[Congestive pelvic syndromes].

Abstract

Pelvic congestion syndrome is encountered in three pathological situations: premenstrual syndrome, intermenstrual syndrome, chronic pelvic congestion syndrome. The first two syndromes, with a range of physical and/or psychological symptoms, are cyclical. Their pathogenesis is multifactorial. Hormonal and circulatory factors are essentially blamed. Treatment is most often based upon combinations of progestogens and venotonics. The third syndrome, that of chronic pelvic congestion, is characterised by long term pelvic pain and raises etiopathogenic problems which remain only partially solved and in which a vascular role may sometimes be recognised. Endovaginal ultrasonography with colour-coded Doppler and celioscopy sometimes reveal pelvic varicose veins and indicate their responsibility for such pain, after having eliminated specific pelvic pathology (post-infectious or post-operative inflammatory sequelae of pelvic tissue, rupture of the broad ligaments, endometriosis, etc.). Treatment is above all medical, based upon hormone therapy acting upon venous receptors, venotonics which decrease the consequences of stasis, intermittent courses of anti-inflammatory agents and antibiotics when there is inflammation secondary to local infection. These various types of treatment may be combined. Surgical treatment should be restricted to certain carefully assessed cases only.