Altered peripheral vascular response of women with and without pelvic paindue to congestion

Objective To test the hypothesis that women with pelvic venous congestion h ave a reduction of reactivity of their peripheral circulation. Design Comparison was made between 20 women, with chronic pelvic pain due t o congestion and a control group of 15 pain-free women matched for age, par ity and body weight. A comparison of these results was made with those from six postmenopausal women taking hormone replacement therapy. Methods Study and control groups were investigated during the mid-follicula r phase of the menstrual cycle (days 5-9) and the mid-luteal phase (days 19 -23). The study group was also investigated during the fifth month of treat ment with suppression of ovarian activity with leuprorelin or medroxyproges terone acetate or six months after hysterectomy and bilateral salpingo-ooph orectomy. Head-up tilt sufficient to increase intra-vascular pressure in th e toe by a standard 40 mmHg was used as a means of raising venous pressure in the lower limb. Skin capillary red blood cell velocity (flux) was measur ed using a laser Doppler flow probe placed over the pulp of the big toe. He art rate and blood pressure were also recorded. The change in skin blood fl ow following head-up tilt was expressed as a percentage of baseline flow in the supine position. Main outcome measures Percentage change in skin red blood cell flux, heart rate and blood pressure in response to 40 degrees head-up tilt. Results In the control group the median response to head-up ti:lt in the fo llicular phase was one of a reduction in flux, whereas in the luteal phase it was more variable ranging from an increase to a decrease in flux. The re sponses in the pelvic congestion group in both the follicular and luteal ph ases were similar to those of the control group in the luteal phase. A smal l but significant increase in heart rate in response to tilt in the pelvic pain group, compared with the control group, was interpreted as being due t o a fall in venous return. Treatment of the pelvic congestion group by medi cal suppression of ovarian activity or total hysterectomy with bilateral sa lpingo-oophorectomy resulted in a significant change in response to head-up tilt from the variable type of luteal response to one of a more constant r eduction in flux, similar to that of the control group in the follicular ph ase. A reduction in flux was also found consistently in postmenopausal wome n. Conclusion The study confirms the hypothesis that women with pelvic pain du e to congestion show a change in peripheral vascular reactivity which retur ns to normal after suppression of ovarian activity. It seems likely that so me alteration of normal ovarian function is responsible for the observed ch anges in peripheral blood flow in response to a rise in venous pressure in women with pelvic congestion.