Embolotherapy eases pelvic congestion: in 131 women who had the procedure, 85% reported improvement at a mean 45 months' follow-up.(Gynecology)

Pelvic congestion syndrome is a real disease entity that affects up to 16% of American women, and can be successfully treated with transfemoral embolotherapy, according to researchers who presented data at the annual meeting of the Society of Interventional Radiology.

About 10% of gynecologic visits are due to chronic, noncyclic pelvic pain of greater than 6 months' duration, and a third of gynecologic laparoscopies are performed to investigate such pain. The differential diagnosis usually includes endometriosis, fibroids, adenomyosis, cysts, and tumors, among other potential causes. Pelvic congestion syndrome (PCS)--pelvic vein insufficiency that causes pooling of blood in the uterine and ovarian veins--is not often on the list, said Hyun S. "Kevin" Kim, M.D., of Johns Hopkins University, Baltimore.

Even standard imaging studies don't always identify the disorder, Dr. Kim said in an interview.

"Only 40% of laparoscopic studies were able to visualize abnormal veins. On MRI, only 59% were diagnosed. This is because these venous abnormalities are caused by physiologic conditions that change during the exam; when you lie down, your heart is at the same level as your pelvis, and all the blood will be quickly decompressed," Dr. Kim said.

Because PCS is difficult to diagnose, many physicians write off the symptoms--dull, typically unilateral pain that worsens during the day and with standing, dyspareunia, and dysuria--as psychosomatic, said Dr. Kim.

Varicocele, the male counterpart of PCS, has no such stigma, he added. In men, the gonadal vein terminates in the testicle, so the painful venous abnormalities are usually visually apparent.

"This condition is accepted in men, because it occurs outside the body and we can see it. In women it's hidden, and this, I think, is part of the reason for misdiagnosis or underdiagnosis," Dr. Kim said.