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Objective: To investigate the effectiveness of transvenous occlusion of incompetent pelvic veins in women presenting with chronic pelvic pain (CPP) in improving symptoms and quality of life. Design: Patient‐blinded randomised controlled trial with objective outcome measures. Results were analysed on an intention‐to‐treat basis. Setting: Gynaecology and Vascular Surgery Services of two teaching hospitals in northwest England. Population: Sixty women aged 18–54 years presenting with CPP after exclusion of other pathology, and who were found to have pelvic vein incompetence. Methods: Participants were randomised and assigned to contrast venography alone or contrast venography plus transvenous occlusion of the incompetent pelvic veins. Main outcome measure: The primary outcome was change in pain score measured using the short‐form McGill Pain Score (SF‐MPQ) and the Visual Analogue Score (VAS) recorded at 12 months post‐randomisation. Secondary outcomes included quality of life using the EQ‐5D instrument, symptomatic improvement and procedure‐related complications. Results: Sixty participants were randomised to transvenous occlusion of incompetent pelvic veins or venography only. At 12 months, median pain scored 2 (3–10) in the intervention group versus 9 (5–22) in controls (p = 0.016). Pain on the VAS scored 15 (0–3) versus 53 (20–71), respectively (p = 0.002). Median EQ‐5D improved after intervention from 0.79 (0.74–0.84) to 0.84 (0.79–1.00; p = 0.008) over 12 months. No major complications were reported. Conclusion: Transvenous occlusion of pelvic vein incompetence reduced pain scores, improved quality of life and diminished symptom burden with no major reported complications. Trial registration: ISRCTN 15091500. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between chronic pelvic pain (CPP) and pelvic vein incompetence (PVI) or pelvic varices. Design: Case–control study. Setting: Gynaecology and vascular surgery services in two teaching hospitals in north‐west England. Sample: A total of 328 premenopausal women (aged 18–54 years), comprising 164 women with CPP and 164 matched controls with no history of CPP. Methods: Symptom and quality‐of‐life questionnaires and transvaginal duplex ultrasound for PVI and pelvic varices. Main outcome measures: Venous reflux of >0.7 s in the ovarian or internal iliac veins (primary outcome) and presence of pelvic varices (secondary outcome). Statistical analysis compared the prevalence of PVI between women with and without CPP using the two‐sided chi‐square test. Logistic regression was used to compare the odds of having PVI and pelvic varices between women with and without CPP. Results: Pelvic vein incompetence was found on transvaginal duplex ultrasound in 101/162 (62%) women with CPP, compared with 30/164 (19%) asymptomatic controls (OR 6.79, 95% CI 4.11–11.47, p < 0.001). Forty‐three of 164 (27%) women with CPP had pelvic varices compared with three of 164 (2%) asymptomatic women (OR 18.9, 95% CI 5.73–62.7, p < 0.001). Conclusions: There was a significant association between PVI, as detected by transvaginal duplex imaging, and CPP. Pelvic varices were strongly associated with CPP and were infrequently seen in control patients. These results justify further evaluation of PVI and its treatment in well‐designed research. [ABSTRACT FROM AUTHOR]

Key content: Lynch syndrome is an autosomal dominant condition closely associated with colorectal, endometrial and ovarian cancer.Women with Lynch syndrome are at increased risk of both endometrial and ovarian cancer and should be offered personalised counselling regarding family planning, red flag symptoms and risk‐reducing strategies.Surveillance for gynaecological cancer in women with Lynch syndrome remains controversial; more robust data are needed to determine its effectiveness.Universal testing for Lynch syndrome in endometrial cancer is being adopted by centres across Europe and is now recommended by the National Institute for Health and Care Excellence; thus, gynaecologists must become familiar with testing strategies and their results.Testing strategies involve risk stratification of cancers based on phenotypical features and definitive germline testing. Learning objectives: To define the pathogenesis of Lynch syndrome and its associated gynaecological cancers.To understand the testing strategies for Lynch syndrome in women with gynaecological cancer.To learn how best to counsel women with Lynch syndrome regarding gynaecological cancer and risk‐reducing strategies to enable informed decision‐making. Ethical issues: Offering gynaecological surveillance despite a lack of robust evidence for its clinical effectiveness may falsely reassure women and delay risk‐reducing hysterectomy.Genetic testing may yield variants of unknown significance with ill‐defined clinical implications, which can lead to confusion and anxiety.Genetic testing has implications not only for the individual, but also for the whole family, so expert counselling is crucial. [ABSTRACT FROM AUTHOR]