Women's Health Procedures
Chronic Pelvic Pain
is estimated that one-third of all women will experience chronic pelvic
pain in their lifetime. Many of these women are told the problem is
"all in their head" but recent advancements now show the pain may be due
to hard-to-detect varicose veins in the pelvis, known as pelvic
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 don't close properly.
This allows blood to flow backwards and pool in the vein, causing
pressure and bulging veins. In the pelvis, varicose veins can cause pain
and affect the uterus, ovaries and vulva. Up to 15 percent of women,
generally between the ages of 20 and 50, have varicose veins in the
pelvis, although not all experience symptoms.
The diagnosis is often missed because women lie down for a pelvic
exam, relieving pressure from the ovarian veins so that the veins no
longer bulge with blood as they do while a woman is standing.
Many women with pelvic congestion syndrome spend many years trying to
get an answer to why they have this chronic pelvic pain. Living with
chronic pelvic pain is difficult and affects not only the woman
directly, but also her interactions with her family and friends and
her general outlook on life. In these cases, because the cause of the
pelvic pain is not diagnosed, no therapy is provided even though there
is therapy available.
- Women with pelvic congestion syndrome are typically less than 45 years old and in their child bearing years.
- Ovarian veins increase in size related to previous pregnancies.
Pelvic congestion syndrome is unusual in women who have not been
- Chronic pelvic pain accounts for 15% of outpatient 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.
- Two or more pregnancies and hormonal increases
- Fullness of leg veins
- Polycystic ovaries
- Hormonal dysfunction
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:
- Following intercourse
- Menstrual periods
- When tired or when standing (worse at end of day)
Other symptoms include:
- Irritable bladder
- Abnormal menstrual bleeding
- Vaginal discharge
- Varicose veins on vulva, buttocks or thigh.
Black area represents engorged pelvic veins responsible for Pain.
Once a diagnosis is made, if the patient is symptomatic, an
embolization should be done. Embolization is a minimally invasive
procedure performed by interventional radiologists using imaging for
guidance. During this outpatient procedure, the interventional
radiologist inserts a thin catheter into the femoral vein in the groin
and guides it to the affected vein using X-ray guidance. To seal the
faulty, enlarged vein and relieve painful pressure, an interventional
radiologist inserts tiny coils, often with a sclerosing agent (the same
type of material used to treat varicose veins) to close the vein. After treatment, patients can return to normal activities immediately.
Additional treatments are available depending on the severity of the
woman's symptoms. Analgesics may be prescribed to reduce the pain.
Hormones such as birth control pills decrease a woman's hormone level,
causing menstruation to stop, which may be helpful in controlling the
symptoms. Surgical options include a hysterectomy with removal of
ovaries and tying off or removing the veins.
In addition to being less expensive than surgery and much less
invasive, embolization offers a safe, effective treatment option that
restores patients to normal. The procedure is very commonly successful
in blocking the abnormal blood flow. It is successfully performed in
over 95-100 percent of all cases. A large percentage of women have
improvement in their symptoms after the procedure - between 85-95%.
Although women usually enjoy improved health, the veins can never be
restored to their normal, working conditions, and in some
cases, other pelvic veins are also affected which may require further