Medical treatment of pelvic congestion syndrome


Taskin O., Sahin L., Gavrilov S. G., Lazarashvili Z.

PHLEBOLYMPHOLOGY, cilt.23, sa.3, ss.146-153, 2016 (ESCI) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 23 Sayı: 3
  • Basım Tarihi: 2016
  • Dergi Adı: PHLEBOLYMPHOLOGY
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE
  • Sayfa Sayıları: ss.146-153
  • Anahtar Kelimeler: chronic pelvic pain, laparoscopy, micronized purified flavonoid fraction, pelvic congestion, pelvis, ultrasonography, varicose veins, PURIFIED FLAVONOID FRACTION, RANDOMIZED CONTROLLED TRIAL, MEDROXYPROGESTERONE ACETATE, VENOUS INSUFFICIENCY, PAIN, WOMEN, DIAGNOSIS, VEINS
  • Akdeniz Üniversitesi Adresli: Hayır

Özet

Pelvic congestion syndrome (PCS) has no clear etiology and the diagnosis relies on precise investigation techniques. PCS patients present with chronic symptoms in the area of the pelvis, which may have various etiologies; therefore, before any treatment is administered, it is important to exclude other medical conditions that may cause similar symptoms. Treatment options include cognitive behavioral pain management using psychotherapy; medical management that combines pain relief and, if the pain has a cyclical component, hormone suppression; endovenous procedures, such as coil or foam sclerotherapy; and surgery. The choice of treatment depends on symptom severity and the presence of vulvar and lower limb varicose veins. Initially, a medical approach should be offered, reserving surgery for resistant cases and patients who present with side effects to the medical treatment. In the majority of women, medroxyprogesterone acetate (MPA) or goserelin acetate effectively reduced pain and the size of the varicose veins. MPA and micronized purified flavonoid fraction provide short-term improvement, but no data are available on their long-term efficacy. Surgery has progressively been replaced by endovenous procedures with distal embolization of the refluxed veins using a coil and/or a foam sclerosant, and/ or by ballooning and stenting the iliac vein compression. Currently, no standard approach is available for the management of PCS; therefore, therapies should be individualized based on symptoms and the patient's needs.