \n25. Creatsas G, Deligeoroglou E, Zachari A, Loutradis D, Papa-\ndimitriou T, Miras K, Aravantinos D. Prostaglandins: PGF α,\nPGE2, 6\n\u000eketo\u000ePGF1α and TXB serum levels in dysmenor-\nrheic adolescents before, during and after treatment with oral\ncontraceptives. Eur J Obstet Gynecol Reprod Biol 1990; 36:\n292-298. \n26. Ekstrom P, Juchnicka E, Laudanski T, Akerlund M. Effect of\nan oral contraceptive in primary dysmenorrhea \u000echanges in\nuterine activity and reactivity to agonists. Contraception 1989;\n40: 39-47. \n27. Ekstrom P, Akerlund M, Forsling M, Kindahl H, Laudanski T,\nMrugacz G. Stimulation of vasopressin release in women with\nprimary dysmenorrhea and after oral contraceptive treatment\n\u000e\neffect on uterine contractility. Br J Obstet Gynaecol 1992; 99:\n680-684.\n28. Milsom I, Andersch B. Effect of various oral contraceptive\ncombinations on dysmenorrhea. Gynecol Obstet Invest 1984;\n17: 284-292. \n29. Larsson G, Milsom I, Lindstedt G, Rybo G. The influence of a\nlow-dose combined oral contraceptive on menstrual blood\nloss and iron status. Contraception 1992; 46: 327-334.\n30. Robinson JC, Plichata S, Weisman CS, Nathanson CA, Ens-\nminger M. Dysmenorrhea and use of oral contraceptives in\nadolescent women attending a family planning clinic. Am J\nObstet Gynecol 1992; 166: 578-583.\n31. Dmowski WP, Cohen MR. Treatment of endometriosis with\nan antigonadotrophin, danazol: a laparoscopic and histological\neducation. Obstet Gynecol 1975; 46: 147-154.\n32. Biberoglu KO, Behrman SJ. Dosage aspects of danazol the-\nrapy in endometriosis: short term and long term effecti-\nveness. Am J Obstet Gynecol 1981; 139: 645-654.\n33. Vercellini P, Bocciolone L, Vendola. N, Colombo A, Rognoni\nMT, Fedele L. Peritoneal endomeriosis: morphologic appea-\nrance in women with chronic pelvic pain. J Reprod Med 1991;\n36: 533-536.\n34. Moghissi KS, Boyce CR. Management fo endometriosis with\noral medroxyprogestrone acetate. Obstet Gynecol 1976; 47:\n265- 267.\n35. Johnston WI. Dydorgesterone and endometriosis. Br J Obstet\nGynecol 1976; 83: 77-80.\n36. Telimaa S. Puolakka J, Ronuberg L, Kauppila A. Placebo con-\ntrolled comparison of danazol and high dose meroxy\n\u000epro-\ngestrone acetate in the treatment of endometriosis. Gynecol\nEndometrinol 1987; 1: 13-23.\n37. Azadien\n\u000eBoulanger G, Secchi J, Tournemine C. Hormonal ac-\ntivity profiles of drugs for endometriosis therapy. In: Raynoud\nJP, Ojassoo T, Martini L, ed. Medical Management fo Endo-\nmtriosis. 2nd ed. New York: Raven Press, 1984: 125-129.\n38. Couthinho EM, Husson JM, Azadieu\n\u000eBoulanger G. Treatment\nof endometriosis with gestrinone\u000efive year’s experience. In:\nRaynoud JP, Ojasso T, Martini L, ed. Medical Management of\nEndometriosis. 2nd ed. New York: Raven Press, 1984: 249-\n253.\n39. Meldrum DR, Chang RJ, Lu J, Vale W, Rivier J, Judd HL.\n62ܐ\nOh ST\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0017 \u0013\n\nഈഥ૑ 63\nMedical oophorectomy using a long\u000eacting GnRH agonsit: a\npossible new approach for the treatment of endotmetrisis. J\nClin Endocrinol Metab 1982; 54: 1081-1083.\n40. Reichel RP, Schweppe KW, Zoladex Endomtriosis Study\nGroup. Goserelin (Zoladex) depot in the treatment of endo-\nmetriosis. Fertil Steril 1992; 57: 1197-1202.\n41. Hardt W, Schmidt\n\u000eGollwitzer M, Schmidt\u000eGollwitzer K, Genz\nT, Nevinny\u000eStickel J. Erste Ergebnisse beil der Behandlung der\nEndometriose mit dem LH\u000eRH Analogen Buserelin. Geburt-\nshilfe Frauenheikunder1986; 46: 483-489.\n42. Tokushige M, Suginami H, Taniguchi F, Kitaoka Y. Laparoscopic\nsurgery for endometriosis: a long\u000eterm follow\u000eup. J Obstet\nGynecol Res 2000; 26: 409-416.\n43. Sutton CJ, Ewen SP, Jacobs SA, Whitelaw NL. Laser laparos-\ncopic surgery in the treatment of ovarian endometriomas. J\nAm Assoc Gynecol Laparosc 1997; 4: 319-323.\n44. Daniell JF, Kurtz BR, Gurley LD. Laser laparoscopic manage-\nment of large endometriomas. Fertil Steril 1991; 55: 692-695. \n45. Donnez J, Squifflet J, Pirard C, Jadoul P, Wyns C, Smets M. The\nefficacy of medical and surgical treatment of endometriosis\n\u000e\nassociated infertility and pelvic pain. Gynecol Obstet Invest\n2002; 54: 2-7. \n46. Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB.\nManagement of ovarian endometriomas. Hum Reprod Update\n2002; 8: 591-597.\n47. Jones KD, Sutton C. Patient satisfaction and changes in pain\nscores after ablative laparoscopic surgery for stage Ǐ\n\u000eǐ\nendometriosis and endometriotic cysts. Fertil Steril 2003; 79:\n1086 -1090.\n48. Reiter RC. A profile of women with chronic pelvic pain. Clin\nObstet Gyenecol 1990; 33: 130-136.\n49. Fall M, Johannson SL, Aldenberg F. Chronic interstitial cystitis:\nA heterogeneous syndrome. J Urol 1987; 137: 35-38.\n50. Holm\n\u000eBentzen M, Jacobsen F, Nerstrom B, Lose G, Kris-\ntensen JK, Pedersen RH, Krarup T, Feggetter J, Bates P, Bar-\nnard R. Painful bladder disease: Clinical and pathoanatomical\ndifferences in 115 patients. J Urol 1987; 138: 500-502.\n51. Larsen S, Thompson SA, Hald T, Barnard RJ, Gilpin CJ, Dixon\nJS, Gosling JA. Mast cells in interstitial cystitis. Br J Urol 1982;\n54: 283-286.\n52. Travell J, Rinzler SH. The myofascial genesis of pain. Postgrad\nMed 1952; 11: 425-434.\n53. Slocumb JC. Neurological factors in chronic pelvic pain: trigger\npoint and the abdominal pelvic pain syndrome. Am J Obstet\nGynecol 1984; 149: 536-543.\n54. Carter JE. Surgical treatment for chronic pelvic pain. J Soc\nLaparoendosc Surg 1998; 2: 129-139.\n55. Simons DG. Diagnostic criteria of myofascial pain caused by\ntrigger points. J Musculoskel Pain 1999; 7: 111-113.\n56. Chan CL, Wood C. Pelvic adhesiolysis\n\u000ethe assessment of\nsymptom relief by 100 patients. Aust N Z J obstet Gynaecol\n1985; 25: 295-298.\n57. Nezhat FR, Crystal FR, Nezhat CH, Nezhat CR. Laparoscopic\nadhesiolysis and relief of chronic pelvic pain. JSLS 2000; 4:\n281-285.\n58. Sutton C, McDonald R. Laser laparoscopic adhesiolysis. J\nGynecol Surg 1990; 6: 155-159.\n59. Sutton C, Hill D. Laser laparoscopy in the treatment of endo-\nmetriosis. Br J Obstet Gynecol 1990; 97: 181-185.\n60. Lichten EM, Bombard J. Surgical treatment of primary dys-\nmenorrhoea with laparoscopic uterosacral nerve ablation. J\nReprod Med 1987; 32: 37-41.\n61. Parsons LH, Stovall TG. Surgical management of chronic\npelvic pain. Obstet Gynecol Clin North Am 1993; 20: 765-778.\nThe Management of Chronic Pelvic Pain\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0017 \u0014\n\n64ܐ\nOh ST\nPeer Reviewer Commentary\nী ҙೠ ୭न ૑Ѽਸ ӝ\nೞ৓Ҋ\r\nੋҗ੸ ૕ജ ৻ী\nਤ\nद ҙ଴ೞৈ ੿नҗ੸\nೞ\n\u000f׮\nੋҗ\nೠ ജ੗\nݶ\n\u000f׮\nࠂחغ۲ \nݺ\n۞\n\u0001\u000f׮ \nӝ੹ਸ ੉೧\n١\nী ੐ೡ\n\u000f׮\nੋҗ\nఖ\u0001\u0001\u0013\u0011\u0011\u0019\u000f\u0012\u000f\u0012\u0011\u0001\u0016\u001b\u0015\u0018\u00011.\u0001\u0001ಕ੉૑\u0017 \u0015","source_license":"CC0","license_restricted":false}