From the Guidelines
Pelvic Congestion Syndrome (PCS) management should prioritize ovarian vein embolization as the gold standard treatment, with internal iliac vein embolization also being a safe and effective option for reducing pelvic pain in most women. Management options for PCS include both medical and interventional approaches. First-line treatment typically involves non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for pain relief. Hormonal treatments are often effective, including medroxyprogesterone acetate, combined oral contraceptives, or gonadotropin-releasing hormone (GnRH) agonists like leuprolide 1.
Key Management Options
- Medical therapy: NSAIDs, hormonal treatments
- Minimally invasive interventional procedures: ovarian vein embolization, internal iliac vein embolization
- Surgical options: laparoscopic ligation of ovarian veins, hysterectomy with bilateral oophorectomy Some studies have also explored the use of left renal vein stenting and surgical removal of the left ovarian vein, but these options are less commonly recommended 1.
Considerations for Treatment Selection
- Symptom severity
- Desire for future pregnancy
- Response to previous interventions Lifestyle modifications such as avoiding prolonged standing, regular exercise, and pelvic floor physical therapy can provide additional symptom relief as adjunctive measures. Ovarian vein embolization has been shown to have success rates of 70-85%, making it a highly effective treatment option for PCS. Internal iliac vein embolization has also been shown to be safe and effective in treating pelvic venous insufficiency and reducing pelvic pain in most women undergoing treatment for PCS 1.
From the Research
Management Options for Pelvic Congestion Syndrome (PCS)
The management of Pelvic Congestion Syndrome (PCS) involves various treatment options, including:
- Conservative treatment methods, such as nonsteroidal anti-inflammatory drugs (NSAIDs), ergot alkaloid derivatives, hormonal agents, venoprotective agents, and compression therapy 2
- Transcatheter ovarian vein embolization, which has been shown to be a safe and effective option for PCS treatment, with significant improvement in clinical status and quality of life in patients 3
- Embolization of insufficient ovarian veins, which is considered an effective and safe way of treatment in a well-selected group of patients with PCS 3
- Surgical phlebectomy of vulvar varices, which may be performed in combination with endovascular embolization 3
- Endovascular stenting of left renal vein (LRV) obstruction, which has shown promise in alleviating symptoms attributed to nutcracker syndrome 4
- Open surgery, which may be considered for patients with outflow obstruction due to nutcracker syndrome 4
Treatment Efficacy and Safety
Studies have demonstrated the efficacy of embolotherapy in reducing pelvic pain, with high success rates and low occurrence of complications 3, 4, 5
- A study found that 100% of patients experienced significant improvement in clinical status after ovarian vein embolization, with 30% experiencing mild recurrence of symptoms at mid-term follow-up 3
- Another study found that embolization of insufficient ovarian veins improved the quality of life in patients, with complete pain relief reported by 60% of patients who had complained of dyspareunia prior to embolization 3
Need for Further Research
Despite the availability of treatment options, high-level evidence on the diagnosis and management of PCS is lacking, with only a small number of randomized controlled trials existing 6, 5