Altered peripheral vascular response of women with and without pelvic pain due to congestion.
OBJECTIVE
To test the hypothesis that women with pelvic venous congestion have a reduction of reactivity of their peripheral circulation.


METHODS
Comparison was made between 20 women with chronic pelvic pain due to congestion and a control group of 15 pain-free women matched for age, parity and body weight. A comparison of these results was made with those from six postmenopausal women taking hormone replacement therapy.


METHODS
Study and control groups were investigated during the mid-follicular phase of the menstrual cycle (days 5-9) and the mid-luteal phase (days 19-23). The study group was also investigated during the fifth month of treatment with suppression of ovarian activity with leuprorelin or medroxyprogesterone acetate or six months after hysterectomy and bilateral salpingo-oophorectomy. Head-up tilt sufficient to increase intra-vascular pressure in the toe by a standard 40 mmHg was used as a means of raising venous pressure in the lower limb. Skin capillary red blood cell velocity (flux) was measured using a laser Doppler flow probe placed over the pulp of the big toe. Heart rate and blood pressure were also recorded. The change in skin blood flow following head-up tilt was expressed as a percentage of baseline flow in the supine position.


METHODS
Percentage change in skin red blood cell flux, heart rate and blood pressure in response to 40 degrees head-up tilt.


RESULTS
In the control group the median response to head-up tilt in the follicular phase was one of a reduction in flux, whereas in the luteal phase it was more variable ranging from an increase to a decrease in flux. The responses in the pelvic congestion group in both the follicular and luteal phases were similar to those of the control group in the luteal phase. A small but significant increase in heart rate in response to tilt in the pelvic pain group, compared with the control group, was interpreted as being due to a fall in venous return. Treatment of the pelvic congestion group by medical suppression of ovarian activity or total hysterectomy with bilateral salpingo-oophorectomy resulted in a significant change in response to head-up tilt from the variable type of luteal response to one of a more constant reduction in flux, similar to that of the control group in the follicular phase. A reduction in flux was also found consistently in postmenopausal women.


CONCLUSIONS
The study confirms the hypothesis that women with pelvic pain due to congestion show a change in peripheral vascular reactivity which returns to normal after suppression of ovarian activity. It seems likely that some alteration of normal ovarian function is responsible for the observed changes in peripheral blood flow in response to a rise in venous pressure in women with pelvic congestion.
Foong
L C
LC
Department of Obstetrics and Gynaecology, Singapore University.
Gamble
J
J
Sutherland
I A
IA
Beard
R W
RW
D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005498:Follicular Phase; D018475:Head-Down Tilt; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008183:Luteal Phase / Q000502:physiology; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D017699:Pelvic Pain / Q000503:physiopathology*; D016491:Peripheral Vascular Diseases / Q000503:physiopathology*; D017698:Postmenopause; D012867:Skin / Q000098:blood supply
D003271:Contraceptive Agents, Female; D005300:Fertility Agents, Female; D017258:Medroxyprogesterone Acetate; D016729:Leuprolide