Chronic pelvic pain associated with pelvic congestion syndrome and the benefit of Daflon 500 mg: a review

Chronic pelvic pain is common in women of childbearing age and causes disability and distress, which result in significant costs to health services. A specific diagnosis for the condition is often difficult because the pain may be of abdominal, neurogenic, or psychogenic origin, or may be caused by other pelvic conditions such as endometriosis, pelvic inflammatory disease, and ovarian cysts. Due to the possible interlinked factors, no diagnosis is made in 60% of patients.(1) The pathogenesis of chronic pelvic pain is poorly understood. The vascular hypothesis offers the most likely explanation for chronic pelvic pain, which is thought to arise from overdistension of the pelvic venous system in which blood flow is markedly reduced. In pelvic congestion syndrome (PCS), pelvic varices are seen in a significant proportion of patients and may be the underlying etiology of chronic pelvic pain.(1) Undetected severe diseases such as endometriosis, adhesions, interstitial cystitis, active chronic pelvic inflammatory disease, and irritable bowel syndrome may cause pain and should be excluded to confirm a diagnosis of PCS. Investigation using laparoscopy is controversial since it often reveals no obvious cause of pain. Complementary investigation uses selective ovarian venography, which is commonly recommended by gynecologists. Newer, noninvasive methods such as magnetic resonance imaging and duplex ultrasound are gaining favor for the diagnosis of pelvic varices. Using the example of micronized purified flavonoid fraction (MPFF, Daflon 500 mg, Servier, France), this review will provide an update on the diagnosis and management of PCS and on the benefits of MPFF 500 mg in the treatment of pelvic pain.