Pelvic Congestion Syndrome TOG 2013

Question 1

Prevalence of pelvic congestions syndrome

Answer 1

3.8%

Question 2

Clinical features of PCS

Answer 2

Chronic pelvic pain
Often premenopausal multiparupus
Worse premestral and pregnancy
Exacerbated by fatigue and standing
Pain after intercourse - usually deep penetration -

Question 3

USS criteria for PCS

Answer 3

Tortuous pelvic veins with a diameter of greater than 6 mm. Mean diameter in PCS ˜8 mm.
Slow blood flow < 3 cm/second or reversed caudal flow in the left ovarian vein demonstrated by Doppler waveforms.
Dilated arcuate veins in the myometrium that communicate between the bilateral pelvic varicose veins.
Polycystic changes within the ovaries. Features ranged from the typical polycystic ovaries appearance to the presence of clusters of four to six cysts of 5–15 mm in diameter in bilaterally enlarged ovaries. Women with polycystic changes of their ovaries secondary to PCS were not hirsute or amenorrheic.

Question 4

Venography features of PCS

Answer 4

ovarian vein diameter >10 mm
uterine venous engorgement
congestion of the ovarian plexus
filling of the pelvic veins across the midline and/or filling of the vulvovaginal thigh varicosities.

Question 5

Management of PCS

Answer 5

1. NSAIDS
2. Ovarian suppression - MPA, GnRH agonist + add back for 6 months
3. Surgical - Percutanous embolisation of ovarian/iliac vein varicosities, hysterectomy + BSO