Pelvic Congestion Syndrome
It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. The
causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian and pelvic
varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the
valves in the veins that help return blood to the heart against gravity become weakened and do not
close properly, which allows blood to flow backwards and pool in the vein. This can cause leg pressure
adjacent to the uterus, ovaries and vulva. Up to 15% of women, between the ages of 20 and 50, have
varicose veins in the pelvis, although not all experience symptoms.
Prevalence
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Women with pelvic congestion syndrome (PCS) are typically less than 45 years old and in their
child bearing years, although PCS can be seen in patients ranging from 18-80 years of age.
Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is
unusual in women who have not been pregnant.
Chronic pelvic pain accounts for 15% of outpatient’s gynecologic visits.
Studies show 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as
a sole cause of their pain and an additional 15% have PCS along with another pelvic pathology.
Risk Factors
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Two or more pregnancies and hormonal increases
Fullness of leg veins
Polycystic ovaries
Hormonal dysfunction
Symptoms
The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in
the lower abdomen and lower back. The pain often increases during the following times:
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Following intercourse
Menstrual periods
When tired or when standing (worse at end of day)
Pregnancy
Other symptoms include:
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Irritable bladder
Abnormal menstrual bleeding
Vaginal discharge
Varicose veins on vulva, buttocks or thigh.
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Diagnosis and Assessment
An interventional radiologist, a doctor specialty trained in performing minimally invasive treatments
using imaging for guidance, will use one or more of the following imaging techniques to confirm
pelvic varicose veins that could be causing chronic pain.
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MRI: A specialized non-invasive MRI exam. The best non-invasive way of diagnosing pelvic
congestion syndrome. The exam needs to be done in a way that is specifically adapted for
looking at the pelvic blood vessels. A standard MRI may not show the abnormality.
Pelvic venography: Thought to be the most accurate method for diagnosis, a venogram is
performed by injecting contrast dye in the veins of the pelvic organs to make them visible
during an X-ray. Pelvic Venography is usually done in conjunction with treatment
(embolization).
Treatment Options
Historically, treatment options included either conservative therapy or surgery. Conservative therapy
includes analgesics and hormones. Surgery options would be a hysterectomy and removal of ovaries,
and tying off or removing the veins.
Advances in technology have provided for treatment measures that are less invasive and less expensive
than surgery. Pelvic embolization has become an option preferred by many patients. Embolization is a
minimally invasive procedure performed by interventional radiologists using imaging for guidance. The
procedure is performed in an outpatient setting while patient is under conscious sedation. The
interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the internal
jugular vein in the neck, and guides it to the affected vein using X-ray guidance. To close the enlarged
pelvic vein and relieve painful pressure, tiny coils are inserted. Once in place, coils are unable to be
removed. Sometimes, a sclerosant liquid is placed within the pelvic vessels to help close affected veins.
Recovery from embolization
Following embolization, patients can return to normal activities immediately. Patients may experience
mild abdominal cramping or tenderness. Pain medication and anti-inflammatory will be prescribed. A
follow-up appointment will be scheduled a few weeks after the procedure with a interventional
radiologist.
Efficacy of embolization
In addition to being less expensive to surgery and much less invasive, embolization offers a safe and
effective option to provide patient with symptom relief. The goal of the procedure is to stop abnormal
blood flow. Between 75-85 percent of women experience significant or complete improvement
following the procedure. In a small percentage of patients, additional venogram treatments may be
necessary, months or years after initial venogram and embolization procedure.
3307 Grand Avenue Suite 201
Billings,MT 59102
O:406.969.5194