Aim — the objective of the present study was to develop the strategy for the treatment of patients presenting with concomitant pelvic varicose veins (PVV) and varicose veins of the lower extremities (VVLE) taking into consideration different clinical variants of either condition. Material and methods. The study involved 106 patients with concomitant PVV and VVLE. All the patients were divided into three groups. Group 1 was comprised of 24 patients having the asymptomatic form of PVV and clinically manifested VVLE, dilatation and reflux in parametrical, left gonadal and superficial veins of the lower extremities. The second group included 9 patients with the clinical signs of pelvic congestion syndrome (PCS) and VVLE, dilatation and reflux in parametrical, uterine, left gonadal and great saphenous veins. The third group was composed of 73 women with symptoms of PCS or without them concomitant with VVLE, vulvar varicose veins (VVV), dilatation and reflux in parametrical veins, uterine, vulvar, and superficial veins of the lower extremities. Results. In the patients with asymptomatic VVP and clinically manifested VVLE, regardless of the involvement in the pathological process of pelvic venous plexus alone or in combination with gonadal venous insufficiency, it is reasonable to perform operations only on the superficial veins of the lower extremities. In the presence of the clinical manifestations of PCS combined with the pathological reflux of blood in gonadal, parametrical and uterine veins, the intervention on the ovarian veins together with phlebectomy in the perineum and in the lower extremities is necessary. Pelvic-perineal reflux of blood occured in 30.2% of the patients with concomitant VVP and VVLE. Conclusion. The choice of the strategy for the treatment of the patients presenting with concomitant VVP and VVLE depends on the presence of symptoms of PCS and the involvement of the gonadal veins in the pathological process. The surgical intervention on these vessels is necessary for 8.5% of the patients. Isolated operations on the perineum and lower extremity veins in the patients with combined varicose veins of the pelvis, perineum, and lower extremities provide an efficient tool for the treatment of VVV and VVLE.