Volume 65, Number 5 OBSTETRICAL AND GYNECOLOGICAL SURVEY Copyright © 2010 by Lippincott Williams & Wilkins
CHIEF EDITOR’S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 CreditsTM can be earned in 2010. Instructions for how CME credits can be earned appear on the last page of theTable of Contents.
Pelvic Congestion Syndrome-Associated Pelvic Pain: A Systematic Review of Diagnosis and Management
Frank F. Tu, MD, MPH,* David Hahn, MD,† and John F. Steege, MD‡
*Clinical Assistant Professor, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Chicago, IL and Pritzker School of Medicine, University of Chicago, Chicago, IL, †Clinical AssistantProfessor, Department of Radiology, NorthShore University HealthSystem, Chicago, IL; and Pritzker School of Medicine, University of Chicago, Chicago, IL ‡Professor, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC To systematically evaluate the diagnosis and treatment of female pelvic congestion syndrome (PCS). We searched the PubMed database and relevantbibliographies for English-language studies published between January 1966 and May 2009 pertaining to diagnosis and treatment of female PCS-related pelvic pain. Treatment articles were restricted to those containing at least 4 subjects and a specified length of follow-up. Diagnostic test studies were included if they included subjects with and without pelvic pain. Two reviewers abstracted characteristicsand outcomes from all controlled diagnostic studies and treatment papers. Six diagnostic and 22 treatment studies met entry criteria. Diagnostic method studies (pelvic venography, magnetic resonance imaging, or ultrasound) generally lacked appropriate reference standards, blinded assessors, or proven reliability. Treatment studies (using transvenous catheter embolization, surgical ligation,hysterectomy, or hormonal suppression) reporting ordinal outcomes found improvement from 24% to 100%; a similarly wide range of improvement was found with change in continuous rating of visual analogue scale pain scores (mean follow-up 4 months to 5.6 years). Both progestins and gonadotropin-releasing hormone agonists are effective in decreasing pain symptoms. The optimal diagnostic approach forPCS-related pelvic pain remains unclear, and controlled trials comparing medical and interventional treatments are urgently needed for PCS-associated pelvic pain. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to Compare different surgical treatments for pelvic congestion syndromes associated with pelvic painsyndromes. Estimate the relative severity of pelvic congestion in women using current venographic criteria. Choose between different diagnostic methods for characterizing pelvic venous blood flow and anatomy in women presenting with pelvic pain.
Unless otherwise noted below, each faculty’s spouse/life partner (if any) has nothing to disclose. The authors have disclosed that they have nofinancial relationships with or interests in any commercial companies pertaining to this educational activity. The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Dr. Tu and Dr. Steege have disclosed that the use ofEtonogestrel, medroxyprogesterone, leuprolide acetate for the treat-
ment of pelvic congestion syndrome associated pelvic pain as discussed in this article has not been approved by the U.S. Food and Drug Administration. Presented at the 74th Annual Meeting of the Central Association of Obstetricians and Gynecologists, Chicago, IL, October 2007; and the 37th Annual Meeting of the AAGL, Las Vegas, NV,...