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adenomyosis vs endometriosis
15Oct

When women are dealing with chronic pelvic pain or other gynecological symptoms, two conditions often come to mind: adenomyosis vs endometriosis.

Though they both share similar symptoms, they are two different diseases with varying underlying causes and treatment methods. This can be a source of confusion for numerous patients and even some healthcare professionals.

Understanding the core differences between these two conditions is key to accurate diagnosis and effective treatment. Both involve the presence of the endometrial tissue (the tissue lining of the uterus) in places where it should not be.

But the location of this misplaced tissue is what sets both adenomyosis and endometriosis apart. This article will serve as a brief guide in explaining the key differences of these conditions, plus their nature, symptoms, and the diagnostic methods that can tell the distinction between the two.

Understanding the difference between Adenomyosis and Endometriosis

Adenomyosis is a condition where the inner lining of the uterus (i.e., the endometrium) breaks through the muscle wall of the uterus (known as myometrium).

The condition causes menstrual cramps, lower abdominal pressure, and bloating before menstrual periods. It also results in heavy periods (heavy menstrual bleeding). This condition has often been confused with fibroids (which are another kind of benign tumor affecting the uterus) due to similar symptoms.

On the other hand, endometriosis is a disorder where the tissues that form in the uterus’s lining grow outside the uterine cavity. Here are the most common locations of endometrial growth:

  • The ovaries
  • Fallopian tubes
  • The tissues lining the pelvis

Unlike the former, endometriosis can spread to other parts of the body. The condition can cause pain (at times quite severe), especially when women are on their period.

A Brief Comparison of Both Adenomyosis and Endometriosis

The following table can help us understand the key differences between these two conditions:

Feature Adenomyosis Endometriosis
Location It occurs inside the uterine wall. It takes place outside the uterus.
Pain It results in crampy and heavy periods with a tender uterus. Painful periods, pain occurring during sexual intercourse, or during movement.
Impact on the Uterus's size It results in an enlarged and bulky uterus There is no change in the size of the uterus.
Effect on fertility in females It rarely causes infertility. The condition is linked to infertility.
Who is affected by it? Commonly affects women above the age of 40. It can affect women at any age.

Symptoms of Adenomyosis and Endometriosis

Even when the uterine lining grows where it should not, it still carries on as usual. It gets thicker as each monthly cycle nears. Then it bleeds when the hormones signal that women aren’t pregnant, and this is where the issues begin.

Endometriosis is an irritating condition that causes swelling in nearby tissues. This causes scarring. Women may notice any of the following symptoms:

  • Belly Pain is a common symptom that worsens during periods
  • Pain in the back or in the legs
  • Pain during or after sexual intercourse
  • Heavy or painful menstrual bleeding
  • Pain during defecation or urination
  • Nausea, vomiting, or a constant feeling of tiredness.

Adenomyosis causes the inside of the womb to get larger and thicker. It does not happen with the former. The enlarged uterus can cause the following:

  • It puts pressure on both the bladder and the rectum
  • It changes the way uterine muscles contract
  • The condition can cause heavy and painful periods

Both conditions can cause anemia due to blood loss from heavy menstruation. Iron supplements can help women recover from such anemia.

Diagnosing Adenomyosis and Endometriosis

Proper diagnosis of these conditions involves a combination of patient history, physical exams, imaging, and, at times, life-saving surgical procedures. Let’s examine how they are diagnosed individually.

How is Adenomyosis Diagnosed?

The condition can be detected through either a magnetic resonance imaging (MRI) or a pelvic ultrasound. These imaging methods reveal either an enlarged uterus or thickened uterine walls.

How is Endometriosis Diagnosed?

The diagnosis is often conducted via laparoscopy. It is a minimally invasive surgical method that allows physicians to view the growth and conduct a direct biopsy. Laparoscopy endometriosis pain is non-existent thanks to its methodological nature.

Importance of Accurate Diagnosis

Accurate diagnosis is essential for custom treatment plans. They help address individual symptoms effectively and improve the quality of life. Those seeking expert care in diagnosis and management should consult a physician immediately. They can help women receive advanced medical support with empathy.

Effect of both conditions on women’s fertility

Adenomyosis and endometriosis can wreak havoc on a healthy woman’s fertility. Yet both have differing effects, which we’ll examine briefly:

  • Adenomyosis has the least ties to infertility. Yet it can interfere with uterine functionality in severe cases. It can also raise the risk of miscarriage
  • Endometriosis can lead to impairments in ovulation. It can further cause blockages in the fallopian tubes, and hormonal imbalances that can further affect fertility

Females affected by these conditions desirous of conceiving a child should not hesitate to consult with a fertility specialist to explore treatment options. Options like assisted reproductive techniques (ART) and in-vitro fertilization (IVF). Seeking care at top-notch medical facilities and hospitals ensures access to experts and top-notch medical technologies.

Is Adenomyosis worse than Endometriosis?

Is the latter more severe than the former? The severity of each condition depends on the individual risk factors and the way they can impact life. A brief analysis is as follows:

  • Adenomyosis is more likely to create menstrual cycles with heavy bleeding and substantial uterine enlargement
  • Endometriosis usually involves widespread complications like infertility, scarred tissue, and severe inflammation

Both conditions require a customized treatment plan. Early intervention with hormonal treatments or nonsteroidal anti-inflammatory drugs (NSAIDs) can help control the pain and improve quality of life.

Treatment Methods for Adenomyosis and Endometriosis

Treatment for adenomyosis focuses on relief of symptoms, especially pain management and heavy menstrual bleeding. Doctors can approach it in the following ways:

  • Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed to reduce menstrual pain and inflammation
  • Hormonal Treatments: Hormonal therapies can help control menstrual bleeding and relieve pain. Among them are birth control pills, progesterone creams, and hormonal intrauterine devices (IUDs)
  • Endometrial Ablation: This procedure destroys the uterus’s lining to reduce the menstrual flow. However, it is less effective if adenomyosis has penetrated deep into the uterine muscle
  • Focused Ultrasound Surgery (FUS): This non-invasive method uses high-frequency sound waves to target and remove the adenomyosis tissue
  • Gonadotropin-releasing Hormone (GnRH) Agonists: These drugs temporarily reduce the production of estrogen. It helps shrink the adenomyosis foci and ease its symptoms .

Treatment for Endometriosis aims at pain alleviation and prevention of the disease’s progression. It helps improve fertility in women. Here are some treatment tactics:

  • Conservative Surgery: This is aimed at removing endometrial growths without affecting the reproductive organs. When fertility preservation is the top priority, then this method is considered
  • Danazol: A steroid that helps suppress the growth of endometrial tissue through inhibition of pituitary hormones and reduction of estrogen levels
  • Hormonal Therapies: Options include oral contraceptives, progestins, and GnRH agonists. They help control the growth of the endometrial tissue
  • Pain Relief Medications: NSAIDs are the first-line treatments to reduce pain and inflammation associated with endometriosis.

Examining surgical and non-surgical treatment options for Adenomyosis and Endometriosis

Each treatment option comes with its own set of considerations, pros, and cons. Medications, on the one hand, can manage symptoms effectively for many. Yet for some, they are unable to cure the conditions and might require long-term treatment plans.

Surgical options are more invasive and provide long-term relief. They are particularly of great use in cases where medication is not effective or when fertility is affected.
Both adenomyosis and endometriosis are managed via an array of surgical and non-surgical methods. Each has its benefits suitable for various cases. Let us now take a look at them.

Non-Surgical Approaches Surgical Approaches
Medications: Both conditions can be initially managed with hormonal treatments and pain relievers. Laparoscopic Surgery: Laparoscopy can be used for both adenomyosis and endometriosis. It can help remove lesions and scar tissue, which helps relieve pain and improve fertility. It involves small incisions and is the least invasive. It thus provides quick recovery.
Physical Therapy: This is recommended to help relieve pelvic pain associated with such conditions. Methods include pelvic floor exercises and manual therapy. Hysterectomy: This method is a definitive treatment for adenomyosis. It removes the uterus. The technique is considered only when other treatments have failed and affected women do not wish to preserve fertility.
Diet and Lifestyle Changes: Adjusting the diet to help reduce inflammatory foods. Also, managing stress via meditation and yoga can help mitigate the symptoms. Uterine Artery Embolization (UAE): This method is suited for adenomyosis. The procedure helps reduce the flow of blood to the uterus. It hence minimizes the size of the adenomyotic tissue.

Over to You

Adenomyosis and Endometriosis are two different conditions that harm a woman’s uterus. Anyone experiencing symptoms similar to those of either condition should consult a medical professional immediately. Treatment for both conditions varies. The correct one is recommended after a thorough assessment by a qualified physician.

adenomyosis causes
15Jan

Uterine adenomyosis is a medical condition that often goes undiagnosed due to its overlap of symptoms and similarities to other reproductive health issues. Lack of MRI facilities is one of the factors in under diagnosis of this crippling disease. This condition occurs when the tissue lining the uterus, called the endometrium, grows into the muscular walls of the uterus. While adenomyosis is not life-threatening, it can cause significant pain and discomfort with major impact on person’s quality of life.

Adenomyosis Causes:

The exact cause of adenomyosis of the uterus remains unclear. There are several theories about the etiology of this condition. The most commonly accepted one says that when the boundary between endometrium (the innermost layer of uterus) and myometrium (the middle layer of uterus) is disrupted a series of inappropriate cell proliferation happens. The endometrial cells start growing into the myometrium resulting in adenomyosis. Here are some risk factors for uterine adenomyosis that may disrupt the boundary between two layers.

Hormonal Influences:

Changes in hormonal levels, particularly an excess of estrogen relative to progesterone, are believed to play a role in the development of this disease. Estrogen promotes the growth of the endometrial tissue.

Inflammation:

Inflammation within the uterus may lead to the development of adenomyosis. This inflammation can cause a breakdown in the normal boundaries between the layers of the uterine wall.

Childbirth:

Women who have undergone multiple pregnancies and childbirths may have an increased risk of developing this condition. The stretching and contractions of the uterus during childbirth could contribute to the displacement of endometrial tissue.

Invasive Procedures:

Uterine surgeries, such as cesarean sections or fibroid removal, may increase the risk of adenomyosis. These procedures can disrupt the normal structure of the uterine walls.

Symptoms of Adenomyosis:

Adenomyosis often presents with symptoms that overlap with those of other reproductive health issues, making it challenging to diagnose. Common symptoms include:

Menstrual Pain:

Increased and prolonged menstrual cramps, often beginning before the period and lasting throughout its duration, are hallmark symptoms of adenomyosis.

Heavy Menstrual Bleeding:

Women with adenomyosis may experience heavier than usual menstrual bleeding, leading to anemia in some cases.

Pelvic Pain and Discomfort:

Persistent pelvic pain or a feeling of fullness in the lower abdomen may occur, especially during menstruation.

Painful Intercourse:

Adenomyosis can contribute to pain or discomfort during sexual intercourse.

Menstrual Irregularities:

Changes in menstrual patterns, such as irregular periods or spotting between periods, may be indicative of adenomyosis.

Diagnosis and Treatment:

Diagnosing adenomyosis can be challenging due to its nonspecific symptoms. However, healthcare providers may use a combination of medical history, physical examinations, imaging studies such as ultrasound (both abdominal and transvaginal) or MRI, and, in some cases, exploratory surgery to confirm the diagnosis.

The difference between a normal uterus vs adenomyosis ultrasound is the uterus appears globally enlarged and bulky. The walls are thicker and more heterogeneous in contrast to normal homogenous appearance. if the lesion is focal, there may be localized thickening. Sometimes the advanced disease can distort the shape of the uterus.

How is uterine adenomyosis treated?

Treatment options vary based on the severity of symptoms and the individual’s reproductive goals. Common approaches include:

Pain Management:

Over-the-counter pain relievers or prescription medications may help manage pain associated with adenomyosis.

Hormonal Therapy:

Hormonal treatments, such as birth control pills or intrauterine devices containing hormones, may help regulate menstrual cycles and alleviate symptoms.

Surgery:

Sometimes when the medical treatment fails and the family is completed doctors may recommend surgery. This surgery requires removal of the uterus.

Dr Imtiaz Ahmed believes that the uterus is as necessary as any other organ of the body and should never be removed like an appendix, regardless of the family status. He introduced a minimally invasive nonsurgical procedure for treating adenomyosis in Pakistan. This procedure is called 3-D Precison Guided Uterine Artery Embolization (UAE).

UAE as the name indicates is an embolization of the vessel. The basic principle of this procedure is to cut off the blood supply to the lesion by embolizing. Once the disease is no longer receiving the blood, it dies. The procedure starts with a thorough evaluation of the lesion. Firstly, the patient is comforted by giving some sort of conscious sedation. Then a catheter is inserted through a small skin hole, usually in the groin, no skin incisions are given, small catheter is guided through the blood vessels to the uterine arteries. The embolizing material is then injected through the catheter into the uterine arteries. It blocks the blood flow to the areas affected by adenomyosis.

The progress of the procedure is monitored using 3-D imaging techniques including digital fluoroscopy, to ensure accurate delivery of embolic particles. After the embolization is completed, the catheter is removed, and hemostasis is achieved by applying gentle manual pressure or by applying a closure device. Patients are typically monitored overnight or for a few hours before being allowed to go home.

This procedure has several benefits when compared with the conventional hysterectomy. The symptoms alleviate quickly, no additional pain and trauma of the major surgery, conservation of the uterus and quick recovery time are some of the advantages of the UAE.

For more information about the non-invasive treatment of adenomyosis email us at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.

how to get pregnant with adenomyosis naturally
9Jan

Fertility struggles can be a challenging and emotional journey for many couples. Adenomyosis, a condition where the tissue lining the uterus starts to grow into the muscular wall, can further complicate the path to conception.

Does adenomyosis affect fertility?

Adenomyosis initiates when the natural boundary between the internal and middle layers of the uterus is disrupted, leading to the growth of endometrial tissue within the uterine walls. Individuals with this condition often encounter symptoms such as heavy periods, pain, and lower abdominal fullness. These symptoms can disrupt the normal conception process, making the implantation of the zygote challenging and compromising adequate uterine support for the developing fetus. Consequently, this heightened difficulty increases the risk of miscarriage and premature birth.

Infertility in adenomyosis

Adenomyosis presents certain symptoms that serve as potential indicators of infertility. The foremost and most important of these is experiencing a painful period. Pain serves as a sign of inflammation, and where inflammation occurs, scar tissue formation follows. The inflamed uterus poses a challenge for the easy implantation of a fertilized egg.

Another notable symptom of adenomyosis is heavy bleeding, often indicative of hormonal imbalance that significantly impacts physiological processes crucial for pregnancy. Additionally, the globally enlarged uterus, a consequence of the presence of endometrial tissue within the uterine wall, adversely affects normal implantation.

Risk Factors for Adenomyosis-Related Fertility Issues

Several factors increase the likelihood of adenomyosis affecting fertility. These are:

  • having a history of pelvic infections
  • endometriosis
  •  previous uterine surgery raises the risk
  •  multiple miscarriages
  • age 35 years or more

Certain lifestyle factors can contribute too. Smoking and having a high body mass index (BMI) may make it harder for women with adenomyosis to get pregnant or sustain a pregnancy.

It’s essential to understand that not all women with adenomyosis will experience fertility problems. For those who do, there are various treatment options, including medication, surgery, and assisted reproductive technologies like in vitro fertilization (IVF).

How to get pregnant with adenomyosis naturally?

Lifestyle Modifications:

Adenomyosis diet: Adopting a nutrient-rich, balanced diet is crucial for overall health and fertility. Include a variety of fruits, vegetables, whole grains, and lean proteins in your daily meals. Antioxidant-rich foods such as berries, leafy greens, and nuts can help combat oxidative stress associated with adenomyosis.

Eating lots of fresh vegetables: Add more veggies in the diet, especially cruciferous ones like cauliflowers, radish, and turnips. These are rich in antioxidants, which fight inflammation caused by adenomyosis.

Don’t skip fruits: Despite concerns about sugar, fruits provide essential vitamins, minerals, fiber, and antioxidants. Berries, in particular, are excellent for their antioxidant properties. Include two servings of fruit daily for a healthy diet.

Include grains and carbs: Contrary to some advice, don’t cut out grains and carbs completely. They are essential for energy and meeting fiber needs. Opt for whole grains like brown rice, wholemeal pasta, and quinoa.

Incorporate healthy fat: Healthy fats, such as omega-3 fatty acids and vitamin E, can help manage pain. Include foods like avocados, nuts, seeds, oily fish, and extra virgin olive oil in your diet.

Cut down on saturated fats and excess sugars: Research suggests that foods high in saturated fats can trigger inflammation. Minimize foods like butter, coconut oil products, ghee, fried items, and sugary treats to manage inflammatory responses associated with adenomyosis.

Maintain a Healthy Weight:

Maintaining a healthy weight is essential for fertility. Both underweight and overweight conditions can negatively impact reproductive function. Achieving a healthy BMI through regular exercise and a balanced diet can improve hormonal balance and enhance fertility.

Regular Exercise:

Engaging in regular physical activity is beneficial for fertility and overall well-being. Exercise helps regulate hormones, improve blood flow to the reproductive organs, and reduce stress. Opt for activities you enjoy, such as walking, swimming, or yoga, and aim for at least 30 minutes of moderate exercise most days of the week.

Adenomyosis treatment for fertility

The treatment approach for adenomyosis-related fertility problems may involve a combination of medical and surgical interventions. It’s important to consult with a healthcare professional for personalized advice based on an individual’s specific situation. Here are some general treatment options:

Pain Management:

Over-the-counter pain relievers such as ibuprofen or naproxen may help manage pain associated with adenomyosis. Prescription medications, such as hormonal therapies, may be recommended by doctors to control pain and reduce inflammation.

Hormonal Therapies:

Hormonal treatments like birth control pills, hormonal IUDs (intrauterine devices), or progestin therapy may help regulate menstrual bleeding and reduce symptoms. Gonadotropin-releasing hormone (GnRH) agonists may be prescribed to induce a temporary menopause-like state, suppressing estrogen production and reducing adenomyosis symptoms.

Fertility Treatments:

If adenomyosis is affecting fertility, fertility treatments such as in vitro fertilization (IVF) may be considered. IVF involves retrieving eggs, fertilizing them outside the body, and then transferring the embryos into the uterus.

Surgery:

In some cases, surgery may be recommended to remove adenomyosis-affected tissue. This can be done through a procedure called adenomyomectomy. In severe cases or when fertility is not a concern, a hysterectomy (removal of the uterus) may be considered.

3-D Precision Guided Uterine Artery Embolization (UAE):

3-D Precision Guided UAE is a minimally invasive procedure where tiny particles are injected into the blood vessels supplying the uterus, cutting off the blood flow to the adenomyosis-affected tissue.

Dr. Imtiaz Ahmad, an expert endovascular surgeon and interventional radiologist, is the pioneer of this procedure in Pakistan. With extensive experience in treating fertility issues in both males and females, he has played a crucial role in helping numerous couples realize their dream of starting a family. Dr. Ahmad is committed to the principle of utilizing minimally invasive technology in his practice, emphasizing a patient-centric approach to provide effective and compassionate care.

For further assistance email us at at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.

Non surgical Adenomyosis Treatment
30Sep

If you or anyone you know struggles with painful periods and have been diagnosed with adenomyosis, Dr Imtiaz Ahmad performs non-surgical adenomyosis treatment which can solve your miseries.

Adenomyosis: The Biology Behind it

In order to fully understand adenomyosis, it is important to first break down the word itself. Adeno meaning glands, while myosis can be further divided into myo for muscle and osis referring to condition. A more specific term for adenomyosis is also adenomyometritis, but it is not as commonly used. The uterus, which is part of the reproductive system in the females, is normally made of three layers of tissue; endometrium(inner), myometrium (middle muscular layer) and Perimetrium (outer epithelial layer). Each layer serves an important function in maintaining the integrity of the reproductive system. Altogether, adenomyosis is a condition wherein the tissue of the endometrium comprised of luminal and glandular cells rapidly divide (hyperplasia) and extend or invaginate into the myometrial layer.

A key point to remember while discussing adenomyosis is to not confuse it with endometriosis. The two conditions may co-exist amongst others and present similar symptoms, but they are different to one another in terms of their pathophysiology. While endometriosis is the growth of endometrial tissue in places near to but outside of uterus and adenomyosis exists only within the uterine muscular layer. Adenomyosis treatment may be necessary in cases where symptoms start interfering with day-to-day matters. This majorly includes severe pain between periods.

When to see a doctor?

Every 1 in 31 women who have adenomyosis remain largely asymptomatic, and therefore undiagnosed. Those who do experience discomfort are also often misdiagnosed due to non-specificity of symptoms, especially in the case of a co-existing problem like uterine fibroids. Nevertheless, adenomyosis may present itself in the form of painful menstruation (dysmenorrhea) accompanied with prolonged bleeding (menorrhagia) and discomfort during sexual intercourse, too. This is commonly known as dyspareunia. On the imaging, the specialist might be able to see an enlarged uterus, but it will be felt by the patient as pressure around the lower abdominal region.

How will you be Diagnosed?

Diagnosis of Adenomyosis usually follows a trans vaginal ultrasound imagining which may be able to reveal the unusually thick lining of the myometrium. Sometimes, it is difficult to distinguish between adenomyosis and fibroids. In that case, an MRI reveals the incidence of adenomyosis. Most of the time,adenomyosis is confirmed after hysterectomy has been performed. This may be when the specialists are not sure of the condition, but the symptoms are too painful or when they suspect that the tissue may also comprise cancerous cells in which case it would be adenocarcinoma.

Adenomyosis Treatment

Women with severe adenomyosis symptoms are usually looking for a period pain treatment. The definitive treatment of adenomyosis is through hysterectomy, which is the complete removal of the uterus. This may be okay for some women but a very upsetting news for most. Since adenomyosis occurs under the influence of estrogen, it is usually at the peak reproductive age. The condition often resolves itself after menopause due to the same reason. Hence, women who still want to conceive may be appalled by hysterectomy. Moreover, the surgical process of removing the uterus is invasive and is slowly becoming obsolete.

Advancement in interventional radiology has now made it possible to alleviate period pain with a non-surgical and noninvasive approach. Adenomyosis treatment now follows a systematic approach which offers little to no post operative complications or care and maximum patient compliance is guaranteed.

Endovascular Adenomyosis Treatment

Three-dimensional precision guided endovascular treatment is a non-invasive approach to provide adenomyosis treatment and alleviate period pain without putting the fertility at risk. The rationale behind the treatment is to precisely block the arteries supplying blood to adenomyosis which is essentially just endometrial tissue. The entire procedure comprises not only uterine artery embolization but also, a complete set of steps to increase patient compliance and comfort. These include post embolization syndrome management, superior hypogastric nerve plexus block and intra-arterial pain management. As a prerequisite, complete health analysis is done to assess the medical fitness status of the patient before moving on to the treatment. Once the procedure is completed, you should also expect a thorough follow-up for up to one year. In cases where the goal is to restore fertility, a more thorough follow up should be expected.

The procedure employs live imaging to accurately locate the blood vessels supplying blood to adenomyosis. The imaging also helps assess the number of arteries involved and their sizes. This makes the procedure accurate and reduces complications. The blood supply to these growths is blocked using miniature but programmed and specially engineered permanent devices. To begin, mild conscious sedation is achieved. Following, microcatheters are introduced in the patient’s body through the femoral/radial artery in the leg or wrist. This is achieved without causing any pain as a result of topical cold spray anesthesia followed by local anesthesia. Once the blood vessels are located, the FDA approved medical particles are then administered through the catheter. These embolic agents are small micron-sized particles that are engineered/programmed to block the blood supply to only adenomyosis while sparing the normal uterine wall. Medical particles/drugs used in the endovascular treatment are highly specific and are only issued to Licensed/Registered practitioners in United States of America. In this way, embolization is successfully achieved.

Adenomyosis treatment is now available in Pakistan by Dr Imtiaz Ahmad, who is an interventional radiology specialist and endovascular surgical specialist. He offers his services in two major cities of Pakistan: Karachi and Lahore. If you or your loved one is suffering from severe period pain and other symptoms that point toward adenomyosis, a consultation by Dr Imtiaz Ahmad or his team of highly qualified consultants available daily is the first step to bring an end to your misery.

pelvic congestion syndrome
3Jun

What is Pelvic Congestion Syndrome (Pelvic Congestion Syndrome)?

Pelvic congestion syndrome is a vascular disease that presents itself in the form of chronic pelvic pain lasting for more than three to six months. Since Pelvic Congestion Syndrome is essentially a venous syndrome, it must be the incompetency in the interconnected veins around the pelvic region that cause it. To understand the anatomy underlying Pelvic Congestion syndrome, let’s consider the nervous system in the area around the pelvis. Generally, uterine and internal Iliac veins drain the blood from the uterus and vagina. However, sometimes the fundus of the uterus is drained not into the uterine veins but into the ovarian plexus. The ovarian plexus divides into left and right wherein the former drains into the left renal vein and the right ovarian plexus drains right below the right renal vein. Eventually, these vulvoperineal veins drain into the femoral vein. When the veins in this route are damaged, it may result in inefficient drainage, also known as ‘congestion’, hence giving the syndrome its name.

Increased pressure in the pelvic veins is the primary cause of Pelvic Congestion Syndrome. Consequently, the patient will suffer at the hands of ovarian vein reflux or/and varicose veins. While ovarian reflux happens as a result of faulty valves, varicosities are more commonly seen in multiparous women or in simple words, women who have had more than one full-term pregnancy. The dilatation of veins around the pelvis plays a major role in compromising the venous drainage as it allows pooling of the blood, and increases pressure. Research suggests a 60-fold increase in the capacity of pelvic veins during pregnancy/post-pregnancy to sustain the pregnancy, however this often results in chronic pelvic pain pre and post pregnancy. Moreover, while the woman is pregnant, the veins are compressed by the belly, increasing the pressure and eventually leading to venous incompetency. Now that we have touched on the anatomy of Pelvic Congestion Syndrome, let’s delve into its symptoms, diagnosis and treatment.

Symptoms of Pelvic Congestion Syndrome

It is important to understand that Pelvic Congestion Syndrome can be easily misdiagnosed as there are many reasons for pelvic pain. Only a close eye on the pelvic congestion syndrome symptoms can tell apart Pelvic Congestion Syndrome from other causes of pelvic pain. These include but are not limited to pain in the lower back, thigh and pelvic region which also extends to the postcoital region. The painful sensations may worsen on the onset of menstruation and also during strenuous activity, including standing for a long duration. Once these symptoms are ruled out against other pelvic pathologies, a thorough analysis, diagnosis and treatment will be done by an interventional radiologist or a vascular specialist. To recapitulate, consider consulting your doctor to rule out Pelvic Congestion Syndrome if you have identified all or majority of the following symptoms:

  1. A prominent pressure felt in the pelvic region
  2. The pelvic pain has lasted for over 6 months
  3. Pain extending to lower back; dull but discomforting
  4. Irritable bladder leading to urinary/stress incontinence
  5. Anomaly in bowel movements; Alternating between diarrhea and constipation
  6. Dyspareunia: painful sexual intercourse

How to diagnose Pelvic Congestion Syndrome?

The prerequisite of correct diagnosis for Pelvic Congestion Syndrome is having awareness and working knowledge of the syndrome. Since pelvic pain is a symptom that is cross-cutting in the pathophysiology of several diseases, it is important to first rule out other possibilities. The doctor does not only do confirmatory tests to diagnose Pelvic Congestion Syndrome but also tests that help avoids misdiagnosis. Firstly, a manual examination of the pelvic and abdominal area is performed. This may reveal varicosities in the region and tenderness around the ovaries/uterus area, which will need further attention. Secondly, blood and urine tests may be advised to rule out the possibility of an infection or even pregnancy, which are frequent causes of pelvic pain. A transabdominal ultrasound will also be performed. During this, the patient is lying down in the supine position. However, there is a greater possibility of missing Pelvic Congestion Syndrome in the supine position since there is no distension of the veins and hence no pressure. Therefore, a better approach is to consider examinations in both positions. Furthermore, a transvaginal Doppler Ultrasound gives a comprehensive picture of the venous blood flow in the pelvic region and final confirmation can be drawn from an MRI.

How to Avoid Pelvic Congestion Syndrome – Risk factors

While Pelvic Congestion syndrome can occur in both men and women, the data is strongly bent in the direction of females. Approximately 3 in every 10 women develop Pelvic Congestion Syndrome. In most cases, multiparous women develop congestion in the pelvic after giving birth. The reason for this has already been discussed above. However, even in a non-pregnant state, the pelvic veins are more vulnerable to dilatation. Even more so, female hormones and congenital venous defects are also counted amongst the causes of Pelvic Congestion Syndrome. Finally, obesity is one of the causes of venous insufficiency and pelvic congestion, too. This is why one of the preventive measures for Pelvic Congestion Syndrome includes maintaining healthy weight gain during pregnancy and otherwise.

Pelvic Congestion Syndrome Treatment: Know Your Options

Medical therapy as a part of conservative management can be employed in patients with non-faulty ovarian veins or isolated dilatation in the venous plexus of the pelvic region. Hormone treatment, non-steroidal anti-inflammatory drugs, psychotropic agents combined with psychotherapy all are approaches taken in medical therapy for PCS. Surgical methods to alleviate PCS include vein ligation, hysterectomy and even uterus repositioning. All of these are highly invasive and data suggests a high recurrence rate, too.

Minimally Invasive Endovascular Treatment

With the advancement in medical science, the treatment options for vascular diseases like pelvic congestion syndrome transitioned from being only a few in number and invasive to becoming minimally invasive and alternative approaches. Pelvic Congestion Syndrome treatment through Endovascular embolization is the safest option and has supplanted other surgical routes.. The treatment aims to remedy the underlying cause of Pelvic Congestion Syndrome, which is the venous reflux. The procedure begins with locating and treating the most severely dilated veins or the ones that are distal. This is done via venography in a semi upright position by inserting guiding catheters into the transfemoral or brachial veins with special dyes. This is performed under anesthesia to reach maximum patient compliance. Once the detailed procedure is performed using valsalva maneuver, the Endovascular surgeon detects the varicose veins and vein reflux. The patient is now ready to go under embolization.

Using microcatheter, the distal/dilated veins are chosen for embolization. A well titrated mixture of Cyanoacrylate mixed with lipoidal or a copolymer dissolved in DMSO serves as the embolizing agent while micronized tantalum powder acts as a contrast agent for easy fluoroscopic guidance and visualization. Through this process, reflux veins are blocked up till the distal ovarian vein to include all possible collateral branch points. The embolization procedure requires no coils. Sometimes, complex venous syndrome calls for multiple embolizations. The success of embolization is assessed on the visual analog scale through the pain scores. The patients undergo a strict follow-up after 1 month and then every six months. Eventually yearly follow up for about five years can be expected.

If you reside in Pakistan and suspect that you might have developed Pelvic Congestion Syndrome then it is time to consult Dr. Imtiaz Ahmad, who is a Consultant Endovascular Surgeon and an Interventional Radiologist. He is the pioneer in bringing and conducting embolization in the country since 2017 in the two cities of Pakistan: Karachi and Lahore. So far, he has treated thousands of patients with varying forms of vascular diseases.

Feel free to WhatsApp all your reports to 03302963300 for free assessment by Dr. Imtiaz Ahmad.