The Complex Aetiology of Chronic Pelvic Pain: Concomitance of Pelvic Venous Disorders and Adenomyosis.

Objective. To determine the prevalence of adenomyosis among patients with Pelvic Venous Disorders (PeVD) presenting with Chronic Pelvic Pain (CPP) and to assess the clinical response to ovarian vein embolization in cases of isolated PeVD versus concomitant PeVD and adenomyosis. Design. Observational cross-sectional study. Setting. Medical University of Lublin, Lublin, Poland. Population or Sample. A total of 147 women hospitalised for evaluation and management of CPP, none of whom had a prior diagnosis of PeVD or adenomyosis or were receiving hormonal or venoactive therapy at baseline. Methods. All participants underwent detailed history-taking, gynaecological examination, and transvaginal ultrasonography (TVUS) including systematic assessment for PeVD and adenomyosis. Patients with symptoms consistent with PeVD for ≥6 months and at least one diagnostic TVUS criterion were referred for pelvic venography and embolization where indicated. Participants were stratified by presence or absence of TVUS signs of adenomyosis. Main Outcome Measures. Pain intensity scores pre- and post-embolization, menstrual-related pain, and need for re-intervention. Results. PeVD was confirmed in all patients. Adenomyosis was identified in 51 of 147 (34.7%). Patients with concomitant adenomyosis reported significantly higher pain scores pre-procedure (7.43 vs 6.61; p=0.03) and at 3 months (4.63 vs 3.24; p=0.01) and 6 months (3.93 vs 2.73; p=0.05). Differences were not significant at 12 months. Severe menstrual pain was more frequent with adenomyosis (64.4% vs 40.0%; p=0.03). Re-intervention occurred in 14.29% versus 8.57%, respectively. Conclusions. Concomitant adenomyosis attenuates the early therapeutic response to pelvic vein embolization in women with CPP. Comprehensive pre-procedural evaluation is essential, and combined venous and hormone-based therapy warrants further investigation.