Ovarian vein incompetence: a potential cause of chronic pelvic pain in women.
OBJECTIVE
To evaluate whether ovarian vein incompetence may be a source of chronic pelvic pain (CPP) in women.


METHODS
Twenty-two women, aged 19-50 years, with chronic pelvic pain, no laparoscopically detected pelvic pathology, and evidence of reflux in dilated pelvic veins on transvaginal color Doppler ultrasound underwent retrograde ovarian venography and sclerotherapy of the ovarian vein(s) if incompetent. The primary outcome was symptom change as assessed by a symptom questionnaire and visual analog pain scales (VAS) at 3, 6, and 12 months of follow-up. Changes in pelvic circulations after sclerotherapy procedure were also evaluated by serial ultrasound examinations. Differences between baseline and post-procedural VAS scores were analysed using the Wilcoxon signed-rank test.


RESULTS
Twenty (91%) of the 22 women had venographic evidence of incompetent ovarian vein(s) and received sclerotherapy. There were no immediate or late complications. Variable symptom relief was observed in 17 (85%) of the 20 treated women, with follow-up at 12 months showing marked-to-complete relief in 15 patients and mild-to-moderate relief in the remaining 2 patients. Three (15%) women had no improvement in symptoms. Median VAS scores at 3 (2.0), 6 (2.5), and 12 months (3.0) were significantly lower than at baseline (8.0) (P<.001). Follow-up ultrasound examinations showed absence of pelvic venous reflux in all but 3 patients, in whom recurrence of reflux was seen at 3 months.


CONCLUSIONS
Ovarian vein sclerotherapy provided symptomatic relief and improved pelvic circulation in most patients. These findings suggest that ovarian vein incompetence was the likely source of chronic pain in these women, and that sclerotherapy was a safe and effective treatment for this condition.


CONCLUSIONS
Ovarian vein incompetence leading to pelvic circulatory changes may be a cause of chronic pelvic pain in women.
Tropeano
Giovanna
G
Department of Obstetrics and Gynaecology, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Roma, Italy. giovannatropeano@rm.unicatt.it
Di Stasi
Carmine
C
Amoroso
Sonia
S
Cina
Alessandro
A
Scambia
Giovanni
G
D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008875:Middle Aged; D010053:Ovary / Q000098:blood supply*; D017699:Pelvic Pain / Q000209:etiology* / Q000503:physiopathology; D010690:Phlebography; D012039:Regional Blood Flow / Q000502:physiology; D015911:Sclerotherapy; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014652:Vascular Diseases / Q000150:complications* / Q000628:therapy; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*