Effectiveness of treatment for pelvic congestion syndrome

Pelvic congestion syndrome accounts for approximately 16% to 31% of patients suffering from chronic pelvic pain, and it is the second most frequent cause of pelvic pain after endometriosis. It is a poorly understood disease, and various treatments have been suggested in the past. Hormonal treatment, which suppresses ovarian function, demonstrated varying results. Hysterectomy with salpingooophorectomy used to be the second option for treatment, though efficacy of this treatment is disputable. In the more recent past, endovascular techniques for abolishing pelvic vein incompetence have been introduced with varying success. Additionally, deep venous obstruction caused by left renal vein entrapment or iliac vein compression has been identified as an important component of pelvic pain. Percutaneous endovenous techniques seem to be the best alternative as the initial treatment option. Several studies have also suggested that psychosocial factors weigh heavily on treatment outcomes, so concurrent psychotherapy may be useful when treating these patients. Future research should focus on reproducibility of treatment procedures, and randomized controlled trials should determine whether treatment of pelvic venous obstruction or incompetence is useful in relieving chronic pelvic pain. Then, properly designed studies should identify the importance of treating obstruction before incompetence. Finally, the additive effect of psychotherapy should be investigated.