Varicose veins of the small pelvis and pelvic congestion syndrome. A differentiated approach: the choice of method of contraception, treatment, prevention

Authors

DOI:

https://doi.org/10.18370/2309-4117.2017.38.42-52

Keywords:

varicose veins of small pelvis, combined oral contraceptives, progestins, pelvic congestion syndrome, ultrasound diagnostics

Abstract

The article considers the main points that affect the quality of life of women with varicose veins of small pelvis with congestion and without it, in particular the use of hormonal methods of contraception, and also discussed the issues of diagnostics, prevention and treatment of these diseases. Algorithms of clinical tactics for conducting such patients are presented. Particular attention is focused on the features of the appointment of hormonal drugs in this category of women. You can determine the methods of treatment and avoid long-term unreasonable prescription of various medicine (especially hormones that will mask or worsen the course of the disease) if you select groups of women with varicose veins of the small pelvis without congestion and with it (reflux).

Varicose veins of the small pelvis and pelvic congestion syndrome are conditions that require an interdisciplinary and differentiated approach. Symptoms of these conditions can be put on a mask of various gynecological, urological, traumatological diseases. Anatomical and physiological features of the structure of the veins and the regulation of their venous tone explain the possibility of forming a venous congestive syndrome in women. This can be due to two reasons: due to the violation of the outflow of venous blood or due to the obstruction of any vein of the ovary, any increase in intravascular pressure not controlled by the venous tone at the level of the pelvis.

Varicose veins of the small pelvis and pelvic congestion syndrome remain unexplored until the end. There are no uniform standards for their diagnostics. Varicose veins of the small pelvis and pelvic congestion syndrome are different diseases which requiring an understanding of the mechanisms of their development and consequences. If a pelvic varicose veins are suspected, the first diagnostic test is usually ultrasound. Modern ultrasound technique can evaluate blood flow in various veins. To study the blood flow in the veins, laparoscopy, venography in combination with CT or MRI can also be performed.

Author Biographies

А. Н. Григоренко, Vinnitsya National Pirogov Memorial Medical Univercity, Center of endosurgery “ІNNOMED”, Vinnitsya

MD, assistant of Obstetrics and Gynecology Department No. 2

А. Б. Гордийчук

PhD

References

  1. Seliverstov, E.I., Avakyants, A.P., Nikishkov, A.S., Zolotukhin, I.A. “Epidemiology of chronic vein diseases.” Phlebology 10.1 (2016): 35–42.
  2. Varicose disease of the pelvis, pelvic congestion syndrome. Online-resource of the specialist in vascular surgery S.N. Didenko. Available from: [https:// angio.kiev.ua/sosudistaya-hirurgiya/varikoznaya-bolezn-taza-sindrom-tazovogovenoznogopolnokroviya.
  3. Mohammadi, A., Zangi, B.M., Azari, M.D., et al. “The effect of the ovarian varicose vein on the DNA methylation in the rat’s oocyte.” Iran J Basic Med Sci 20.10 (2017): 1166-71. DOI: 10.22038/IJBMS.2017.9449
  4. Bulavenko, O.V., Grigorenko, A.M., Slyvka, E.V. “Diagnosis and treatment of luteal phase insufficiency in women with varicose veins in the reproductive organs of the small pelvis.” Bulletin of the Vinnytsia National Medical University 1 Part 2 Vol. 20 (2016).
  5. Zhuk, S.I., Grigorenko, A.M., Shliakhtina, A.O. “Ethiopathogenetic approach to conservative treatment of varicose veins of small pelvis in women.” Woman’s Health 5.111 (2016): 52–57.
  6. Artymuk, N.V., Rudneva, O.D. “Pelvic venous congestion as one of the leading causes of chronic pelvic pain.” Status Praesens 4 (2015): 42–49.
  7. Durham, J.D., Machan, L. “Pelvic Congestion Syndrome.” Semin Intervent Radiol 30.4 (2013): 372–80.
  8. Ahlberg, N.E., Bartley, O., Chidekel, N. “Right and left gonadal veins. An anatomical and statistical study.” Acta Radiol Diagn (Stockh) 4.6 (1966): 593–601.
  9. Ignacio, E.A., Dua, R., Sarin, S., et al. “Pelvic Congestion Syndrome: Diagnosis and Treatment.” Semin Intervent Radiol 25.4 (2008): 361–8.
  10. Vascular surgery: National guideline. Brief edition. Ed. by V.S. Savelyev, A.I. Kirienko. Moscow. GEOTAR-Media (2015).
  11. Mark, S., Whiteley, P. “Objective measurements of pelvic venous reflux and stratification of severity of venous reflux in pelvic congestion syndrome due to pelvic venous reflux.” Curr Med Res Opin 33.11 (2017): 2089–2091.
  12. Mathias, S.D., Kuppermann, M., Liberman, R.F., et al. “Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates.” Obstet Gynecol 87 (1996): 321–327.
  13. Metzger, D.A. “Mechanism of pain in pelvic congestion syndrome.” Presented at the 9th Scientific Meeting of the IPPS, San Diego, Calif (2002)/
  14. Dos Santos, S.J., Holdstock, J.M., Harrison, C.C., et al. “Ovarian vein diameter cannot be used as an indicator of ovarian venous reflux.” Eur J Vasc Endovasc Surg 49 (2015): 90–4.
  15. Malgor, R.D., Adrahtas, D., Spentzouris, G., et al. “The role of duplex ultrasound in the workup of pelvic congestion syndrome.” J Vasc Surg Venous Lymphat Disord 2 (2014): 34–8.
  16. Whiteley, M.S., Dos Santos, S.J., Harrison, C.C., et al. “Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women.” Phlebology 30 (2015): 706–13.
  17. Perry, C.P. “Current concepts of pelvic congestion and chronic pelvic pain.” JSLS 5 (2001): 105–10.
  18. Gavrilov, S.G., Turischeva, O.O. “Conservative treatment of varicose disease of the pelvis: indications and possibilities of therapy.” Angiology and Vascular Surgery 3 Vol. 22 (2016).
  19. Nascimento, A.B., Mitchell, D.G., Holland, G. “Ovarian veins: magnetic resonance imaging findings in an asymptomatic population.” J Magn Reson Imaging 15 (2002): 551–6.
  20. Rozenblit, A.M., Ricci, Z.J., Tuvia, J., Amis, E.S. Jr. “Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women.” Am J Roentgenol 176 (2001): 119–22.
  21. Braun, K. “Women’s Health Queensland Wide Inc.” Health Journey 3–4 (2015). Available from: [https://womhealth.org.au/sites/womhealth/files/public/Health%20Journey%20Issue%203-4.pdf], last accessed Dec 8, 2017.
  22. BMJ editorial. “Thrombosis, phlebitis, and varicose veins.” BMJ 312 (1996): 198.
  23. Bhutta, H.Y., Walsh, S.R., Tang, T,Y., et al. “Ovarian vein syndrome: A review.” International Journal of Surgery 7.6 (2009): 516–20.
  24. Soysal, M.E., Soysal, S., Vicdan, K., Ozer, S. “A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion.” Human Reproduction 16.5 (2001): 931–9.
  25. Shokeir, T., Amr, M., Abdelshaheed, M. “The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study.” Arch Gynecol Obstet 280.3 (2009): 437–43.
  26. Farquhar, C.M., Rogers, V., Franks, S., et al. “A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion.” Br J Obstet Gynecol 96 (1989): 1153–62.
  27. Schleussner, E., Michels, E., Bethge, W., Klinger, G. “Die Wirkung von Dienogest auf die hypothalamisch-hypophysare Achse: Ergebnisse einer Pilotstudie.” In: Dienogest – Preclinical and Clinical Features of a New Progestogen. Ed. by A.T. Teichmann. Walter de Gruyter. Berlin, Germany (1995): 171–9.
  28. Katsuki, Y., Takano, Y., Futamura, Y., et al. “Effects of dienogest, a synthetic steroid, on experimental endometriosis in rats.” Eur J Endocrinol 138 (1998): 216–26.
  29. Oettel, M., Breitbarth, H., Elger, W., et al. “The pharmacological profile of dienogest.” Eur J Contracept Reprod Health Care 4 Suppl. 1 (1999): 2–13.
  30. Zhuk, S.I., Nochvina, E.A. “Thoughts on hormonal contraception.” Women’s doctor 5.73 (2017): 32–6.

Published

2017-12-28

How to Cite

Григоренко, А. Н., & Гордийчук, А. Б. (2017). Varicose veins of the small pelvis and pelvic congestion syndrome. A differentiated approach: the choice of method of contraception, treatment, prevention. REPRODUCTIVE ENDOCRINOLOGY, (38), 42–52. https://doi.org/10.18370/2309-4117.2017.38.42-52

Issue

Section

Interdisciplinary problems