Pelvic Congestion Syndrome
Pelvic congestion syndrome is a condition that causes chronic pelvic pain. It is thought to be caused by problems with the veins in the pelvic area. The pelvic area is inside the lower part of your belly (abdomen).
Understanding veins in the pelvic area
Veins are the blood vessels that carry blood back to the heart. In some women, veins in the lower abdomen may stop working well. Blood may start to build up inside the veins. When this happens, the veins in your pelvis can enlarge and change shape, like varicose veins. This may lead to the pain and other symptoms of pelvic congestion syndrome.
What causes pelvic congestion syndrome?
Doctors are still learning about the causes of pelvic congestion syndrome. Enlarged veins in the pelvis may be part of the cause. But many women have enlarged veins and no symptoms.
The syndrome happens mostly in women of childbearing age. It may be more common in women who have given birth to more than one child. The veins in the pelvis get larger during pregnancy. They can stay large after pregnancy and cause symptoms.
Hormones also may be part of the cause. Estrogen makes veins wider (dilated). This may be why the condition is not common after menopause. Estrogen levels are lower after menopause. Other hormones may also cause veins to grow wider and cause symptoms.
You may have a higher risk for pelvic congestion syndrome if you have given birth to more than one child. You may also have a higher risk if other members of your family have it.
Symptoms of pelvic congestion syndrome
The main symptom of pelvic congestion syndrome is pelvic pain that lasts at least 6 months. This pain often first starts during or after a pregnancy. It may get worse after a later pregnancy. The pain may be a heavy or aching feeling. Or the pain may be sharp. Usually the pain is only on one side, often the left. At times you may feel it on both sides. The pain is often worse at the end of the day.
Some things may make the pain worse, such as:
Standing for a long time
Changing your posture
Having sexual intercourse
Some women also have symptoms such as:
Pain before or during their periods
Feeling a sudden need to urinate
Enlarged and distorted veins on the buttocks, external genitals (vulva), or thighs
Diagnosing pelvic congestion syndrome
Pelvic congestion syndrome is not easy to diagnose. Pelvic pain is common, and it can be caused by many things. Pelvic pain can result from problems with the reproductive system, like your ovaries and uterus. It can be caused by the urinary system, like your bladder. It can be caused by the gastrointestinal system, such as your large intestine. And it can be caused by muscles or bones. Psychological conditions such as depression are also linked to chronic pelvic pain. Your doctor will need to consider many possible causes before diagnosing pelvic congestion syndrome.
Your primary care doctor or an obstetrics and gynecology (OB/GYN) doctor may diagnose the condition. Your doctor will ask about your medical history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam.
You may also need some tests, such as:
Urine tests, to check for problems with your urinary system
Blood tests, to check for pregnancy, sexually transmitted diseases, and anemia
Pelvic ultrasound, to look for growths in the pelvis
Doppler ultrasound, to check the blood flow in the pelvic blood vessels
CT scan or MRI for more detailed pictures
Diagnostic laparoscopy, a minimally invasive surgery to rule out other causes of pelvic pain
Venography, a procedure to take X-rays of the pelvic veins
Treatment for pelvic congestion syndrome
Your doctor will treat you according to your symptoms. Possible treatment choices include:
Gonadotropin-releasing hormone medicines, which may ease pain
Progestin hormone medicines, which may also ease pain
Sclerotherapy, to shut off damaged veins
Embolization, to shut off damaged veins
Surgery to remove damaged veins
Surgery to remove your uterus and ovaries
Your doctor may suggest starting with medicines. If these don't relieve your symptoms, your doctor may advise a procedure to treat the condition. Your symptoms may lessen as you enter menopause.
When to call the healthcare provider
Call your healthcare provider right away if you have any of these:
Symptoms that don’t get better with treatment
Symptoms that get worse
October 03, 2017
Causes of chronic pelvic pain in women, Up To Date, Treatment of chronic pelvic pain in women, Up To Date, Vulvovaginal varicosities and pelvic congestion syndrome, Up To Date
Burd, Irina, MD, PhD,Freeborn, Donna, PhD, CNM, FNP