Symptoms
Pelvic congestion syndrome is a clinical condition that has largely been unrecognized so far. This is most common in women of childbearing age. Pregnancy-associated hormones result in the pelvic veins becoming larger, which leads to the worsening of symptoms. Typically, large, dilated, superficial veins are seen in the pelvic, vulvar and buttock areas. There is pelvic pain typically after sexual intercourse and dysmenorrhea, which is pain in the perineal region during or before menstruation. Symptoms typically improve after menopause. It is one of the causes of chronic pelvic pain. It’s a condition that is very common in women and can potentially lead to significant disability.
Approximately one-third of all women will suffer from chronic pelvic pain at some point during their lifetime. Chronic pelvic pain is by definition that which lasts longer than six months and is not related to a woman’s menstrual cycle.
Why Does This Condition Happen?
Blood starts flowing in the reverse direction and therefore varicosities (enlarged veins) develop in the uterus and ovaries. It is seen more frequently on the left side than on the right.
Differential Diagnosis
Nutcracker phenomenon, May-Thurner syndrome (compensatory), post-thrombotic syndrome (compensatory)
All other diagnoses must be ruled out prior to diagnosis of pelvic congestion syndrome, including endometriosis, uterine fibroids, and pelvic mass.
How Is This Condition Diagnosed?
- Duplex ultrasound (first transabdominal and transvaginal). It is diagnosed if the ovarian vein is dilated to more than 6 mm upon bearing down.
- CT venogram or magnetic resonance venogram (special type of scans)
How Is This Condition Treated?
Endovascular embolization by coils or plugs is the preferred method of treatment.
A vascular surgeon with special interest in managing this condition can help if you experience any of these symptoms.
BIO: Dr. Aparajita is a fellowship-trained vascular and endovascular surgeon. She is a co-author of 20-plus journal articles and publications and was recently nominated for an Inspiration Award by the American Medical Association.
This column is sponsored by KSC Cardiology, and the opinions expressed herein may not reflect those of CFHN or its advertisers.