Understanding Pelvic Venous Congestion Syndrome

Pelvic pain is one of the common conditions amounting for 40 % of gynaecological referrals. Pelvic venous congestion syndrome is one of the causes of pelvic pain which is hard to understand and relatively unknown amongst patients. It is estimated that up to 30% of women with pelvic pain may suffer from this condition.

What is Pelvic Venous Congestion Syndrome?

 Pelvic venous congestion syndrome is a condition causing pelvic pain due to the varicosity of the pelvic veins. It may simply go undiagnosed or underdiagnosed as the clinicians do not look for it.

Who is at risk?

 If you are in the childbearing age, you are more likely to suffer from this condition, more commonly if you have given birth more than once.

• If you suffer from varicose veins.
• Members of the family having varicose veins or Pelvic venous congestion syndrome.
• Polycystic Ovarian Syndrome (PCOS)

It is rare in postmenopausal women.

 What are the symptoms?

Pelvic Pain is the most common symptom. It usually appears on one side but can affect both sides, worsening while standing, lifting, when you are tired at the end of the day, during pregnancy and during or after sexual intercourse. Veins are also affected by the menstrual cycle/hormones and therefore pain may increase during menstruation.

Common symptoms:

• Pelvic pain or aching around the pelvis and lower abdomen
• Dragging sensation in the pelvis
• Feeling of fullness in the legs
• Worsening of stress incontinence
• Worsening in the symptoms associated with irritable bowel syndrome
• Pain while passing urine in the absence of urinary tract infection.

Symptoms usually improve by lying down.

How is Pelvic Venous Congestion syndrome diagnosed?

• History and pelvic examination are to elicit the site of tenderness in the pelvic area.
• The most common causes of pelvic pain such as endometriosis, pelvic inflammatory disease or ovarian cysts etc., must be excluded by imaging (ultrasound) and laparoscopy. Dilated pelvic veins may be seen on ultrasound scan and laparoscopy.
• High index of suspicion is required to diagnose this condition.
• CT contrast venography is the gold standard for diagnosing this condition provided ultrasound and or laparoscopy have excluded other conditions before recommending this procedure.

How is it treated?

Your gynaecologist can tailor your treatment according to your symptoms.

Possible treatment options include:

• Gonadotropin-releasing hormone drugs (GnRh agonists or antagonists), which block ovarian function and may relieve pain
• Progestin hormone drugs – tablets, injection (depo-provera), implant (Implanon) or IUD (Mirena), which may relieve pain
• Procedures to shut off damaged veins (sclerotherapy, embolization).
• Surgery to remove your uterus and ovaries

When should I seek Medical Advice?

Your gynaecologist may suggest starting medicines. If these don’t relieve your symptoms, your gynaecologist may advise a procedure to treat the condition. Your symptoms may ease up as you enter menopause.

If you think you or someone you might know exhibit the symptoms of pelvic venous congestion syndrome, please contact Rockingham Women’s Health Centre on 0895918943 to book an appointment or www.rockinghamwomenshealth.com.au