Pelvic Congestion Syndrome & Uterine Veins: Symptoms, Treatment & Fertility

Question
I am 21 years old.  I have 2 children-a four year old and 20 month old.  I was just diagnosed with "pelvic congestion syndrome".  I have been in a lot of pain for a long time and am relieved to finally get a diagnosis for my pain.  I was just wanting more information on this disorder.  I was wondering treatment options, pain help, and if I would be able to have any more children. I would appreciate any help you could give me. Thank You.  

Answer
In 1954, Taylor suggested that emotional stress could lead to autonomic nervous system dysfunction manifested as smooth muscle spasm and congestion of the veins draining the ovaries and uterus. Transuterine venography in women with chornic pelvic pain often reveals delayed disappearance of contrast medium from the uterine and ovarian veins. Considering that pregnant and postpartum women have asymptomatic pelvic congestion, the role of congested veins in the causation of pelvic pain is uncertain. The specific neurotransmitters involved in mediating sympathetic efferent maintained pain syndrome are unknown. Typical symptoms include lower abdominal and back pain, secondary dysmenorrhea, dyspareunia, abnormal uterine bleeding, chronic fatigue, and irritable bowel syndrome. Pain usually begins with ovulation and lasts until the end of menses. The uterus is often bulky, and the ovaries are enlarged with multiple cysts. The uterus and uterosacral ligaments are tender. Transuterine venography has been the primary method for diagnosis, although pelvic ultrasound, MRI, and laparoscopy may  demonstrate varicosities.  Treatment of suspected pelvic congestation ranges from the less invasive hormonal suppression and cognitive behavioral pain management to the more invasive ovarian vein embolization or hysterectomy. Oral contraceptives,, high dose progestins, and GnRH analogues often provide pain relief.  Hormonal suppression should be the initial mode of treatment for women with suspected pelvic congestion. Provera has been found to be useful. Concurrently, a multidisciplinary approach incorpororating psychotherapy, behavioral pain management, or both is important. Several studies with limited follow-up have reported pain reduction with transcatheter embolization of pelvic veins.