Pelvic congestion syndrome

• condition is characterised by the presence of dilated pelvic veins associated with stasis
  • aetiology
    • considered that ovarian dysfunction is responsible for the excessive production of local oestrogen, causing dilatation and stasis in the pelvic veins, which leads to pelvic pain (1)
• women with this condition commonly complain of a dull, aching pain, exacerbated by activities that increase intra-abdominal pressure; the pain is relieved by lying down
  • other clinical features may also be deep dyspareunia, congestive dysmenorrhoea and post-coital ache
  • condition usually occurs in the reproductive age group, with a mean age of 33 years (1)
• examination may reveal tenderness that is maximal over the ovaries. Vaginal and cervical examination may reveal an apparent blue colouration due to congestion of the pelvic veins. The patient may also have varicose veins of the legs
  
  
• investigations for endometriosis and pelvic inflammatory disease must be instigated
  • venography is still considered the definitive radiological investigation for women with pelvic congestion syndrome (2)
    • radiological features
      • dilated uterine and ovarian veins with reduced venous clearance of contrast medium
        
        
• management options include:
  • explanation may be helpful ('pelvic migraine')
  • medical treatment options include:
    • medroxyprogesterone acetate (MPA)
      • suppresses ovarian function and therefore reduces pelvic congestion and pain
      • MPA given orally at a dose of 30 mg per day, usually for 6 months, has been shown to be effective in the management of pelvic congestion syndrome
        • however benefit was not sustained after discontinuing treatment (1)
    • gonadorelin analogues
      • goserelin 3.6 mg per month given for 6 months provided an alleviation of symptoms, an improvement in sexual functioning and a reduction of anxiety and depressive states in women with pelvic congestion (1)
  • other possible treatment options include:
    • bilateral ovarian vein ligation
    • hysterectomy plus bilateral salpingo-oophrectomy (with post-operative hormone replacement therapy)

Reference:

1. Kroon N, Reginald P. Medical management of chronic pelvic pain. Curr. Obs. & Gynae. 2005; 15 (5): 285-290.
2. Cheong Y, Stones W. Investigations for chronic pelvic pain. Revs in Gynaecol Pract 2005; 5 (4): 227-236.