Pelvic Congestion Syndrome Treatment (Venous Sclerotherapy and Embolization)

Procedure Description

Once a Pelvic Congestion Syndrome 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 the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, 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 birth control pills decrease a woman’s hormone level causing menstruation to stop may be helpful in controlling her symptoms.

Conditions Treated

Chronic pelvic pain caused by abnormal veins (Pelvic Congestion Syndrome).  It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Recent advancements show the pain may be due to hard-to-detect varicose veins in the pelvis, known as pelvic congestion syndrome.  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, friends, and her general outlook on life.  Because the cause of the pelvic pain is not diagnosed, no therapy is provided even though there is therapy available.

Am I a good candidate?

If you have pelvic pain that worsens throughout the day when standing, you may want to seek a second opinion with an interventional radiologist, who can work with your gynecologist.   Diagnosis is often made with clinical history and through the use of medical imaging such as CT, MRI or Ultrasound.

What should I Expect?

This procedure can be performed in an outpatient setting and typically involves a small incision in the groin or neck.

Recovery Time

Resume normal activity within 1-2 hours following the procedure.

First Steps

Consult with your OB/GYN or Primary Care physician.

Benefits Comparison

There are very few treatment options for chronic pelvic pain resulting from abnormal veins.  Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.  Venous Sclerotherapy and Embolization offers a minimally invasive treatment alternative.

Resources