Hypothesis: Chronic pelvic pain in endometriosis in combination with depression in women can be effectively reduced using a combination of Dienogest and antidepressants, leading to a significant decrease in symptom duration and an overall improvement in the quality of life for patients.
Кesearch objectives: The main purpose of this study is to evaluate the effectiveness of an integrated approach to the treatment of chronic pelvic pain in endometriosis in women. This study also aims to identify the effectiveness of surgical treatment followed by pharmacotherapy for endometriosis and concomitant depression. We aim to determine the degree of improvement that can be achieved through a combination of surgical and pharmacological treatment.

Study Design: We are conducting a case study that provides an in-depth examination of one patient's clinical case.

Materials and Methods:
-The participant is a 34-year-old woman suffering from chronic pelvic pain for eleven years. Her pain is rated at 9 out of 10 on the Visual Analog Scale (VAS).
-A thorough clinical examination is performed, including gynecological assessment and evaluation of pelvic floor muscle condition.
-Psychological assessment is conducted using the Hospital Anxiety and Depression Scale (HADS), which provides data on levels of anxiety and depression.
-The first stage of treatment included laparoscopic removal of a cyst of the right ovary, excision of foci of endometriosis on the peritoneum and sacro-uterine ligaments. Conservative treatment includes selective serotonin reuptake inhibitors (SSRIs), as well as the drug Dienogest.
-The patient's condition is monitored 10 and 20 weeks after the start of treatment.

Over the course of 20 weeks, the patient reported a significant reduction in pain levels. By week 10, her pain level decreased to 4/10 on the VAS, and by week 20, it was completely resolved. Additionally, improvements in her emotional state were noted, supported by psychological assessment results.

The findings highlight the importance of a comprehensive approach to the treatment of chronic pelvic pain. Psychological factors play a crucial role in the development of these conditions, and their elimination during treatment can enhance the effectiveness of therapy. An effective combination of surgical and hormonal treatment for endometriosis and SSRIs not only relieves physical pain, but also improves the overall quality of life for patients.

This clinical case highlights the need to consider psychological factors in the treatment of chronic pelvic pain and endometriosis. The combination of hormone therapy and SSRIs can significantly improve patients' quality of life. The results obtained will serve as the basis for further research aimed at optimizing treatment methods and improving the quality of women with similar problems.