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Pelvic Congestion Syndrome

By

JoAnn V. Pinkerton

, MD, University of Virginia Health System

Last full review/revision Jul 2019| Content last modified Jul 2019
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Pelvic congestion syndrome is chronic pain exacerbated by standing or sexual intercourse in women who have varicose veins in or near the ovaries.

Pelvic congestion syndrome is a common cause of chronic pelvic pain. Varicose veins and venous insufficiency are common in the ovarian veins but are often asymptomatic. Why some women develop symptoms is unknown. Most women with pelvic congestion syndrome are aged 20 to 45 years and have had multiple pregnancies.

Symptoms and Signs

Pelvic pain develops after pregnancy. Pain tends to worsen with each subsequent 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 sometimes abnormal menstrual bleeding (1).

Women may also have varicose veins in the buttocks, thighs and vagina.

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

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

Pelvic examination detects tender ovaries and cervical motion tenderness.

Symptoms and signs reference

  • 1. Perry CP: Current concepts of pelvic congestion and chronic pelvic pain. JSLS (2):105–110, 2001.

Diagnosis

  • Clinical criteria

  • Ovarian varicosities, detected during imaging

Diagnosis of pelvic congestion syndrome requires that pain be present for > 6 months and that ovaries be tender when examined.

Ultrasonography is done but may not show varicosities in women when they are recumbent.

Some experts recommend additional tests (eg, venography, CT, MRI, magnetic resonance venography) if necessary to confirm pelvic varicosities. Pelvic varicosities may be confirmed by selectively catheterizing specific veins and injecting a contrast agent (venography).

If pelvic pain is troublesome and the cause has not been identified, laparoscopy is done.

Treatment

  • Medroxyprogesterone acetate, nonsteroidal anti-inflammatory drugs (NSAIDs), and gonadotrophin-releasing hormone (GnRH) agonists

Treatment of pelvic congestion syndrome includes high-dose medroxyprogesterone acetate, NSAIDs, and GnRH agonists. If these drugs are ineffective and the pain persists and is severe, embolization or sclerotherapy may be considered.

Varicosities detected during venography may be embolized with small coils or an embolic agent after local anesthesia and IV sedation are used. This procedure reduces the need for analgesics by up to 80%.

Key Points

  • Ovarian varicosities are common; why only some women with varicosities develop pelvic congestion syndrome is unclear.

  • Pain is usually unilateral and worsened by standing and by sexual intercourse; other symptoms include low back pain, leg pain, and sometimes abnormal menstrual bleeding.

  • Try treating with medroxyprogesterone acetate, NSAIDs, or GnRH agonists.

  • If pain persists and is severe, consider embolization or sclerotherapy.

Drugs Mentioned In This Article

Drug Name Select Trade
PROVERA
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