12 de março de 2021 Author : Marina Dias Neto Pelvic congestion syndrome is a set of symptoms, including non-cyclical pain in the pelvic region that lasts for at least 6 months. It mainly affects young and multiparous women (with more than one delivery), between 20 and 30 years old. The average age at the time of treatment is 41 years. Usually the problem disappears after menopause. The disease was first described in the 19th century, and was called the pelvic congestion syndrome in 1949, but only recently has been recognized as a frequent cause of chronic pelvic pain . Causes of pelvic congestion syndrome In pelvic congestion syndrome, pelvic pain is due to blood congestion near the organs of the reproductive system in the pelvic region, caused by reflux of blood in the ovarian veins, pelvic varicose veins, or hypogastric venous insufficiency, either by: Problems associated with vein valves (primary valve incompetence); Obstruction to venous flow. The reasons why this happens are not fully known. Symptoms Pelvic pain , a common symptom in women, is responsible for a high number of medical appointments, especially in gynecology. In this syndrome, pelvic pain is described as a feeling of heaviness that increases during the day , especially when sitting or standing and when standing up, and that can be relieved by lying down. In addition to pain, in pelvic congestion syndrome it may also occur : Dyspareunia or pain during or after intercourse; Dysmenorrhea or menstrual pain; Urinary symptoms, such as difficulty or pain when urinating, increased urination frequency and urinary urgency; Constipation; Hemorrhoids. Some of the symptoms often occur on one body side only, but it can also be bilateral. Diagnosis For the diagnosis of pelvic congestion syndrome , clinical history, physical exam and the results of several diagnostic tests are important, such as: Pelvic ultrasound; Powered venotomography; Computed tomography venography; Magnetic resonance venography. On physical examination , the combination of hypersensitivity on ovarian region abdominal palpation with a history of pain after sexual activity allows often to separate the pelvic congestion syndrome from other causes of pelvic pain. Sometimes perineal varices, mainly vulvar, and other vascular findings are identified, for example: Superficial venous insufficiency in the lower limbs; Atypical varicose veins, for example on the buttocks, and on the posterior and lateral sides of the thigh; Recurrence after treatment of varicose veins. Imaging exams document the existence of pelvic varices, as well as dilation of the ovarian veins. Computed tomography or magnetic resonance imaging also allows the diagnosis of obstructive causes and other sources of pelvic pain, such as endometriosis. Phlebography can be used in the diagnosis of pelvic congestion syndrome, when anticipating a therapeutic intervention. Treatment of pelvic congestion syndrome Treatment of pelvic congestion syndrome includes surgical and non-surgical options . Pharmacological treatment , for example with medroxyprogesterone, goserelin or venotropic drugs, relieves symptoms, but has no permanent effects once discontinued. In most patients, endovascular treatment with pelvic embolization is currently the first-line treatment. The access is made in a groin vein through which the materials that will embolize and eliminate varicose veins are inserted. Current guidelines recommend that pelvic varices due to incompetence of pelvic veins are treated by embolization with coils, plugs or by transcatheter sclerotherapy, used alone or in combination. Pelvic embolization can be performed under local anesthesia and does not require hospitalization. Meet the vascular team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
