Pelvic Congestion Syndrome - Dr Amir Malkawi

27 Sep Pelvic Congestion Syndrome

Posted at 18:09h in English by admin

Dear reader, when discussing pelvic pain, you might not be aware that approximately 40% of women’s visits to gynecological clinics are due to complaints of chronic pelvic pain. Notably, around 30% of these cases are associated with a medical condition known as Pelvic Congestion Syndrome (PCS). What are its causes and symptoms? And how is it treated?

Symptoms of Pelvic Congestion Syndrome

Pelvic Congestion Syndrome is a condition that causes persistent chronic pelvic pain lasting more than 6 months that not related to other health issues or menstruation.

The primary symptom is ongoing pelvic pain, which often decreases when lying down but worsens when standing or sitting.

Some women may experience additional symptoms, including:

Lower back pain.
Pain during urination, or during or after sexual intercourse.
Urinary incontinence.
Symptoms of irritable bowel syndrome, characterized by recurrent abdominal pain accompanied by alternating episodes of diarrhea and constipation.
Swelling of the veins in the vaginal or vulvar area, or in the upper part of the inner thighs or behind them.

Causes of Pelvic Congestion Syndrome

Although the exact cause of Pelvic Congestion Syndrome is not fully understood, experts believe that the condition results from ovarian vein varicosities.

In this condition, the venous valves fail to function properly, leading to retrograde blood flow.

This causes the veins to become congested with blood, which results in the sensation of pain.

Who is Most at Risk for Pelvic Congestion Syndrome?

Women in the following categories are at higher risk for developing this condition:

Those between the ages of 20 and 45 who have had multiple pregnancies.
Individuals with varicose veins or a family history of varicose veins.
Women with polycystic ovary syndrome (PCOS).
Those with a retroverted uterus.
Women undergoing hormonal changes or those with hormonal disorders.

Diagnosis of Pelvic Congestion Syndrome

A physician can confirm the diagnosis of Pelvic Congestion Syndrome through imaging studies that allow visualization of the tissues and detection of enlarged veins.

These include:

Ultrasound: This is the initial imaging test performed by the doctor.
Computed Tomography (CT): Healthcare providers perform Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) subsequently to obtain more detailed information.
Venography: This imaging test allows for visualization of the shape and size of the vins and can identify any issues present.

In some cases, laparoscopy may be required to examine the pelvic organs for any diseases or health problems.

Treatments

Pelvic Congestion Syndrome is primarily treated with surgery.

Until the surgical procedure, the physician may recommend medications to alleviate symptoms.

Here are the treatment details:

Surgery

The nature and type of surgery depend on the woman’s health condition and the specific issues she faces.

Key surgical options include:

Ovarian Vein Embolization or Sclerotherapy

This procedure involves blocking the affected veins to prevent blood from pooling or flowing backward.

Studies have shown that this surgery has alleviated symptoms in more than 83% of patients who underwent the procedure.

Laparoscopy

This procedure involves ligating the ovarian veins to prevent blood reflux.

Research indicates that this method has improved symptoms in over 70% of patients who underwent the procedure.

Oophorectomy with Salpingectomy

This option is rarely used and is reserved for cases with severe symptoms that are difficult to manage through other means, once the healthcare provider confirms that the woman does not wish to conceive or will be unable to do so in the future.

Medications

Notable medications include:

GnRH Agonists: These drugs reduce symptoms by suppressing ovarian function.
Progestin-Based Medications: These help manage symptoms through hormonal regulation.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): such as ibuprofen (Advil), which provide pain relief and reduce inflammation.

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