Reviewed by Brian R. Robinson, MDPelvic congestion syndrome is caused by a disorder in the veins connected to the pelvic area. In patients with pelvic congestion syndrome, leakage occurs in the valves in the veins that assist in blood flow from the pelvic area toward the heart. Blood then flows backward and pools in the veins, causing pain and discomfort.
In normally functioning veins, blood flows in only one direction, and is prevented from flowing backwards by periodically occurring valves in the veins that route the blood and close after blood passes through. In patients with Pelvic congestion syndrome, these valves do not work properly; they either open at the wrong time or never close completely, allowing blood to pool where it does not belong. This pooling causes the veins to stretch, putting unhealthy amounts of stress on veins and vein walls, and with painful results. The uterus, ovaries, and vulva may all be affected by pelvic congestion syndrome.Symptoms include:
• Pain during sexual intercourse (dyspareunia) , lasting up to 24 hours after intercourse
• Tender ovaries
• Backache
• Pain during periods (dysmenorrhea)
• Irritable bladder
• Abnormal menstrual bleeding (metrorrhagia)
• Vaginal discharge
Pelvic congestion syndrome is difficult to diagnose. Endometriosis, fibroids, and uterine prolapse may be considered before the correct diagnosis is found, because these conditions all have similar symptoms, and when symptoms overlap, one condition can be easily mistaken for the other until more conclusive testing is done. A thorough pelvic exam, possibly including a pelvic ultrasound or venography, is helpful in distinguishing pelvic congestion syndrome from other disorders of the reproductive tract. MRI and laparoscopy may also be considered as diagnostic aids.
Many women suffering from it have also been treated for varicose veins in their legs without experiencing pain relief. These leg treatments may not have been successful because the pelvic vein problems were not recognized. Women who have a tipped uterus or have had two or more pregnancies are at a higher risk for pelvic congestion syndrome.
The cause of pelvic congestion syndrome is unclear, but anatomic or hormonal abnormalities or dysfunction may be possible sources.
