Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

A Scoping Review of Clinical Study in Pelvic Congestion Syndrome Focused on Blood Stasis

Article information

J Korean Med. 2024;45(3):76-90
Publication date (electronic) : 2024 September 1
doi : https://doi.org/10.13048/jkm.24039
Hye-Won An1orcid_icon, Miso Park2orcid_icon, Ji-Yeon Lee1,orcid_icon
1Department of Obstetrics and Gynecology of Korean Medicine, College of Korean Medicine, Daejeon University
2Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
Correspondence to: 이지연 (Ji-Yeon Lee), Daejeon Korean Medicine Hospital of Daejeon University, 75 Daeduk-daero 176 beon-gil, Seo-gu, Daejeon, Tel:+82-42-470-9139, Fax:+82-42-470-9009, E-mail:jyounl@daum.net
Received 2024 July 3; Revised 2024 August 19; Accepted 2024 August 19.

Abstract

Objectives

The purpose of this study is to summarize the etiology, diagnosis and treatment of pelvic congestion syndrome(PCS) in traditional East-Asian medicine(TEM) and Western medicine(WM) from the point of blood stasis.

Methods

We followed the methodology of 5 steps of scoping review by Arksey and O’Malley and Levac et al. Studies from 2010 to October 19, 2023 were searched through seven search engines. Two reviewers independently searched and screened the studies. When there was a disagreement, a third reviewer decided its eligibility.

Results

A total of 78 studies were selected, and 40 were TEM studies and 38 were WM. The average age of the study subjects was in their 30s and most had more than one child. Most of TEM were intervention studies and WM were mostly observational studies. In the WM, the etiology of PCS was considered pelvic venous insufficiency, and in the TEM, pathological conditions caused blood stasis in the pelvis. In TEM, the diagnosis was made according to previous studies’ criteria; in WM, it was made through imaging. To treat PCS, WM seeks to block extended veins with embolization, and TEM to improve the environment in which stagnant blood is created through various treatments such as herbal medicine, enema therapy, etc. Total efficient rate (TER) in TEM and imaging findings in WM were most often used as outcome measures.

Conclusions

This study summarized and analyzed overall concepts of PCS in TEM and WM.

Keywords: Pelvic congestion syndrome; Blood stasis; Scoping review; Traditional Chinese Medicine; Korean Medicine
Fig. 1

A flow chart for study selection

Fig. 2

The distribution of publication dates of included studies

Fig. 3

Frequently used medicinal herbs in internal treating Pelvic Congestion Syndrome

Search Strategy for Each Database

Research Methodology by TEM, WM

Country Distribution by TEM, WM

Demographic Characteristics of Patients by Research Methodology

Diagnostic Methods by TEM, WM

Interventions by TEM, WM

Outcome Measurements by TEM, WM

Research Map by Medicine Type

Acknowledgments

감사의 글

이 성과는 정부 (과학기술정보통신부) 의 재원으로 한국연구재단의 지원을 받아 수행된 연구임 (No.RS-2023-00209469).

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No.RS-2023 -00209469).

References

1. World Health Organization. WHO international standard terminologies on traditional Chinese medicine Geneva: World Health Organization; 2022.
2. Yoon YJ. A Fundamental Study to Make a Questionnaire of Blood Stasis Specially Designed for Korean Obstetrics & Gynecology. J Korean Obstet Gynecol 2013;26(1):92–108.
3. Lee YJ, Son SS. The Difference of Quality of Life on Blood Stasis Using SF-36. J Korean Obstet Gynecol 2014;27(4):15–24.
4. Beard RW, Reginald PW, Wadsworth J. Clinical Features of Women With Chronic Lower Abdominal Pain and Pelvic Congestion. British Journal of Obstetrics and Gynecology 1988;95(2):153–61.
5. Lass A, Croucher C, Lawrie H, Margara R, Winston RM. Right or left ovary--which one is better? Human Reproduction 1997;12(8):1730–1.
6. Brătilă E, Brătilă CP, Coroleucă CB, et al. Collateral Circulation in the Female Pelvis and the Extrauterine Anastomosis System. Romanian Journal of Functional & Clinical, Macro-& Microscopical Anatomy & of Anthropology 2015;14(2):223–7.
7. Sladkevicius P, Valentin L, Maršál K. Blood Flow Velocity in the Uterine and Ovarian Arteries during the Normal Menstrual Cycle. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 1993;3(3):199–208.
8. Tan SL, Zaidi J, Campbell S, Doyle P, Collins W. Blood flow changes in the ovarian and uterine arteries during the normal menstrual cycle. Am J Obstet Gynecol 1996;Sep. 175(3 Pt 1):625–31.
9. Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician 2014;Mar-Apr. 17(2):E141–7.
10. Murata T. Oriental Medicine and Pain in Obstetrics and Gynecology. Pain and Kampo: The Use of Japanese Herbal Medicine in Management of Pain In : Oyama T, Smith G, eds. London: Springer-Velag; 1994. p. 119–28.
11. Kim DI, Lee DK, Lee TG. A Study of Pelvic Congestion Syndrome(PCS) causing Chronic Pelvic Pain. J Korean Obstet Gynecol 2002;15(2):114–25.
12. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19–32.
13. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci 2010;5:69.
14. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018;169(7):467–73.
15. Aromataris E. JBI Manual for Evidence Synthesis. Adelaide, JBI 2020;
16. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22(3):276–82.
17. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;Mar. 33(1):159–74.
18. Zhang X. Practical Obstetrics and Gynecology 2nd Editionth ed. Beijing: People’s Medical Publishing House; 2003. p. 603–8.
19. Hiromura T, Nishioka T, Nishioka S, Ikeda H, Tomita K. Reflux in the left ovarian vein: Analysis of MDCT findings in asymptomatic women. AJR Am J Roentgenol 2004;183:1411–5.
20. Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab F. D. A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLoS One 2019;Apr. 2. 14(4):e0213834.
21. Garcia-Jimenez R, Valero I, Borrero C, Garcia-Mejido JA, Gonzalez-Herraez JV, Muñoz-Chimbo AV, Pelayo-Delgado I, et al. Transvaginal ultrasonography predictive model for the detection of pelvic congestion syndrome. Quant Imaging Med Surg 2023;Jun. 1. 13(6):3735–46.
22. Williams MR, Westerman RA, Kingwell BA, Paige J, Blombery PA, Sudhir K, Komesaroff PA. Variations in endothelial function and arterial compliance during the menstrual cycle. J Clin Endocrinol Metab 2001;86(11):5389–95.
23. Valero I, Garcia-Jimenez R, Valdevieso P, Garcia-Mejido JA, Gonzalez-Herráez JV, Pelayo-Delgado I, Fernandez-Palacin A, et al. Identification of Pelvic Congestion Syndrome Using Transvaginal Ultrasonography. A Useful Tool. Tomography 2022;Jan. 4. 8(1):89–99.
24. Xia C, Zheng Z. Clinical observation of ultrashort wave combined with muscle strength training in the treatment of pelvic congestion syndrome. Jilin Medicine 2011;32(31):6589–90.
25. Szaflarski D, Sosner E, French TD, Sayegh S, Lamba R, Katz DS, Hoffmann JC. Evaluating the frequency and severity of ovarian venous congestion on adult computed tomography. Abdom Radiol (NY) 2019;Jan. 44(1):259–63.
26. Dick E. A, Burnett C, Anstee A, Hamady M, Black D, Gedroyc WM. Time-resolved imaging of contrast kinetics three-dimensional (3D) magnetic resonance venography in patients with pelvic congestion syndrome. Br J Radiol 2010;Oct. 83(994):882–7.
27. Hocquelet A, Le Bras Y, Balian E, Bouzgarrou M, Meyer M, Rigou G, Grenier N. Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagn Interv Imaging 2014;Mar. 95(3):301–6.
28. Meneses LQ, Uribe S, Tejos C, Andía ME, Fava M, Irarrazaval P. Using magnetic resonance phase-contrast velocity mapping for diagnosing pelvic congestion syndrome. Phlebology 2011;Jun. 26(4):157–61.
29. Meneses L, Fava M, Diaz P, Andía M, Tejos C, Irarrazaval P, Uribe S. Embolization of incompetent pelvic veins for the treatment of recurrent varicose veins in lower limbs and pelvic congestion syndrome. Cardiovasc Intervent Radiol 2013;Feb. 36(1):128–32.
30. van der Vleuten CJ, van Kempen JA, Schultze-Kool LJ. Embolization to treat pelvic congestion syndrome and vulval varicose veins. Int J Gynaecol Obstet 2012;Sep. 118(3):227–30.
31. Siqueira FM, Monsignore LM, Rosa-E-Silva JC, Poli-Neto OB, Castro-Afonso LH, Nakiri GS, Muglia VF, et al. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome. Clinics (Sao Paulo) 2016;Dec. 1. 71(12):703–8.
32. Chen H, Jin H, Huang K. Observation on the efficacy of self-prepared Huayu Decoction in the treatment of 44 cases of pelvic congestion syndrome. Journal of Chengdu University of Traditional Chinese Medicine 2013;36(01):88–90.
33. Park YC, Lee JS, Kim MH, Kim DY, Lee SD. Pharmacological action and Toxicity of Angelica sinensis. The Korean J of Oriental Medical Prescription 2011;19(2):93–108.
34. Gao R, Yang D, Ma X. Observation on the clinical efficacy of traditional Chinese medicine enema combined with moxibustion in the treatment of pelvic congestion syndrome. Chongqing Medicine 2017;46(23):3283–6.
35. Liu H, Chen D, Wan Z. Effect of traditional Chinese medicine enema combined with Xiaoyu patch on related indicators of pelvic congestion syndrome. Chinese J of Traditional Chinese Medicine Emergencies 2019;28(08):1395–7.

Appendices

Appendix 1 List of included papers of WM

  1. Cimsit C, Yoldemir T, Tureli D, Aribal ME. Evaluation of sacroiliac joint MRI for pelvic venous congestion signs in women clinically suspected of sacroiliitis. Acta Radiol. 2017 Jul; 58(7):849–55.

  2. Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab FD. A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLoS One. 2019 Apr 2; 14(4):e0213834.

  3. Szaflarski D, Sosner E, French TD, Sayegh S, Lamba R, Katz DS, Hoffmann JC. Evaluating the frequency and severity of ovarian venous congestion on adult computed tomography. Abdom Radiol (NY). 2019 Jan; 44(1):259–63.

  4. Peker A, Camkerten GT, Balci A, Akin IB, Altay C, Can G. Increased prevalence of pelvic venous congestion sign on sacroiliac MRI in women with clinically suspected sacroiliitis. North Clin Istanb. 2020 Jul 22; 7(6):551–6.

  5. An J. Diagnostic analysis of color Doppler ultrasound on pelvic uterine venous stasis syndrome. Hainan Medicine. 2010; 21(04):98–9.

  6. Gu H, Zhang X. Diagnostic value of transvaginal color Doppler ultrasound in pelvic venous stasis syndrome. Imaging Research and Medical Applications. 2018; 2(22):153–4.

  7. Nanavati R, Jasinski P, Adrahtas D, Gasparis A, Labropoulos N. Correlation between pelvic congestion syndrome and body mass index. J Vasc Surg. 2018 Feb; 67(2):536–41.

  8. Gavrilov SG, Vasilieva GY, Vasiliev IM, Efremova OI. Calcitonin Gene-Related Peptide and Substance P As Predictors of Venous Pelvic Pain. Acta Naturae. 2019 Oct-Dec; 11(4):88–92.

  9. Valero I, Garcia-Jimenez R, Valdevieso P, Garcia-Mejido JA, Gonzalez-Herráez JV, Pelayo-Delgado I, Fernandez-Palacin A, et al. Identification of Pelvic Congestion Syndrome Using Transvaginal Ultrasonography. A Useful Tool. Tomography. 2022 Jan 4; 8(1):89–99.

  10. Garcia-Jimenez R, Valero I, Borrero C, Garcia-Mejido JA, Gonzalez-Herraez JV, Muñoz-Chimbo AV, Pelayo-Delgado I, et al. Transvaginal ultrasonography predictive model for the detection of pelvic congestion syndrome. Quant Imaging Med Surg. 2023 Jun 1; 13(6):3735–46.

  11. Laborda A, Medrano J, de Blas I, Urtiaga I, Carnevale FC, de Gregorio MA. Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovasc Intervent Radiol. 2013 Aug; 36(4):1006–14.

  12. Shi Y, Zheng Y, Cai H, Kong F, Yang X, Li H, Zhang D, et al. The value of transvaginal three-dimensional color ultrasound combined with contrast-enhanced ultrasound in the diagnosis of pelvic venous stasis syndrome. Chinese Experiment Diagnostics. 2015; 19(10): 1722–4.

  13. Wang K. Analysis of the diagnostic value of transvaginal three-dimensional color ultrasound combined with contrast-enhanced ultrasound in pelvic venous stasis syndrome. Qinghai Medical Journal. 2018; 48(08):68–9.

  14. Shi Y. Analysis of the value of transvaginal three-dimensional color ultrasound combined with contrast-enhanced ultrasound in the diagnosis of pelvic venous stasis syndrome. Systems Medicine. 2018; 3(14):108–10.

  15. Gavrilov SG, Vasilyev AV, Moskalenko YP, Mishakina NY. Diagnostic value of pelvic venography in female patients with pelvic varicose veins and vulvar varicosities. Int Angiol. 2020 Dec; 39(6):452–60.

  16. Ignacio LLJ, Gallardo MG, Alcázar PA, Pillado Rodríguez E, Cárdenas Santos R, Alonso Burgos A. Bilateral Ovarian Vein Embolisation from a Unilateral Basilic Approach with n-2-Butyl Cyanoacrylate and Crossover Technique for Pelvic Congestion Syndrome. Eur J Vasc Endovasc Surg. 2022 Jan; 63(1):163–4.

  17. Dick EA, Burnett C, Anstee A, Hamady M, Black D, Gedroyc WM. Time-resolved imaging of contrast kinetics three-dimensional (3D) magnetic resonance venography in patients with pelvic congestion syndrome. Br J Radiol. 2010 Oct; 83(994):882–7.

  18. Jiang Y, Pan Y, Qin L, Xiong S. Discussion on the diagnosis of pelvic congestion syndrome by transvaginal color ultrasound. Chinese Medical Guide. 2013; 11(26):162–3.

  19. Hocquelet A, Le Bras Y, Balian E, Bouzgarrou M, Meyer M, Rigou G, Grenier N. Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagn Interv Imaging. 2014 Mar; 95(3):301–6.

  20. Malgor RD, Adrahtas D, Spentzouris G, Gasparis AP, Tassiopoulos AK, Labropoulos N. The role of duplex ultrasound in the workup of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2014 Jan; 2(1):34–8.

  21. Nasser F, Cavalcante RN, Affonso BB, Messina ML, Carnevale FC, de Gregorio MA. Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. Int J Gynaecol Obstet. 2014 Apr; 125(1):65–8.

  22. Gandini R, Konda D, Abrignani S, Chiocchi M, Da Ros V, Morosetti D, Simonetti G. Treatment of symptomatic high-flow female varicoceles with stop-flow foam sclerotherapy. Cardiovasc Intervent Radiol. 2014 Oct; 37(5): 1259–67.

  23. Siqueira FM, Monsignore LM, Rosa-E-Silva JC, Poli-Neto OB, Castro-Afonso LH, Nakiri GS, Muglia VF, et al. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome. Clinics (Sao Paulo). 2016 Dec 1; 71(12):703–8.

  24. Guan L, Ye L, Li N, Yang D, Zhou H. Ultrasound observation of 35 cases of pelvic venous stasis syndrome. Jilin Medicine. 2016; 37(12):2979–80.

  25. Chen Q, Sun G, Yang Y, Peng H, Wang X. Study on the diagnostic value of color Doppler ultrasound for pelvic congestion syndrome and its correlation with clinical factors. Progress in Modern Biomedicine. 2021; 21 (01): 141–5.

  26. Macher J, Brahmbhatt A, Shetty A, Chughtai K, Baran T, Baah NO, Dogra V. Predicting pelvic congestion syndrome: Concomitant pelvic pain diagnoses do not affect venography or embolization outcomes. J Clin Imaging Sci. 2021 Nov 15; 11:61.

  27. Osman AM, Mordi A, Khattab R. Female pelvic congestion syndrome: how can CT and MRI help in the management decision? Br J Radiol. 2021 Feb 1; 94(1118): 20200881.

  28. Gavrilov SG, Sazhin A, Krasavin G, Moskalenko E, Mishakina N. Comparative analysis of the efficacy and safety of endovascular and endoscopic interventions on the gonadal veins in the treatment of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2021 Jan; 9(1):178–86.

  29. Sulakvelidze L, Tran M, Kennedy R, Lakhanpal S, Pappas PJ. Presentation patterns in women with pelvic venous disorders differ based on age of presentation. Phlebology. 2021 Mar; 36(2):135–44.

  30. Meneses LQ, Uribe S, Tejos C, Andía ME, Fava M, Irarrazaval P. Using magnetic resonance phase-contrast velocity mapping for diagnosing pelvic congestion syndrome. Phlebology. 2011 Jun; 26(4):157–61.

  31. van der Vleuten CJ, van Kempen JA, Schultze-Kool LJ. Embolization to treat pelvic congestion syndrome and vulval varicose veins. Int J Gynaecol Obstet. 2012 Sep; 118(3):227–30.

  32. Meneses L, Fava M, Diaz P, Andía M, Tejos C, Irarrazaval P, Uribe S. Embolization of incompetent pelvic veins for the treatment of recurrent varicose veins in lower limbs and pelvic congestion syndrome. Cardiovasc Intervent Radiol. 2013 Feb; 36(1):128–32.

  33. Marcelin C, Izaaryene J, Castelli M, Barral PA, Jacquier A, Vidal V, Bartoli JM. Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx®). Diagn Interv Imaging. 2017 Dec; 98(12):843–8.

  34. Gavrilov SG, Karalkin AV, Turischeva OO. Compression treatment of pelvic congestion syndrome. Phlebology. 2018 Jul; 33(6):418–24.

  35. De Gregorio MÁ, Yamamoto-Ramos M, Fredes A, Serrano-Casorran C, Sierre S, Ciampi -Dopazo JJ, Méndez S, et al. A Comparative Study of a Small Series of Patients (50 Patients) with Pelvic Varicose Veins Treated with Plugs Alone or Plugs and Polidocanol. J Clin Med. 2023 Aug 20; 12(16):5408.

  36. Xia C, Zheng Z. Clinical observation of ultrashort wave combined with muscle strength training in the treatment of pelvic congestion syndrome. Jilin Medicine. 2011; 32(31): 6589–90.

  37. Guirola JA, Sánchez-Ballestin M, Sierre S, Lahuerta C, Mayoral V, De Gregorio MA. A Randomized Trial of Endovascular Embolization Treatment in Pelvic Congestion Syndrome: Fibered Platinum Coils versus Vascular Plugs with 1-Year Clinical Outcomes. J Vasc Interv Radiol. 2018 Jan; 29(1): 45–53.

  38. Akhmetzianov RV, Bredikhin RA. Clinical Efficacy of Conservative Treatment with Micronized Purified Flavonoid Fraction in Female Patients with Pelvic Congestion Syndrome. Pain Ther. 2021 Dec; 10(2): 1567–78.

Appendix 2 List of included papers of TEM

  1. Liu C. 36 cases of pelvic congestion syndrome treated with acupuncture. Journal of Shaanxi College of Traditional Chinese Medicine. 2010; 33(02):49.

  2. Zhang J, Cao X, Zhang C, Deng X, Wu X, Liu F. Clinical observation of Buyang Huanwu Decoction combined with moxibustion in the treatment of pelvic congestion syndrome. World Journal of Integrated Traditional Chinese and Western Medicine. 2012; 7(09):802–3.

  3. Duan X. Clinical observation of Dan’e Fukang decoction on chronic pelvic pain caused by pelvic congestion syndrome. Chinese Practical Medicine. 2010; 5(33):172–3.

  4. Kong D, Zheng L, Yu J, Fan Y. Observation on the clinical efficacy of the Jueyin method of activating blood circulation and guiding turbidity combined with extracorporeal electric field thermal therapy machine in the treatment of pelvic congestion syndrome. Chinese Sexual Science. 2011; 20(06):43–4, 51.

  5. Liu H, Wu S. Clinical observation on the treatment of pelvic venous stasis with self-made Huoxue decoction enema combined with physical therapy. Electronic Journal of Practical Gynecological Endocrinology, 2015; 2(03):116.

  6. Zhang W. Analysis of the efficacy of Yiqihuoxuehuayu decoction in the treatment of 21 cases of pelvic congestion syndrome [J]. Chinese Medical Guide, 2013, 11(36):209–10.

  7. Ji M. Observation on the clinical efficacy of Tibetan enema in the treatment of pelvic venous stasis. Chinese Journal of Ethnic Medicine. 2015; 21(06):23–4.

  8. Lamaoyou. Observation on the clinical efficacy of external Tibetan medicine in the treatment of pelvic venous stasis. Chinese Journal of Ethnic Medicine. 2016; 22(01):33.

  9. Gao R, Yang D, Ma X. Observation on the clinical efficacy of traditional Chinese medicine enema combined with moxibustion in the treatment of pelvic congestion syndrome. Chongqing Medicine. 2017; 46(23):3283–6.

  10. Wang J. Treatment of 34 cases of pelvic congestion syndrome with Danggui Zhuyu decoction combined with moxibustion at Shenque point. Chinese Community Physicians (Medical Professional). 2010; 12(22):159.

  11. Liu H. Observation on the clinical efficacy of the self-prepared Pelvic Huoxue Decoction in the treatment of pelvic congestion syndrome. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine. 2010; 20(06): 370–2.

  12. Qu Z, Liu X, Li H. Clinical observation on the treatment of pelvic congestion syndrome by rectal infusion of Guizhi Fuling decoction combined with microwave. Heilongjiang Traditional Chinese Medicine. 2011; 40(06): 17–8.

  13. Guo X. Observation on the efficacy of 57 cases of pelvic congestion syndrome treated with Penyu Decoction orally and enema. Journal of Clinical Rational Drug Use. 2011; 4(08): 21–2.

  14. Hu X. 40 cases of pelvic congestion syndrome treated with Buqi Huoxue decoction combined with vaginal lateral fornix injection. Jiangxi Traditional Chinese Medicine. 2011; 42(05): 42.

  15. Zhang D, Sende. Analysis of the efficacy of traditional Chinese medicine enema for pelvic congestion syndrome. Chinese Practical Medicine. 2011; 6(22): 55–6.

  16. Nie H, Xu J. Observation on 32 cases of pelvic congestion syndrome treated with moxibustion and medicine. Journal of Practical Traditional Chinese Medicine. 2011; 27(04): 234–5.

  17. Zhao Z, Xu J, Hu X, Liu M, Yu Y. Observation on the efficacy of heat-sensitive moxibustion combined with vaginal fornix puncture injection in the treatment of 52 cases of pelvic venous stasis syndrome. Chinese Practical Medicine. 2011; 6(20):11–2.

  18. Ma J, Hu X. Clinical observation on 30 cases of pelvic congestion syndrome treated with traditional Chinese medicine cycle therapy combined with acupuncture. Chinese Community Physicians (Medical Professional). 2011; 13(18): 164.

  19. Chen H, Jin H, Huang K. Observation on the efficacy of self-prepared Huayu Decoction in the treatment of 44 cases of pelvic congestion syndrome. Journal of Chengdu University of Traditional Chinese Medicine. 2013; 36(01): 88–90.

  20. Ge W. Observation on the efficacy of Zhuyu Tuomu Decoction combined with Nuangong Patch in the treatment of pelvic congestion syndrome. Chinese Medicine and Clinic. 2013; 13(S1):120–1.

  21. Xu W. Observation on the efficacy of Shaofu Zhuyu Granules combined with pelvic floor rehabilitation in the treatment of 55 cases of pelvic venous stasis syndrome. Chinese Ethnic and Folk Medicine. 2014; 23(03): 80–1.

  22. Yao S, Chen D, Guo S, Song Q, You B. Clinical observation of 94 cases of pelvic congestion syndrome treated with Xiaoyu patching on the navel. Jiangsu Traditional Chinese Medicine. 2014; 46(12):71–2.

  23. Wu S. Analysis of the clinical efficacy of Yiqihuoxuehuayu decoction in the treatment of pelvic congestion syndrome. Contemporary Medical Discussions. 2014; 12(17):19.

  24. Wang B. Acupuncture combined with muscle strength training to treat pelvic congestion syndrome. Jilin Traditional Chinese Medicine, 2015; 35(02):196–8.

  25. Huang M, Li S, Ye P. Observation on the efficacy of Xiyuxue Decoction combined with Guizhi Fuling Pills in the treatment of pelvic congestion syndrome. New Chinese Medicine. 2015; 47(06):172–3.

  26. Kamousian. Tibetan medicine retention enema for the treatment of pelvic venous stasis. Chinese Journal of Ethnic Medicine. 2016; 22(05):2.

  27. Zhong L, Zhou Y, Jiang Q. Clinical observation on the treatment of pelvic venous stasis syndrome with bioelectrical stimulation along the meridians. Popular Science and Technology. 2016; 18(10):54–6.

  28. Liu X. Research on the clinical effects of traditional Chinese medicine cycle therapy and acupuncture in the treatment of pelvic congestion syndrome. Inner Mongolia Traditional Chinese Medicine. 2017; 36(02):112.

  29. Wang N. Study on the clinical effect of self-made Huayu decoction in the treatment of patients with pelvic congestion syndrome. Feet and Health Care. 2017; 26(02): 62, 67.

  30. Ren L. 36 cases of pelvic congestion syndrome treated with traditional Chinese medicine retention enema and external application. Journal of Traditional Chinese Medicine and External Treatment. 2017; 26(01):18–9.

  31. Liu X. Clinical observation on 44 cases of pelvic congestion syndrome treated with traditional Chinese medicine enema combined with iontophoresis. Jiangsu Traditional Chinese Medicine. 2017; 49(03):47–8.

  32. Wu H, Wen N. Clinical observation of traditional Chinese medicine enema combined with acupoint injection of Astragalus injection in the treatment of pelvic congestion syndrome. New Chinese Medicine. 2017; 49(05): 124–6.

  33. Liu Y. Randomized parallel controlled study of Yiqi Sanyu Decoction in the treatment of pelvic congestion syndrome. Journal of Practical Traditional Chinese Medicine; 2018; 32(04): 13–5.

  34. Zhong L, Zhong J, Jiang Q. Clinical study on the regulation of PG by meridian-like bioelectrical stimulation in 50 cases of female pelvic venous stasis syndrome. Popular Science and Technology. 2018; 20(08): 80–2.

  35. Ji M. Observation on the clinical efficacy of Tibetan medicine Twenty-five-flavor podophyllum pills in the treatment of pelvic venous stasis. Chinese Journal of Ethnic Medicine. 2019; 25(05): 14–5.

  36. Liu H, Chen D, Wan Z, Lu S. Effect of traditional Chinese medicine enema combined with Xiaoyu patch on related indicators of pelvic congestion syndrome. Chinese Journal of Traditional Chinese Medicine Emergencies. 2019; 28(08):1395–7.

  37. Chen J, Xie P, Zhong Y. Clinical observation on the treatment of pelvic congestion syndrome with acupuncture combined with transcutaneous electrical stimulation. Guangming Traditional Chinese Medicine. 2019; 34(10): 1567–9.

  38. Chen Y, Huang Y, Liu J, Yu Z. Observation on the clinical efficacy of two different methods in the treatment of pelvic congestion syndrome. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine. 2019; 29(07): 5–8.

  39. Zhong L, Zhong J, Jiang Q. 60 cases of pelvic congestion syndrome treated with bioelectrical stimulation along the meridian. Henan Traditional Chinese Medicine. 2020; 40(09): 1415–8.

  40. Zhang S, He H, Gao W. Clinical observation of electroacupuncture in the treatment of pelvic congestion syndrome. Journal of Guangzhou University of Traditional Chinese Medicine. 2022; 39(07): 1555–61.

Article information Continued

Fig. 1

Fig. 1

A flow chart for study selection

Fig. 2

Fig. 2

The distribution of publication dates of included studies

Fig. 3

Fig. 3

Frequently used medicinal herbs in internal treating Pelvic Congestion Syndrome

Table 1

Search Strategy for Each Database

Database Search terms
MEDLINE/PUBMED (“pelvic congestion”[All Fields] OR “blood congestion”[All Fields] OR “blood stasis”[All Fields] OR “blood stagnation”[All Fields] OR “blood stagnant”[All Fields])
Google scholar “pelvic congestion” OR “blood congestion” OR “blood stasis” OR “blood stagnation” OR “blood stagnant”
CNKI Title, Keyword and Abstract: pelvic congesiton(盆腔瘀血)
Domestic DB “ 골반 울혈 “, “ 어혈 “, “ 혈어 “, “ 축혈 “

Table 2

Research Methodology by TEM, WM

Reseach methodology TEM WM
Observastional studies 2 [5.0%] 29 [76.3%]
Cross-sectional study 0 [0.0%] 4 [10.5%]
Case-control study 0 [0.0%] 6 [15.8%]
Prospective cohort study 0 [0.0%] 6 [15.8%]
Retrospective cohort study 2 [5.0%] 13 [34.2%]
Intervention studies 38 [95.0%] 9 [23.7%]
Before-and-after study 3 [7.5%] 4 [10.5%]
Non randomized controlled trial 4 [10.0%] 2 [5.3%]
Randomized controlled trial 31 [77.5%] 3 [7.9%]
Total 40 [100.0%] 38 [100.0%]

Table 3

Country Distribution by TEM, WM

Country TEM WM
China 40 [100.0%] 9 [23.7%]
Spain 0 7 [18.4%]
Russia 0 5 [13.2%]
United States 0 5 [13.2%]
France 0 2 [5.3%]
Turkey 0 2 [5.3%]
Chile 0 2 [5.3%]
Brazil 0 1 [2.6%]
Egypt 0 1 [2.6%]
Italy 0 1[2.6%]
Netherlands 0 1 [2.6%]
Switzerland 0 1 [2.6%]
United Kingdom 0 1 [2.6%]
Total 40 [100.0%] 38 [100.0%]

Table 4

Demographic Characteristics of Patients by Research Methodology

Reseach methodology Sample size* (average) Average age† Average parity‡
30s 40s etc. 1≤ <2 2≤ etc. No ment.
Cross-sectional study 4739 (1184.8) 1 2 1 0 1 0 3
Case-control study 446 (74.3) 1 3 2 1 2 2 1
Prospective cohort study 606 (101.0) 3 3 0 0 2 2 2
Retrospective cohort study 2054 (136.9) 7 6 2 1 6 4 4
Before-and-after study 242 (34.6) 4 3 0 0 3 0 4
Non randomized controlled trial 449 (74.8) 4 1 1 2 0 0 4
Randomized controlled trial 2756 (81.1) 25 4 5 6 6 1 21
Total 11292 (144.8) 45 22 11 10 20 9 39
*

sum of sample size

†

Number of studies that average age of subjects is in their 30s, 40s, or et cetera.

‡

Number of studies that average parity of subjects is 1 or more, 2 or more, et cetera, or there was no mention.

Table 5

Diagnostic Methods by TEM, WM

Diagnostic Methods TEM WM
US* 2 25
CT† 0 6
MRI‡ 0 9
venography 2 17
preceding literature 44(all included US) 3
Etc. 1 6
no mention 6 0
*

Ultrasonography,

†

Computed Tomography,

‡

Magnetic Resonance Imaging.

Table 6

Interventions by TEM, WM

TEM N WM N
herbal medicine oral administration 24 embolization 18
herbal medicine enema 11 stenting 2
herbal extract injection 8 surgery 2
Physiotherapy 8 drug oral administration 2
Moxibustion 7 physiotherapy 1
Acupuncture 7 compression therapy 1
Western medicine 6 no mention 17
Electroacupuncture 5
Tibetan medicine 4
Chinese medicine patch 3

Table 7

Outcome Measurements by TEM, WM

TEM N WM N
TER* 38 imaging findings 24
clinical symptom and sign score 20 clinical symptom and sign score 18
imaging findings 12 clinical and technical success 5
molecular indicators 4 TER 1
blood viscosity 3 BMI† 1
recurrent rate 2
*

Total Efficient Rate,

†

Body Mass Index.

Table 8

Research Map by Medicine Type

Medicine type Study design Year Country Diagnostic criteria (method) Intervention Outcomes (measurement)
WM Cross sectional study(4)
Case-control study(4)
Prospective cohort study(6)
Retrospective cohort study(13)
Before and after study(4)
Non randomized controlled trial(2)		 2010(2), 2011(2), 2012, 2013(3), 2014(4), 2015, 2016(2), 2017(2), 2018(6), 2019(3), 2020(2), 2021(6), 2022(2), 2023(2) China(9)
Spain(7)
Russia(5)USA(5)
Chile(2)
France(2)
Turkey(2)
Brazil
Egypt
Italy
Netherlands
Switzerland
UK		 US(25)
Venography(17)
MRI(9)
CT(6)
Preceding literature(3)
Laparoscopy(2)
MRA(2)
CTV
MRV		 Embolization(18)
Stenting(2)
Surgery(2)
Oral drug(2)
Compression therapy
Physiotherapy
No mention(17)		 Imaging findings(24)
Symptom and sign
score(18)
Clinical and technical
success(5)
TER
BMI
TEM Retrospective cohort study(2)
Before and after study(3)
Non randomized controlled trial(4)
Randomized controlled trial(31)		 2010(4), 2011(8), 2012, 2013(3), 2014(3), 2015(4), 2016(3), 2017(6), 2018(2), 2019(4), 2020, 2022 China(40) Preceding literature included
US(44)
Venography(2)
US(2)
Laparoscopy
No mention(6)		 Oral herbal medicine(24)
Enema(11)
Herbal extract injection(8)
Physiotherapy(8)
Moxibustion(7)
Acupuncture(7)
Western medicine(6)
Electro-acupuncture(5)
Tibetan medicine(4)
Patch(3)		 TER(38)
Imaging findings(12)
Symptom and sign
score(20)
Blood viscosity(3)
Molecular
indicators(4)
Recurrent rate(2)