From the Guidelines
Pelvic Congestion Syndrome (PCS) in postmenopausal patients is a complex condition that requires careful evaluation to rule out more serious underlying conditions, and its characteristics are not well-defined due to the limited evidence available 1. When evaluating postmenopausal subacute or chronic pelvic pain localized to the deep pelvis, the initial imaging study of choice is a combined transabdominal and transvaginal pelvic US, which can provide anatomic information about uterine size and endometrial canal distension, fallopian tube dilation, ovaries, and adnexal masses 1. Some key characteristics of PCS in postmenopausal patients may include:
- Residual venous incompetence
- Anatomical factors
- Secondary causes rather than hormonal influences
- Pelvic fluid, hydrosalpinx or pyosalpinx, inflammatory adnexal masses, and peritoneal inclusions visible by US 1
- Adhesive disease, although this is a notoriously difficult diagnosis to confirm nonoperatively 1 The most appropriate initial imaging approach for postmenopausal subacute or chronic pelvic pain is a combined transabdominal and transvaginal US, as it is broadly used and clinically accepted worldwide, despite the lack of high-quality evidence supporting its specific usefulness 1. In terms of treatment, options may include:
- Hormonal therapy with low-dose estrogen if not contraindicated
- Non-hormonal management focusing on pain control with NSAIDs
- Venous embolization procedures for severe cases with documented pelvic varicosities
- Lifestyle modifications such as regular exercise, weight management, and avoiding prolonged standing
- Pelvic floor physical therapy for symptom relief. Given the complexity and rarity of PCS in postmenopausal women, consultation with a specialist experienced in postmenopausal pelvic pain is strongly recommended for proper diagnosis and treatment planning.
From the Research
Characteristics of Pelvic Congestion Syndrome (PCS) in Postmenopausal Patients
- The characteristics of Pelvic Congestion Syndrome (PCS) in postmenopausal patients are not well-defined, as most studies focus on premenopausal women 2, 3, 4, 5.
- However, one study reports a case of a 53-year-old postmenopausal woman with PCS, highlighting that this condition can occur in postmenopausal women, although it is relatively rare 6.
- The study found that the patient presented with unique symptoms and imaging findings on CT and ultrasonography, which were analyzed to understand the potential causes of this condition 6.
- Another study found that dilated pelvic veins were present in 10% of postmenopausal patients, and chronic pelvic pain of unclear etiology was documented in 0.5% of postmenopausal women with dilated veins 5.
- The symptoms of PCS in postmenopausal patients may include pelvic pain, urological symptoms such as hematuria, dysuria, and urinary frequency, and vulval varicosities 4, 5.
- Diagnostic tests such as transvaginal ultrasound and CT scans may be used to diagnose PCS in postmenopausal patients 4, 5, 6.
- Treatment options for PCS in postmenopausal patients may include medical therapy, such as hormone therapy and venotonics, as well as surgical or minimally invasive endovascular treatments 2, 3, 4.