Prior to carrying out invasive measures, symptomatic treatment to differentiate gastrointestinal, genitourinary, or myofascial etiology of CPP should be performed. Different techniques are now available to diagnose pelvic congestion, but none are as accurate as the transuterine venogram which is not widely available. On transvaginal ultrasound or MRI there may be uterine enlargement, thickened endometrium, cystic ovaries, and dilated pelvic veins. Laparoscopy can reveal varicosities62 but false negative findings may occur.

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