Causes of Pelvic Congestion Pain

Pelvic pain could be from multiple causes but pelvic venous congestion is responsible for up to 30% of pelvic pain in women. Pelvic congestion needs to be differentiated from other causes of pelvic pain like uterine fibroids, adenomyosis, endometriosis, pelvic inflammatory disease, ovarian cyst and gastrointestinal causes.

Pelvic Congestion Syndrome Presentations

Many times patient come to us due to non cyclical pain lasting for more than six months. Other times they come to us due to recurrence of leg varicose veins after initial successful treatments. Common symptoms of pelvic congestion are

  • Pelvic pain & discomfort, sometimes associated with generalized lethargy & depression.
  • Pain worse by sitting, prolonged standing & towards end of the day or just before menses.
  • Dyspareunia
  • Varicose veins in perineum, buttock, lower extremities & hemorrhoids mostly in women.
  • Most common in pre-menopausal age group.

Pelvic Congestion Syndrome Treatment Options

Treatments for pelvic congestion has evolved over couple of decades

  • Medical management included medroxyprogesterone acetate or the GnRH analogue Goserelin.
  • Laparoscopic ligation bilateral ovarian veins- needs general anesthesia.
  • Newest & non surgical treatment is percutaneous pelvic vein embolization therapy.
  • Significant improvement in up to 83% of women in their overall pain perception.

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