Pelvic Congestion Syndrome

Basic Facts

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Pelvic congestion syndrome is a cause of chronic pelvic pain related to the presence of varicose veins surrounding the uterus and ovaries.
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The most common symptom of pelvic congestion syndrome is chronic pain in the pelvis and lower back.
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Pelvic congestion syndrome can be missed during conventional diagnostic tests such as a gynecologic exam, sonography, or laparoscopy.
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Pelvic congestion syndrome is typically treated with embolization, medication, or, rarely, with surgery.

Pelvic congestion syndrome is a cause of chronic pelvic pain related to the presence of varicose (abnormally dilated) veins surrounding the uterus and ovaries. All veins contain tiny one-way valves that ensure that blood travels toward the heart to become oxygenated. When these valves fail, blood can pool and the veins can stretch or bulge. In pelvic congestion syndrome, varicose veins can affect a woman’s uterus, ovaries, and vulva and may cause dull, aching pelvic pain, and occasionally, vaginal discharge or abnormal menstrual bleeding.

CAUSES AND RISK FACTORS

Most women with pelvic congestion syndrome are younger than age 45 and in their childbearing years. Certain factors can put a woman at higher risk for the condition, including:

  • Having had 2 or more pregnancies;
  • Having a “tipped” (retroverted) uterus;
  • Having fullness of the leg veins;
  • Having polycystic ovaries; and
  • Having hormonal increases or dysfunction.

DIAGNOSIS

The physician will likely first perform a pelvic examination to rule out other abnormalities that can cause symptoms similar to those of pelvic congestion syndrome. Next, the following imaging tests may be used to help confirm the presence of varicose veins in the pelvis:

  • Ovarian vein and pelvic venography;
  • Magnet resonance imaging (MRI) scan;
  • Pelvic ultrasound;
  • Transvaginal ultrasound; and
  • Laparoscopy.

TREATMENT APPROACH

Treatments for pelvic congestion syndrome depend on the severity of a woman’s symptoms and may include:

  • Analgesics;
  • Oral contraceptives;
  • Embolization (seals the vein and helps relieve the pressure that is being abnormally transmitted through these veins to the pelvic organs); and
  • Surgery (removal of the veins, or hysterectomy with removal of ovaries).