Pelvic congestion syndrome is a vastly underrecognized cause of chronic pelvic pain in women of childbearing age. The pain is present all the time or can be intermittent, lasting three to six months, and present in the pelvic or tummy region throughout the menstrual cycle and without any association with pregnancy.
Enlarged veins in the pelvis seem to play a major role, but many women do have enlarged veins and no symptoms. Multiple pregnancies may increase the risk of pelvic congestion syndrome because the veins tend to become enlarged with increased blood flow during pregnancy to support the growing fetus. Sometimes this can permanently enlarge the veins and lead to the symptoms.
Undoubtedly, the female hormones progesterone and estrogen play a role in pelvic congestion syndrome. Estrogen is known to make the veins wider, and perhaps therefore this condition is not common after menopause.
Who Is at Risk for Pelvic Congestion Syndrome?
Women in the childbearing age with multiple pregnancies who experience chronic pain in the pelvic region may be at higher risk.
Pelvic pain that lasts at least six months and is first noticed during or after her pregnancy and typically worsens after the pregnancy. The pain is often worse at the end of the day. Changing posture, increasing sexual activity (both during and after), standing for a long time, and walking may also make the pain worse.
This condition is diagnosed by performing an ultrasound to check the blood flow in the pelvic blood vessels. Ask your doctor to see a vascular surgeon if you suspect you may have pelvic congestion syndrome.
Typically, a CT scan or MRI is needed to confirm the diagnosis.
Treatment includes a venogram — a procedure in which X-rays are taken of the pelvic veins — and, if needed, coil embolization of the dilated veins.
This column is sponsored by KSC Cardiology, and the opinions expressed herein may not reflect those of CFHN or its advertisers.
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.