E2 ModeratePreliminaryPEM not requiredObservationalPeer-reviewedReviewed
Nonpelvic comorbid symptoms of 45 patients with pain of pelvic venous origin, before and after treatment.
Smith, Steven J, Smith, B Holly, Sichlau, Michael J et al. · Phlebology · 2025 · DOI
Quick Summary
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).
Why It Matters
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.
Observed Findings
- Brain fog present in 76% of patients; improved 49–63% after treatment
- Constipation and abdominal bloating present in 76–82% of patients; improved 47–63% after treatment
- ME/CFS-like and fibromyalgia-like symptom clusters present in 64–82% of patients; all improved 49–63% after treatment
- Migraine prevalence was 69%; improved significantly post-treatment
- POTS-associated symptoms ranged from 29–76% prevalence; showed 23–59% improvement after treatment
Inferred Conclusions
- Pelvic venous pooling may contribute to a systemic symptom spectrum that overlaps with recognized syndromes (POTS, fibromyalgia, ME/CFS).
- Catheter-based correction of pelvic venous abnormality can reduce severity of multiple non-pelvic symptoms beyond the primary pelvic pain complaint.
- The symptom burden in venous-origin CPP extends far beyond the pelvis and should prompt investigation for systemic manifestations.
Remaining Questions
- Does this finding apply to ME/CFS patients without diagnosed pelvic venous disease, or is it limited to a specific subgroup?
- What is the long-term durability of symptom improvement after vein stenting, and are repeat procedures needed?
What This Study Does Not Prove
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.
Tags
Symptom:Cognitive DysfunctionOrthostatic IntolerancePainFatigueTemperature Dysregulation
Method Flag:No ControlsSmall SampleExploratory OnlyMixed CohortWeak Case Definition
Metadata
- DOI
- 10.1177/02683555241273109
- PMID
- 39126670
- 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 →
Contribute
Private, reviewed by a human. Not a public comment thread.