From the Guidelines
Pelvic congestion syndrome should be managed with a combination of iliac vein stent placement and ovarian vein embolization for patients with gonadal vein reflux and nonthrombotic iliac vein lesions, as this approach has been shown to improve symptom relief. This condition is a chronic cause of pelvic pain in women, affecting up to 26% of women worldwide at some point during their lives 1. The management of pelvic congestion syndrome typically involves a multidisciplinary approach, including medical therapy, minimally invasive procedures, and lifestyle modifications.
Medical Therapy
Medical therapy for pelvic congestion syndrome often begins with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to manage pain. Hormonal treatments such as medroxyprogesterone acetate (30-50mg daily) or combined hormonal contraceptives can help reduce symptoms by suppressing ovarian function and decreasing blood flow to the pelvic veins.
Minimally Invasive Procedures
For patients with severe symptoms not responding to medication, minimally invasive procedures like ovarian vein embolization may be recommended, which involves blocking the affected veins to redirect blood flow. The use of iliac vein stent placement in combination with ovarian vein embolization has been shown to improve symptom relief in patients with gonadal vein reflux and nonthrombotic iliac vein lesions 1.
Lifestyle Modifications
Lifestyle modifications including regular exercise, avoiding prolonged standing, and elevating the legs when possible can help manage symptoms. Pelvic congestion syndrome often affects women of reproductive age and may worsen during pregnancy due to increased blood volume and pressure on pelvic veins. Diagnosis typically requires imaging studies such as transvaginal ultrasound or MRI to visualize the dilated veins, as symptoms can mimic other gynecological conditions. Treatment should be individualized based on symptom severity, desire for future pregnancy, and response to initial therapies. Percutaneous endoluminal left renal vein stenting is also increasingly performed due to the morbidity associated with surgical techniques 1.
From the Research
Definition and Symptoms of Pelvic Congestion Syndrome
- Pelvic congestion syndrome is a condition characterized by chronic pelvic pain in women, often associated with pelvic varicosities and worsened by prolonged standing, coitus, menstruation, and pregnancy 2.
- The precise etiology of this syndrome remains uncertain, and it is probably multifactorial, involving valvular insufficiency, venous obstruction, and hormonal factors 2, 3.
- Symptoms of pelvic congestion syndrome include pelvic pain, venous varices, and dilated pelvic veins, which can be present in asymptomatic women, making diagnosis challenging 2, 4.
Diagnosis of Pelvic Congestion Syndrome
- Diagnosis of pelvic congestion syndrome is difficult to make and often requires a combination of imaging studies, such as Doppler ultrasound, CT scan, and MRI, as well as transcatheter venography 4, 3.
- The optimal diagnostic approach for pelvic congestion syndrome-related pelvic pain remains unclear, and controlled trials comparing medical and interventional treatments are urgently needed 5.
Treatment Options for Pelvic Congestion Syndrome
- Treatment options for pelvic congestion syndrome include medical, surgical, and endovascular therapy, with transcatheter pelvic vein embolization being a safe, effective, and durable therapy for the treatment of pelvic congestion syndrome 6, 4, 3.
- Minimally invasive interventions, such as percutaneous approach, have become the method of first choice for the treatment of pelvic congestion syndrome, with high efficacy and low risk of serious complications 3.
- Hormonal suppression, such as progestins and gonadotropin-releasing hormone agonists, can also be effective in decreasing pain symptoms 5.