E2 ModeratePreliminaryPEM not requiredCross-SectionalPeer-reviewedReviewed
An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes.
Smith, Steven J, Sichlau, Michael, Sewall, Luke E et al. · Phlebology · 2022 · DOI
Quick Summary
This study surveyed women with pelvic congestion syndrome (a vascular condition affecting pelvic blood vessels) to see how often they also experience other medical conditions like chronic fatigue, fibromyalgia, and irritable bowel syndrome. Researchers found that these co-occurring conditions were much more common in this group than in the general population, suggesting that these conditions may be connected in ways we don't yet understand.
Why It Matters
This study identifies a potential cluster of overlapping conditions—including ME/CFS—that occur together more often than chance would suggest in people with pelvic congestion syndrome. Understanding these associations may help researchers identify shared biological mechanisms and inform better diagnostic and treatment approaches for patients experiencing multiple overlapping illnesses.
Observed Findings
- Among 232 untreated PCS respondents, 72% reported severe fatigue, 63% reported dizziness, and 61% reported IBS symptoms
- 29% of the overall sample self-reported IBS; 13% fibromyalgia; 10% chronic fatigue syndrome; 9% postural tachycardia syndrome
- 18% reported spinal nerve problems and 6% self-identified with Ehlers-Danlos Syndrome
- Comorbid symptom and syndrome prevalence was substantially higher than reported in the general female population
Inferred Conclusions
- Multiple overlapping somatic symptoms and syndromes cluster together in people with pelvic congestion syndrome at rates exceeding general population prevalence
- Ehlers-Danlos Syndrome appears unexpectedly common among self-identifying PCS women and warrants formal investigation
- Formal investigation is needed to evaluate potential etiologic links between PCS and commonly co-occurring conditions like ME/CFS and fibromyalgia
Remaining Questions
- What is the true prevalence of these comorbidities when diagnoses are clinically confirmed rather than self-reported?
- Do PCS, ME/CFS, fibromyalgia, and related conditions share common biological mechanisms or pathophysiology?
- What is the direction and nature of causality—does one condition predispose to others, or do they stem from a common underlying process?
What This Study Does Not Prove
This study does not prove that pelvic congestion syndrome causes chronic fatigue syndrome or other comorbidities, nor does it establish the direction of causality. The study relies entirely on self-reported diagnoses without independent clinical verification, so actual prevalence rates may differ. The self-selected sample from a support group website may not represent all people with pelvic congestion syndrome, potentially overestimating comorbidity rates.
Tags
Symptom:Cognitive DysfunctionOrthostatic IntolerancePainFatigueSensory SensitivityTemperature Dysregulation
Method Flag:Weak Case DefinitionNo ControlsExploratory OnlyMixed Cohort
Metadata
- DOI
- 10.1177/02683555221112567
- PMID
- 35831253
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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