Pelvic congestion syndrome: Not all pelvic pain is gynaecological

BACKGROUND: Chronic pelvic pain is a debilitating but common syndrome that is a burden both for patients and health systems. Pelvic congestion syndrome (PCS) contributes to 30-40% of patients presenting with chronic pelvic pain where no other cause is identified. However, PCS is poorly understood, underdiagnosed and undertreated, with the average time to diagnosis being reported as up to four years after initial presentation. OBJECTIVE: This article describes the pathophysiology of PCS and outlines the symptomatology, the most efficient diagnostic pathway and the optimal treatment methods for practitioners encountering patients presenting with PCS. DISCUSSION: The aetiology of PCS is multifactorial and it is thought to be caused by both hormonal and anatomical dysfunction. Patients with PCS present with a cluster of symptoms related to pelvic venous congestion, including pelvic pain worse on standing, irritable bowel symptoms, dyspareunia, vulval varicosities and lower limb venous pathology. Transvaginal ultrasound is a non-invasive and sensitive test for PCS. Ovarian vein embolisation is a safe, minimally invasive and efficacious treatment for PCS.