Pelvic congestion syndrome and May-Thurner syndrome as causes for chronic pelvic pain syndrome: neuropelveological diagnosis and corresponding therapeutic options

Marc Possover; Shaheen Khazali; Alireza Fazel

doi:10.52054/fvvo.13.2.019

Pelvic congestion syndrome and May-Thurner syndrome as causes for chronic pelvic pain syndrome: neuropelveological diagnosis and corresponding therapeutic options

Marc Possover, Shaheen Khazali, Alireza Fazel

In: Facts, Views and Vision in ObGyn · 2021 · vol. 13(2) , pp. 141–148 · doi:10.52054/fvvo.13.2.019 · PMID:34184843 · PMC8291989 · W3174424747

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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study investigated pelvic congestion syndrome and May-Thurner syndrome as causes of chronic pelvic pain, finding ovarian vein embolization improved visceral pain and laparoscopic decompression improved somatic neuropathic pain.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This retrospective tertiary-referral study evaluated women with intractable pelvic neuropathic pain using Doppler criteria for pelvic congestion syndrome, specifically left uterine venous plexus dilation above 6 mm with reversed and slow flow and dilated arcuate veins, and further radiological work-up when May-Thurner syndrome was suspected. Across 61 consecutive patients, those presumed to have visceral pain from pelvic congestion syndrome (14 patients) underwent ovarian vein embolization with mean VAS pain reduction from 7.21 to 3.28 over 6 months (p<0.01), while among 47 with pelvic somatic neuropathic pain, 19 received endovascular interventions and ultimately all underwent laparoscopic exploration/decompression of the sacral plexus and endopelvic portion of the pudendal nerves, with VAS reduction from 8.56 to 2.63 at one-year follow-up (p<0.01). The authors’ main limitations include the retrospective design and limited clarity on causal attribution for endovascular interventions because laparoscopic decompression was performed for the somatic neuropathy group. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

OBJECTIVE: To report on diagnosis and management of pelvic congestion including the May-Thurner syndrome (MTS) as potential etiologies for intractable pelvic neuropathic pain. DESIGN: Retrospective study of women presented with intractable pelvic neuropathic pain, who had left sided venous uterine plexus above 6mm with reversed and slow flow on Doppler, with dilated arcuate veins passing through the uterine muscle. Those with suspicion of MTS underwent further radiological investigations and if applicable, endovascular interventions. SETTING: Tertiary referral unit specialized in advanced gynaecological surgery and neuropelveology. INTERVENTION: 61 consecutive patients were included. 14 with visceral pain presumed to be caused by Pelvic Congestion Syndrome were treated by ovarian vein embolization. An improvement of pain was observed in all patients - mean pain reduction of 3.93 points, from 7.21 (±1.42; 4-10) to 3.28 pts (±1.54; 1-6) over 6 months (p<0.01). 47 presented with pelvic somatic neuropathic pain; 19 underwent endovascular intervention (angioplasty, stenting) and finally all of them a laparoscopic exploration/decompression of the sacral plexus and the endopelvic portion of the pudendal nerves, with an overall VAS reduction from 8.56 (±1.1712;7-10) to 2.63 (±1.53; 0-6) at one-year-follow-up (p<0.01). CONCLUSION: Laparoscopic exploration/decompression of the nerves seems to be effective in a carefully selected group of patients. Endovascular interventions for pelvic somatic neuropathies may not be an effective treatment. We recommend that Doppler studies of the uterine vessels are performed as an extension to gynaecological examination in women with intractable pelvic pain.

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Abstract

Objective: To report on diagnosis and management of pelvic congestion including the May-Thurner syndrome (MTS) as potential etiologies for intractable pelvic neuropathic pain. Design: Retrospective study of women presented with intractable pelvic neuropathic pain, who had left sided venous uterine plexus above 6mm with reversed and slow flow on Doppler, with dilated arcuate veins passing through the uterine muscle. Those with suspicion of MTS underwent further radiological investigations and if applicable, endovascular interventions. Setting: Tertiary referral unit specialized in advanced gynaecological surgery and neuropelveology. Intervention: 61 consecutive patients were included. 14 with visceral pain presumed to be caused by Pelvic Congestion Syndrome were treated by ovarian vein embolization. An improvement of pain was observed in all patients – mean pain reduction of 3.93 points, from 7.21 (±1.42; 4-10) to 3.28 pts (±1.54; 1-6) over 6 months (p<0.01). 47 presented with pelvic somatic neuropathic pain; 19 underwent endovascular intervention (angioplasty, stenting) and finally all of them a laparoscopic exploration/decompression of the sacral plexus and the endopelvic portion of the pudendal nerves, with an overall VAS reduction from 8.56 (±1.1712;7-10) to 2.63 (±1.53; 0-6) at one-year-follow-up (p<0.01).

Conclusion

Laparoscopic exploration/decompression of the nerves seems to be effective in a carefully selected group of patients. Endovascular interventions for pelvic somatic neuropathies may not be an effective treatment. We recommend that Doppler studies of the uterine vessels are performed as an extension to gynaecological examination in women with intractable pelvic pain.

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