Does pelvic venous congestion syndrome exist and can it be treated?

Chronic pelvic pain (CPP) is a common and costly health problem in gynecology. Operative pathological findings are often absent. In some women with CPP, pelvic venous congestion has been reported; however, this observation has also been made in asymptomatic women. Thus, it is not clear whether pelvic venous congestion causes CPP and, if it does, whether it is a direct or indirect cause. Venography and non-invasive imaging methods are used for the diagnosis, but scoring systems have not been validated. The current mainstay of treatment is venography-controlled embolization, which is less invasive than surgical interventions. However, the only evidence on effectiveness comes from uncontrolled case series. A systematic review of causation evidence is needed to prove whether pelvic venous congestion causes CPP and whether embolization treatment is effective. In addition, if causation is established, good-quality primary randomized controlled trials on embolization may be required.