Introduction
Pelvic Congestion Syndrome is a chronic condition characterized by severe aching and pelvic pain, painful sexual intercourse and urinary symptoms caused by increased venous pressure and varicose veins in the pelvis. It is thought to be due to the presence of ovarian and pelvic varicosities and is more prevalent in women with multiple previous pregnancies.
Pelvic varicosities during pregnancy are caused by hormone changes, increased vein capacity causing distension of veins and valve incompetence. Weight gain and anatomic changes in the pelvic structures during pregnancy can cause intermittent venous obstruction.
Blood pooling in the pelvic and ovarian veins may lead to further engorgement and thrombosis, and affect the local nerves. Most women are premenopausal and it is suggested that oestrogen plays a role. It is known that oestrogen weakens the vein walls. Many women report varying degrees of symptoms throughout the menstrual cycle.
Diagnosis
- Duplex ultrasound.
- Physical examination.
Of note, ovarian vein dilatation and incompetence (reverse flow) is found in 50% of women who have had children. This is thought to not be of concern unless the symptoms of pelvic congestion syndrome are present.
Diagnosis is therefore complex and in part relies on exclusion of other causes.
Treatment
Treatment options include medication and Pelvic Vein Embolisation.
