Interventional Radiology

Pelvic Congestion

Women's Health

Chronic pelvic pain is a very common problem in the United States, and accounts for 10-15% of referrals to gynecologists and pain clinics. Dozens of conditions can result in chronic pelvic pain. In many cases, the root cause is never discovered, despite numerous tests and operations. For some women, however, pelvic pain is caused by a condition known as pelvic congestion sydrome (PCS), which may go undiagnosed simply because physicians often fail to look for it.

PCS occurs when varicose veins develop around the ovaries, similar to varicose veins that occur in the legs. The valves in the veins no longer function normally, blood backs up, and the veins become engorged or "congested", which can be very painful. In men, a similar condition can causes varicose veins to form on the scrotum, which is known as a varicocele. In women, however, these varicose veins are internal. Rarely do veins appear on the vulva, thighs, or buttocks, which is why PCS is often missed.

The painful symptoms typically worsen as the day goes on, especially for women who sit or stand all day, and then go away after a night of sleep. The pain can also be worse during or following intercourse, around menstrual periods, and after certain physical activities, such as bicycling or horseback riding. Symptoms frequently don't appear until a woman becomes pregnant and then they fail to resolve afterward.

Although pelvic varicose veins can cause pain and are the hallmark of PCS, many normal women will have enlarged pelvic veins discovered on an ultrasound, CT, or MRI scan, especially if they have had children. Fortunately, not everyone gets symptoms and only those women who have pain are given the diagnosis of PCS.

Routine gynecologic pelvic exams are usually normal. Laparoscopy, hysteroscopy, and other tests and surgical investigations may also not show any dilated or engorged veins. If you have the typical pattern of pelvic pain of PCS, please discuss the possibility of this diagnosis with your gynecologist, who can then guide the choice of appropriate testing.

Treatment Options for Pelvic Congestion Syndrome

There are several treatment options for PCS. Hormonal medications, prescribed by your gynecologist, can reduce blood flow and congestion of the varicose veins. If these are ineffective, then minimally invasive therapies may be considered.

The treatment option we offer in Interventional Radiology is nonsurgical embolization (intentional plugging) of the varicose veins. This is an outpatient procedure, in which an Interventional Radiologist inserts a small catheter (plastic tube) into a central vein in the upper arm, shoulder, or thigh and guides it to the problem area using X-ray guidance. No incisions or stitches are required and there is no sensation inside while this is happening. Intravenous medications are all that is required for comfort and relaxation.

The varicose veins are permanently sealed off from the inside. Patients typically return to work and light activities the following day, and to full activities in a week.

If you believe you have PCS and are interested in learning whether you are a candidate for embolization, you may either ask your gynecologist for a referral to our office using our provider referral form, or you may contact us directly using this form and we will contact your gynecologist to obtain your medical information and imaging prior to consultation with us.

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