Pelvic congestion syndrome (PCS) as a pathology of postmenopausal women: a case report with literature review

Abstract

Background Due to the scarcity of adequately powered, randomized controlled trials and internationally standardized diagnostic criteria, evidence on the diagnosis and treatment of pelvic congestion syndrome (PCS) is limited. Earlier epidemiologic observations led to the attribution of PCS to the premenopausal state, and a remission of symptoms after menopause is frequently described a hallmark of the pathology. This concept has currently been challenged by radiological studies reporting a notable prevalence of ovarian venous congestion in adult female patients of advanced age. PCS as a pathology of postmenopausal women, however, has not been acknowledged by systematic research to date, impeding appropriate diagnostics and therapy for affected patients. Case presentation A 69-year-old postmenopausal patient presented with newly diagnosed dilated and insufficient pelvic veins in combination with characteristic pain anamnesis, thereby fulfilling the diagnostic criteria of PCS. Interventional coil embolization of both ovarian veins as a standard treatment previously described for premenopausal patients was successfully performed, resulting in prompt alleviation of symptoms. The patient remained symptom-free at the 18-month follow-up visit. Conclusions Given this first systematically documented case of a patient with postmenopausal symptomatic PCS in the light of recently published data on the prevalence of ovarian venous congestion in patients of advanced age, it may be assumed that PCS is not to be considered a pathology strictly limited to premenopausal state. Further clinical studies expanding the diagnostic scope beyond menopause may help to substantiate evidence and subsequently define standardized therapeutic approaches for affected postmenopausal patients.

The Depression Anxiety Stress Scale 8: Its Psychometric Evaluation Among Women with Chronic Non-Cancer Pelvic Pain

“…CPP is commonly experienced by up to 22% of women [1][2][3]. It can be idiopathic or due to numerous urological, bowel-related, and gynecological reasons [3,4]. Because chronic noncancer pain conditions in women worsen over time, especially during the peak reproductive years, uctuations in ovarian hormones are suggested to be key modulators in the pathologies underlying CPP such as endometriosis and irritable bowel syndrome [1,5,6].…”

“…Differences in CPP experience and pathology between reproductive age women and peri/postmenopausal women are reported in the literature [4]. Conditions entailing reduced levels of feminine hormones (e.g., menopause and during menses) are associated with increased sensitivity to visceral and pelvic pain [5].…”

Pelvic Congestion Syndrome in a Postmenopausal Female

“…The second one was in a 69-year-old postmenopausal patient with varicose veins, but she was asymptomatic. The lack of symptoms is very uncharacteristic of PCS [ 9 ]. Furthermore, other syndromes like May-Thurner appear to have similarities with PCS, which seem to be more applicable to patients experiencing menopause.…”

Psychometric evaluation of the Depression Anxiety Stress Scale 8 among women with chronic non-cancer pelvic pain

“…Differences in CPP experience and pathology are reported between reproductive age women and peri/postmenopausal women 4 . Conditions entailing reduced levels of feminine hormones (e.g., menopause and during menses) are associated with increased sensitivity to visceral and pelvic pain 5 .…”

“…CPP is commonly experienced by up to 22% of women 1-3 . It can be idiopathic or due to numerous urological, bowel-related, and gynecological reasons 3,4 . Because non-cancer CPP conditions in women worsen over time, especially during the peak reproductive years, fluctuations in ovarian hormones are suggested to be key modulators in the pathologies underlying CPP such as endometriosis and irritable bowel syndrome 1,5,6 .Differences in CPP experience and pathology are reported between reproductive age women and peri/postmenopausal women 4 .…”