Introduction to Pelvic Congestion Syndrome:
Epidemiology of Pelvic Congestion Syndrome:
Pathogenesis of Pelvic Congestion Syndrome:
Ovarian vein dilatation, stasis, and/or reflux on pelvic venography are common findings in multiparous premenopausal women, and most of these women are asymptomatic. Why these findings are associated with chronic pelvic pain in some women, but not in others, is unclear. A causal relationship has not been proven, but is supported by limited data showing pain relief upon administration of venoconstrictors or ovarian vein ligation/embolization. Other small studies of women with chronic pelvic pain, venous congestion, and reflux by either Doppler ultrasound and/or venography and no evidence of pelvic pathology at laparoscopy have reported improvement in pain after sclerotherapy, embolization, or venous ligation.
The higher prevalence of PCS in multiparous women may be related to the 50 percent increase in pelvic vein capacity during pregnancy, which may lead to venous incompetence and reflux in the non-pregnant state. The increased frequency of PCS symptoms on the left side may be due to extrinsic compression of the left renal vein between the aorta and superior mesenteric artery (“nutcracker phenomenon;” ie, pelvic congestion, left flank pain, and hematuria), or because valvular incompetence of the ovarian vein due to absent ovarian vein valves is more common on the left. Ovarian vein valves are missing in 15 percent of women on the left side and 6 percent of women on the right and nearly one-half of these women have valvular incompetence on at least one side.The absence of PCS in menopause has been attributed to the decline in estrogen, which acts as a venous dilator. This hypothesis is supported by observations that pharmacologic or surgical induction of a hypoestrogenic state may result in improvement or resolution of symptoms.
Treatments Pelvic Congestion Syndrome:
Robinson JC. Chronic pelvic pain.Curr Opin Obstet Gynecol 1993; 5:740–743.
Kim HS, Malhotra AD, Lee ML, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol 2006; 17:289–297.
Richet MA. Traite pratique d’anatomie medico-chirurgicale [Treatise on practical medical-surgical anatomy]. Paris:Balliere et fils, 1857.