Effectiveness of a comprehensive management approach for pelvic congestion syndrome
DOI:
https://doi.org/10.15574/PP.2025.3(103).711Keywords:
chronic pelvic pain, pelvic varicose veins, ultrasonography, venoactive flavonoids, diosmin, hesperidin, quality of life (PVVQ)Abstract
Chronic pelvic pain is a common symptom in obstetric and gynecologic practice; in 15–40% of reproductive-age women it is caused by pelvic congestion syndrome (PCS). This syndrome is considered a form of chronic venous disease; among conservative approaches there is growing interest in venoactive flavonoids (diosmin, hesperidin, anthocyanins, triterpenes of Centella asiatica) with venotonic, anti-inflammatory, and antioxidant effects.
Aim - to investigate the effectiveness of pharmacological treatment with the dietary supplement Flego in women with PCS by comparing changes in venous diameter and quality of life before and after therapy.
Materials and methods. Sixty women aged 25-38 years with PCS were included. All participants received Flego plus lifestyle modification (healthy diet, cessation of harmful habits, increased physical activity, Pilates exercises). Assessments included pelvic vein diameter (ultrasound), quality of life by Pelvic Varicose Vein Questionnaire (PVVQ) and pain by Visual Analogue Scale (VAS) at baseline and at 3 months.
Results. The baseline mean venous diameter was 8.56±1.38 mm (range 6.54-11.65 mm). After 3 months: in 48 (80.0%) patients the diameter decreased to 5.86±1.48 mm; in 10 (16.7%) there was a moderate decrease to 7.12±1.31 mm; in 2 (3.3%) no change was recorded. VAS pain scores decreased from 6.46±1.89 points to 2.62±1.46 points; quality of life by PVVQ improved from 56.32±12.51 points to 27.43±10.11 points.
Conclusions. The combination of Flego with lifestyle modification was associated with a reduction in pelvic vein diameter in 80% of patients, a significant decrease in pain, and improved quality of life. These findings support this approach as a conservative option in early stages of PCS.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution’s local ethics committee. Informed consent was obtained from patients.
The authors declare no conflict of interest.
References
Akhmetzianov RV, Bredikhin RA. (2021). Clinical efficacy of conservative treatment with micronized purified flavonoid fraction in female patients with pelvic congestion syndrome, Pain and Therapy. 10: 1567-1578. https://doi.org/10.1007/s40122-021-00312-6; PMid:34537951 PMCid:PMC8586324
Bıldırcın F. (2019). An often-overlooked factor in pelvic pain: pelvic congestion syndrome. J Gynecol Res Obstet. 5(2): 038-039. https://doi.org/10.17352/jgro.000069
Borghi C, Dell'Atti L. (2016). Pelvic congestion syndrome: the current state of the literature,Arch Gynecol Obstet. 293(2): 291-301. https://doi.org/10.1007/s00404-015-3895-7; PMid:26404449
Brown CL, Rizer M, Alexander R, Sharpe EE 3rd, Rochon PJ. (2018). Pelvic congestion syndrome: systematic review of treatment success. Semin Interv Radiol. 35(1): 35-40. https://doi.org/10.1055/s-0038-1636519; PMid:29628614 PMCid:PMC5886772
Durham JD, Machan L. (2013). Pelvic congestion syndrome. Semin Interv Radiol. 30(4): 372-380. https://doi.org/10.1055/s-0033-1359731; PMid:24436564 PMCid:PMC3835435
Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. (2009). Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 49(2): 498-501. https://doi.org/10.1016/j.jvs.2008.09.014; PMid:19216970
Gallo G, Lori E, Goglia M et al. (2024). Effectiveness of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on hemorrhoidal disease: A case-matched analysis. Tech Coloproctol. 28: 126. https://doi.org/10.1007/s10151-024-02998-0; PMid:39287845 PMCid:PMC11408642
Huwait E, Mobashir M. (2022). Potential and therapeutic roles of Diosmin in human diseases. Biomedicines. 10(5). https://doi.org/10.3390/biomedicines10051076; PMid:35625813 PMCid:PMC9138579
Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab FD. (2019). A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLoS ONE. 14(4): e0213834. https://doi.org/10.1371/journal.pone.0213834; PMid:30939134 PMCid:PMC6445463
Katsenis K. (2005). Micronized purified flavonoid fraction (MPFF): a review of its pharmacological effects, therapeutic efficacy and benefits in the management of chronic venous insufficiency. Curr Vasc Pharmacol. 3(1): 1-9. https://doi.org/10.2174/1570161052773870; PMid:15641940
Lee I, Lin T, Sun S., Sun C. (2025). Medical treatment for pelvic congestion syndrome with flavonoid: A pilot study. Taiwanese Journal of Obstetrics and Gynecology. 64(2): 293-297. https://doi.org/10.1016/j.tjog.2024.12.008; PMid:40049814
Liddle AD, Davies AH. (2007). Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology. 22(3): 100-104. https://doi.org/10.1258/026835507780807248; PMid:18268860
Lyseng-Williamson KA, Perry CM. (2003). Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs. 63(1): 71-100. https://doi.org/10.2165/00003495-200363010-00005; PMid:12487623
Meissner MH, Gloviczki P, Bergan J, Kistner RL, Morrison N, Pannier F et al. (2007). Primary chronic venous disorders. J Vasc Surg. 46(6): 54s-67s. https://doi.org/10.1016/j.jvs.2007.08.038; PMid:18068562
Phillips D, Deipolyi AR, Hesketh RL, Midia M, Oklu R. (2014). Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. JVIR. 25(5): 725-733. https://doi.org/10.1016/j.jvir.2014.01.030; PMid:24745902
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