Pelvic congestion syndrome (PCS) is a common and treatable cause of chronic pelvic pain in women. Chronic pelvic pain affects up to one third of all women. PCS is most common in multiparous women of reproductive age. PCS is caused by the abnormal reversal of blood flow in pelvic veins that normally return blood from the uterus and ovaries. This results in dilated pelvic veins with increased pressures, potentially causing inflammation and activating pain receptors.
What are the symptoms of PCS?
- Dull, aching non-cyclic pelvic pain lasting greater than 6 months, worse with standing or activity
- Pain with sexual intercourse
- Urinary frequency or urgency
- Abnormal menstrual bleeding
- Varicose veins around the genitals/buttocks/thigh
- Multiple pregnancies
- Prolonged standing
- Clinical symptoms and exclusion of other common causes of chronic pelvic pain such as pelvic inflammatory disease, endometriosis, fibroids, ovarian cysts, adenomyosis, etc.
- Ovarian point or cervical motion tenderness on physical exam
- Imaging with ultrasound can be helpful in aiding diagnosis
- Analgesic and hormonal therapy can occasionally provide relief. However, this is usually effective for a short period of time
- Ovarian vein embolization is a minimally invasive, non-surgical treatment performed by an interventional radiologist to treat the abnormal pelvic veins
Ovarian Vein Embolization
During the procedure, a small catheter is advanced from a vein in the neck or leg to the abnormal pelvic veins under x-ray guidance. Under imaging guidance, the abnormal veins are occluded with small coil plugs. This prevents the blood in the veins from refluxing into the pelvis in the wrong direction.
Advantages of Ovarian Vein Embolization
- Minimally invasive procedure performed as an outpatient under IV sedation
- Extremely high technical success rate with very low risk profile
- Most patients return to their normal activities immediately
- Symptom relief has been reported in over 80% of women who have chronic pelvic pain due to pelvic congestion syndrome