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What are the symptoms and long-term effects of May Thurner syndrome?

I am taking birth control pills and am worried that I am going to develop May Thurner syndrome. How will I know if I have May Thurner syndrome? What happens if it goes untreated?


Doctors Answers (2)

Birth control pills do not cause May Thurner syndrome. However, if you have May Thurner syndrome, I would consider an alternative to the oral contraceptive pill.

May-Thurner Syndrome is an old term for compression of the left common iliac vein in the pelvis by the overlying right common iliac artery. The original description includes development of fibrosis (much like scar tissue) inside the vein near the point of compression due to turbulence within the compressed vein. The preferred nomenclature now describes the compression with terms such as "left common iliac vein compression." The pelvic veins can be compressed at other points as well by other segments of artery or by overlying structures such as an enlarged uterus or a tumor. Mild to moderate degrees of compression are common and will not cause any symptoms. Some patients whose iliac veins are compressed by 70% or more of the diameter of the vein will develop one or more of a variety of symptoms including leg pain or swelling, pelvic pain, pain with intercourse (dyspareunia), pelvic pain after intercourse (post-coital pain), low back pain, or urinary bladder discomfort. The symptoms are caused by high pressure in the veins due to the obstruction and enlargement of other veins to carry blood flow around the obstruction to get venous blood back to the heart. Placement of a stent into the compressed iliac vein by a needlestick approach in the groin usually yields impressive improvements in the quality of life for those who have severe symptoms from iliac vein compression. A small fraction of patients who have significant arterial compression of the iliac vein will develop a clot in the vein and may clot off most of the veins of one lower extremity as well as some of the pelvic veins. This usually presents with a fairly sudden onset of leg pain, swelling, and a bluish appearance of the leg. About 80% of patients who develop iliofemoral deep vein thrombosis involving the iliac vein and leg veins will be found to have an arterial compression of the iliac vein as an underlying problem. If the patient is diagnosed and treated early enough, much of the clot with the veins can be dissolved with medication injected into the clot (catheter-directed thrombolysis). When an iliac vein narrowing (stenosis) is discovered, this can be treated with placement of a stent in the vein. Some patients who have a compression of an iliac vein are more prone to develop thrombosis if they have other risk factors for clotting such as oral contraceptives, estrogen therapy, long periods of sitting, or certain inherited disorders which increase the risk of abnormal clotting such as Factor V Leiden mutation, Factor II Prothrombin mutation, Protein S or Protein C deficiency, or Anti-Thrombin III deficiency.

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