Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls – "New Data on VO-CPP (PeVD) Therapy"

Episode Date: December 30, 2025
Host: Dr. Chapa
Episode Focus: Latest evidence and discussion on managing vascular origin chronic pelvic pain (VO-CPP), more properly known as pelvic venous disorder (PeVD), especially the role of flavonoid therapy.

Overview

This episode dives into fresh, evidence-based data on the diagnosis and treatment options for chronic pelvic pain stemming from pelvic vein problems – a condition increasingly refined in terminology from "pelvic congestion syndrome" to "pelvic venous disorder" (PeVD). Dr. Chapa unpacks a new systematic review (published Dec 2025 in Phlebology) examining the therapeutic potential of specific flavonoids, explains diagnostic approaches, and discusses practical clinical implications for providers. The tone remains practical, energetic, and collaborative, emphasizing cross-specialty cooperation.

Key Discussion Points

1. Understanding Chronic Pelvic Pain from a Vascular Perspective

• Terminology Evolution: Previously called pelvic congestion syndrome; now termed "pelvic venous disorder" (PeVD) as per 2023 radiology expert panel (00:36, 09:56).
• Prevalence & Enigma: 10–40% of chronic pelvic pain cases may involve PeVD, especially in premenopausal women. However, venous dilation is sometimes found in asymptomatic women, complicating diagnosis (00:36–03:00).
  • “About 10 to 40% of chronic pelvic pain cases may be attributed to pelvic vascular congestion, a term that has been now replaced by pelvic venous disorder…” (00:36)

2. Diagnosis Approaches & Algorithm

• Essential Steps: Start with history and rule out common causes (endometriosis, fibroids, adenomyosis).
• Key Imaging:
  • Pelvic ultrasound with Doppler (non-invasive, looks for dilated veins and reversed flow, especially in the broad ligament or left ovarian vein).
  • MRI (02:00)
  • Venography (gold standard, but invasive)
• Diagnostic Dilemmas: Findings sometimes appear in women without symptoms; hence, clinical correlation is crucial (03:00–05:00).

3. Collaboration Across Specialties

• Radiology in the Game: Interventional radiologists leading research and guidance, breaking discipline “territory” and collaborating with OB/GYNs (09:56–11:20).
  • “Nothing is owned by a discipline. … That’s how, you know, medicine gets greedy and covers it and gets very territorial and then nobody wins.” (10:25)
• Notable Recent Guidance: Radiology panel's 2023 review on diagnosis and management (Reference: AJR, 2023; shared in show notes).

4. Therapy: From Embolization to Flavonoids

• Embolization: Effective but carries procedural risks (05:00–05:30, 23:12).
• Flavonoids Enter the Chat: Recent attention on “venoactive” supplements as low-risk alternatives for select patients (03:50, 05:30).
  • “Now, taking a flavonoid pill seems to be much better as a treatment option for care than something like embolization, which obviously carries additional risks.” (03:20)

The Systematic Review (Phlebology, Dec 2025)

• Authorship & Collaboration: Multicenter, multidisciplinary team led by interventional radiologist Dr. Neil Kalnani (11:20).
  • “The lead author ... is actually out of the division of interventional radiology at Weill Cornell and also at a New York Presby ... Dr. Kalnani, thank you for sharing this good systematic review...” (11:40)
• Why Systematic Review, Not Meta-Analysis?
  • Marked heterogeneity in study designs, patient populations, dosing, and endpoints prevented meta-analysis. (25:50–26:30)

Notable Quotes & Moments

• “If it might, could help, why not?” (Dr. Chapa, 15:50)
• “...This is not a cure, okay? This is a treatment for vascular origin CPP. Once they stop, there seems to be a regression...” (21:15)
• “Even if this is a placebo ... if they’re feeling better and nobody died from the treatment ... I’ll take it.” (24:05)
• “This is worth discussing. I think it’s a great journal club [topic].” (26:00)
• “In the meantime, flavonoids should be considered a therapeutic option for symptomatic patients with PEVD who are not qualified for, not wishing, or who are awaiting some other intervention.” (From paper conclusion, 28:45)

Detailed Review of the Data & Therapy

Micronized Purified Flavonoid Fraction (MPFF)

• What is MPFF?
  • Specific formulation: 90% diosmin, 10% hesperidin (19:40)
  • Not just any flavonoid off the shelf; exact blend matters.
• Dosing Regimen:
  • 1,000–2,000 mg daily, typically for 1–6 months. (19:55)
  • Benefits appear only while on therapy; symptoms tend to return after stopping.
• Data Summary (Systematic Review):
  • 11 studies, total ~748 women (23:12)
  • Three RCTs; eight prospective studies.
  • Primary outcome: Pain reduction (VAS score). Also looked at clinical severity and objective imaging endpoints (23:12, 25:10).
  • Results: Consistent trend towards improvement in pain and quality of life; some objective reductions in vein diameter and congestion validated via imaging (25:20).
  • Tolerability: Mainly mild headaches or GI upset (24:15). No major safety concerns.

Practical Pearls for Providers

• Who to Consider for MPFF:
  • Patients with chronic pelvic pain, negative workup for endometriosis/fibroids/adeno, and imaging evidence of pelvic vein dilatation or reversed flow (14:40–16:15).
  • Women who are not candidates for, or decline, hormones, surgery, or embolization.
• How to Use in Practice:
  • Shared decision-making; discuss experimental nature and data limitations.
  • Monitor for improvement while on treatment; set expectations about symptoms returning after stopping.
• Caveats:
  • Not for endo/adeno/other clear causes without vascular findings.
  • Need for better, larger RCTs and commercially available, standardized MPFF (27:35).
  • Encouraged as a topic for journal clubs and collaborative discussion.

Notable Segments & Timestamps

• Intro to VO-CPP/PeVD: 00:36–08:58
• Cross-specialty collaboration and recent radiology guidance: 09:56–13:00
• Explanation of flavonoid therapy and review’s significance: 13:00–22:42
• Systematic review details and results: 23:12–26:30
• Clinical recommendations and future research needs: 26:30–29:10

Conclusion

Dr. Chapa emphasizes the evolving understanding and collaborative management possibilities for PeVD-related chronic pelvic pain, with the new systematic review giving cautious but real hope for MPFF as a low-risk therapeutic option. He calls for more rigorous studies but urges clinicians to consider the potential of flavonoid therapy, particularly in well-selected patients, as an interim measure or alternative to invasive procedures.

Resource Mentioned:

• Venoactive Drugs for Venous Origin Chronic Pelvic Pain in Women: A Systematic Review (Phlebology, Dec 2025)
• Radiology expert panel on PeVD (AJR, 2023)

Tone Takeaway:
Engaged, collaborative, a little irreverent, highly practical, and committed to improving women’s health and education — “medical education should NOT be boring!”