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Pelvic Congestion Syndrome

By

JoAnn V. Pinkerton

, MD, University of Virginia Health System

Last full review/revision Feb 2021| Content last modified Feb 2021
Click here for the Professional Version

Pelvic congestion syndrome is long-lasting (chronic) pain in the lowest part of the torso (pelvis) caused by accumulation of blood in veins of the pelvis, which have widened (dilated) and become convoluted.

Pelvic congestion syndrome seems to be a common cause of chronic pelvic pain (pelvic pain lasting more than 6 months). Pain occurs because blood accumulates in veins of the pelvis, which have dilated and become convoluted (called varicose veins). The resulting pain is sometimes debilitating. Estrogen may contribute to the development of these veins.

Many women of childbearing age have varicose veins in their pelvis, but not all of them have symptoms. Why some women develop symptoms is unknown.

Most women with pelvic congestion syndrome are aged 20 to 45 years and have had several pregnancies.

Symptoms of Pelvic Congestion Syndrome

In women with pelvic congestion syndrome, pelvic pain often develops during or after a pregnancy and tends to worsen with each pregnancy.

Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after women have been sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse. It is often accompanied by low back pain, aches in the legs, and abnormal vaginal bleeding.

Some women occasionally have a clear or watery discharge from the vagina.

Other symptoms may include fatigue, mood swings, headaches, and abdominal bloating.

Diagnosis of Pelvic Congestion Syndrome

  • Ultrasonography or another imaging test

  • Sometimes laparoscopy

Doctors may suspect pelvic congestion syndrome when women have pelvic pain but a pelvic examination does not detect inflammation or another abnormality. For doctors to diagnose pelvic congestion syndrome, pain must have been present for more than 6 months and the ovaries must be tender when they are examined.

Ultrasonography to check for varicose veins in the pelvis can help doctors confirm the diagnosis of pelvic congestion syndrome. However, another imaging test may be needed to confirm the diagnosis. These tests may include venography (x-rays of veins taken after a radiopaque contrast agent is injected into a vein in the groin), computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance venography.

If the pain is troublesome and the cause has not been identified, laparoscopy is done. In this procedure, doctors make a small incision just below the navel and insert a viewing tube to directly view the structures of the pelvis.

Treatment of Pelvic Congestion Syndrome

  • Usually the progestin medroxyprogesterone or nonsteroidal anti-inflammatory drugs

  • If needed, a procedure to block blood flow to the varicose veins

Medroxyprogesterone is usually used first to provide pain relief. It is a progestin (a synthetic form of the female hormone progesterone). Nonsteroidal anti-inflammatory drugs (NSAIDs) or gonadotrophin-releasing hormone (GnRH) agonists (synthetic forms of a hormone produced by the body), such as leuprolide and nafarelin, may also help relieve the pain.

If these drugs are ineffective, doctors may try to block blood flow to the varicose veins and thus prevent blood from accumulating there. Two procedures are available:

  • Embolization of a vein: After using an anesthetic to numb a small area of the thigh, doctors make a small incision there. Then, they insert a thin, flexible tube (catheter) through the incision into a vein and thread it to the varicose veins. They insert tiny coils, sponges, or gluelike liquids through the catheter into the veins to block them.

  • Sclerotherapy: Similarly, doctors insert a catheter and inject a solution through it and into the varicose veins. The solution blocks the veins.

When blood can no longer flow to the varicose veins in the pelvis, pain usually lessens.

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