Pelvic Congestion Syndrome (PCS)
PCS is a persistent pain in the lower abdomen combined with varices in the pelvis minor. Prominent symptoms are a heavy feeling in the lower abdomen, deep dyspareunia and post coital ache.
The ovarian veins drain to the inferior vena cava and left renal vein in the mid abdomen. Valves have been described as either usually absent or present in up to 90 % of cases, in the latter studies, valves were more likely to be absent in parous women.
Valves at the ovarian vein terminations weaken, as a result blood flows under gravity down into the pelvis, gross dilatation and incompetence of one or both ovarian veins can occur. As a result pelvic varices develop, thigh and vulval varices may also develop.
A transabdominal and transvaginal scan are performed to assess prominent varices and allows visualisation of the uterine plexus and broad ligament varices. Valsalva is performed and if there is a significant increase in diameter of the varices, this is documented.
Normal ovarian veins should measure 2-3 mm. Colour and pulse Doppler is used to assess the blood flow with the ovarian vein.
The diagnosis of PCS can be confirmed using venography and the patient may be treated effectively with embolotherapy.
Women with chronic pelvic pain require a thorough history and physical examination. Women with chronic pelvic pain, in whom ultrasound has given positive results, should undergo selective ovarian vein venography with the intent to treat varices if found.