Guidelines for the assessment of female pelvic congestion syndrome

Varicocele in women, is a “ pelvic congestion syndrome “ (PCS), consisting of pelvic pain, dyspareunia, dysmenorrhoea, dysuria, vulvar congestion with or without vulvar varicose vein Unlike male varicocele, in ovarian varicose veins fertility disorders are never found. Diagnosis is made with the presence of the chronic pelvic pain, with exacerbations during ovulation and menstruation and the presence of varicose veins in the thigh with atypical distribution, generally on the posterior and parainguinal areas. Closure of the incompetent ovarian veins will carry a considerable improvement of chronic pelvic pain in at least 70% of the cases, and a considerable reduction of the extrapelvic peripheral varicose veins in roughly 90% of the cases. Diagnosis is established by the transvaginal color Doppler sonography (CDS), which completely depicts the pelvic veins and the anastomosiswith the abdominal veins and lower limbs with a high degree of reliability. The transvaginal CDS performed with high frequency (5-7.5 MHz) endocavitary probes. Multi-layer angioCT and angioMRI are able to display the retro-ovarian and periuterine veins of increased diameter, but these second level studies are justified only for differential diagnoses with other diseases of the pelvis (e.g. expanding ovarian formations etc.). They and do not measure the entity of reflux. Arare PCS with associated varicose veins in the lower limbs is caused by compression of the left renal vein between the superior mesenteric artery and the aorta and it is known as “Nutcracker Syndrome”. It should be suspectedin women with PCS and haematuria and can be confirmedby angioMRI or angioCT Treatment consists of interrupting the reflux. Medical treatment (eliminating the ovarian function,pain killers) plays a palliative role. The first choice treatment today is percutaneous endovascular catheterization and sclerosis that can be performed with transbrachial access, like in men. The procedure is performed under local anaesthesia, in day hospital