ObjectiveTo evaluate the effect of orally administered dienogest (DNG) for dysmenorrhea and pelvic pain associated with endometriosis.MethodsFor this study we recruited 89 patients with dysmenorrhea and pelvic pain associated with endometriosis diagnosed by laparoscopy. All patients complained of persistent dysmenorrhea and pelvic pain despite surgical treatment 6 months previously. After 6 months of DNG treatment, we used a 0 to 3 point verbal rating scale to measure the severity of disability in daily life due to dysmenorrhea and pelvic pain, and the use of analgesics. Weight gain, serum lipid and liver enzyme tests were performed before treatment and after 6 months of DNG treatment.ResultsTotal dysmenorrhea scores assessed by the verbal rating scale significantly decreased by the end of treatment (P<0.001). The mean (±standard deviation) pain score for dysmenorrhea before and after treatment were 1.42±1.1 and 0.1±0.3, respectively. The mean non-menstrual pelvic pain scores before and after treatment were 0.52±0.6 and 0.18±0.3, respectively, showing a significant difference (P<0.001). The use of analgesics significantly decreased by the end of the treatment (P<0.001). The associated adverse effects were weight gains (in 56 of 89 patients, 63%) and uterine bleeding (in 28 of 89 patients, 31.5%). The weight gain (before treatment, 57.9±9.7; after treatment, 61.1±12.6) was statistically significant (P<0.040).ConclusionThis study demonstrated that orally administered DNG could be used to effectively treat dysmenorrhea and pelvic pain associated with endometriosis although the side effects of weight gain and uterine bleeding should be considered.

ObjectivesTo evaluate the efficacy of raloxifene in preventing bone loss associated with long term gonadotropin-releasing hormone agonist (GnRH-a) administration.MethodsTwenty-two premenopausal women with severe endometriosis were treated with leuprolide acetate depot at a dosage of 3.75 mg/4 weeks, for 48 weeks. Bone mineral density (BMD) was evaluated at admission, and after 12 treatment cycles.Results At cycle 12 of GnRH-a plus raloxifene treatment, lumbar spine, trochanter femoral neck, and Ward's BMD differed from before the treatment. A year after treatment, the lumbar spine and trochanter decreased slightly, but were not significantly different.ConclusionsOur study shows that the administration of GnRH-a plus raloxifene in pre-menopausal women with severe endometriosis, is an effective long-term treatment to prevent bone loss.

ObjectivesWe sought to describe the perioperative and postoperative adverse events associated with sacral colpopexy and evaluate the surgical outcome, complications, and benefits of laparoscopic sacral fixation for patients with pelvic prolapse.MethodsNinety-two women with uterine prolapse underwent sacral colpopexy between January 2011 and September 2016 at Chosun University Hospital. Patients' electronic medical records were investigated for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Patients' outcomes were documented with 1 self-administered quality of life questionnaires: the Pelvic Floor Distress Inventory-20 focused on symptom distress. The primary analysis looking at perioperative and postoperative adverse events was descriptive and statistics were reported for all groups as n/N (%) with 95% confidence intervals for categorical variables and as mean ± standard deviation and mean (range) for all continuous variables.ResultsTheir mean age was 69 ± 8.1 years, mean follow-up duration was 12 months, and mean operating time was 61 minutes. There were seven conversions due to anesthetic or surgical difficulties. Follow-up was performed using a telephone questionnaire and physical examination at 12 months. There were three cases of sacral pain with strong analgesics, one of vaginal erosion, two of transient urinary retentions, one of spondylitis, and two of mesh infection. Of the patients, 98.9% were satisfied with the surgical results, while none complained of sexual dysfunction or problems performing her usual activities.ConclusionsLaparoscopic sacral colpopexy is a feasible and highly effective technique that offers good long-term results with complication rates similar to those of open surgery with the added benefit of being minimally invasive.

ObjectivesTo access the effectiveness of radiofrequency myolysis (RFM) in women with midline dysmenorrhea.MethodsWe designed RFM in two ways laparoscopic RFM (LRFM), vaginal ultrasound-guided RFM (URFM). One hundred and thirty-two patients were in the LRFM group and, 140 patients were in the URFM group.ResultsUpon receipt of surgery, both the LRFM and the URFM groups demonstrated a significant decrease (P < 0.001) in the mean pain score when compared to those before and after surgery.ConclusionThe RF uterine myolysis procedure provides an alternative for those patients who suffer from intractable midline dysmenorrhea. LRFM is an alternative choice because it is relatively safe and, simple to perform and moreover, it is satisfactory. LRFM appears to increasingly succeed in the treatment of midline dysmenorrhea.

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