Smith, Steven J, Smith, B Holly, Sichlau, Michael J et al. · Phlebology · 2025 · DOI
This study looked at 45 women with chronic pelvic pain caused by abnormal blood pooling in pelvic veins. These patients experienced many symptoms beyond pelvic pain—including brain fog, fatigue, migraines, constipation, and anxiety. After receiving a catheter-based procedure to fix the blood pooling, most of these systemic symptoms improved significantly (by 50% or more).
Many ME/CFS patients report overlapping symptoms with POTS, fibromyalgia, and pelvic dysfunction. This study suggests that pelvic venous pathology may be one treatable underlying cause for a subset of patients experiencing this symptom cluster, potentially offering a new diagnostic pathway and treatment option for individuals with these comorbid conditions.
This study does not prove that pelvic venous abnormality is the primary cause of ME/CFS in all or most patients; it was a small retrospective cohort without a control group. It cannot establish causality or determine whether symptom improvement was due to the vein procedure itself or other factors (placebo effect, regression to the mean, concurrent treatments). The findings may not generalize beyond this specific patient population.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Smith, Steven J, Smith, B Holly, Sichlau, Michael J, Chen, Brenda, Knight, Dacre, & Rowe, Peter C (2025). Nonpelvic comorbid symptoms of 45 patients with pain of pelvic venous origin, before and after treatment.. Phlebology. https://doi.org/10.1177/02683555241273109
BibTeX
@article{mecfsatlas-smith-2025-nonpelvic-comorbid,
author = {Smith, Steven J and Smith, B Holly and Sichlau, Michael J and Chen, Brenda and Knight, Dacre and Rowe, Peter C},
title = {Nonpelvic comorbid symptoms of 45 patients with pain of pelvic venous origin, before and after treatment.},
journal = {Phlebology},
year = {2025},
doi = {10.1177/02683555241273109},
note = {PubMed: 39126670},
url = {https://www.mecfsatlas.com/evidence/smith-2025-nonpelvic-comorbid},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/smith-2025-nonpelvic-comorbid
Contribute
Private, reviewed by a human. Not a public comment thread.