Ovarian Vein Incompetence: A Potential Cause of Chronic Pelvic Pain in Women

Abstract

Conclusion: Ovarian vein incompetence is a cause of chronic pelvic pain in women and responds to ovarian vein sclerotherapy. Summary: For many years investigators have suggested pelvic varices can be responsible for otherwise unexplained pelvic pain. Venographic studies have demonstrated dilation of major pelvic veins with congestion of the ovarian plexus and broad ligaments in a high percentage of women with chronic pelvic pain and normal laparoscopy. It appears retrograde flow in incompetent ovarian veins may be the primary mechanism for dilation of pelvic veins and congestion of surrounding tissues leading to chronic pelvic pain. The clinical utility of ovarian vein occlusion and the treatment of such women are controversial. The authors evaluated 22 women with laparoscopy aged 19-50 years who had chronic pelvic pain and no recognized pelvic pathology. All did have evidence of reflux and dilated pelvic veins on transvaginal color Doppler ultrasound and subsequently underwent retrograde ovarian vein venography and sclerotherapy of incompetent ovarian veins. Outcomes were assessed by a symptom questionnaire and visual analog pain scales at 3, 6, and 12 months. Serial ultrasound examinations were used to evaluate changes in pelvic circulation after sclerotherapy. Venography showed 20 of the 22 women had incompetent ovarian veins, and they subsequently received sclerotherapy, which was not associated with immediate or late complications. Symptom improvement of varying magnitude was observed in 85% of the 20 treated women at a mean follow-up of 12 months. Marked or complete relief occurred in 15 patients and mild to moderate relief in two patients, with three women (15%) having no improvement in symptoms. Median visual analog pain scales at 3, 6, and 12 months were significantly lower than at baseline: 2.0, 2.5, and 3.0 at 3, 6, and 12 months vs 8.0 at baseline (P < .001). Follow-up ultrasound examinations demonstrated recurrence of venous reflux in three patients at 3 months. Comment: All the women in this study underwent laparoscopy. In fewer than half were pelvic varices detected by laparoscopy, indicating the absence of pelvic varicosities at laparoscopy does not rule out the diagnosis. Ovarian vein reflux as a cause of so-called pelvic congestion syndrome will remain controversial. The data do suggest, in patients who have had a thorough history, clinical evaluation, and negative results on standard diagnostic tests, that ovarian venography should be considered with the idea of possibly treating underlying ovarian vein reflux.