Ovarian Vein Embolization
(Conditions treated: Chronic pelvic pain; Pelvic congestion.)
What is Pelvic Congestion Syndrome?
Pelvic congestion syndrome is a cause of chronic pelvic pain in women. It is typically described as worse after prolonged periods of standing or straining. The pain may radiate down the back or thighs and may worsen with menstruation or during sex. Lying down may provide some relief. It is more common in women who have had multiple children and is often seen in conjunction with varicose veins on the legs or vulva.
What are the typical symptoms of Pelvic Congestion Syndrome?
This condition may present with a variety of symptoms. Most patients, however will note chronic pain lasting at least 6 months. The pain is usually described as a dull ache and is centred in the pelvis.
Symptoms are often worsening with prolonged standing, sex or in association with menstruation or pregnancy.
Many patients will notice an associated feeling of fullness in the legs. Discomfort with urination may also be present and is felt to reflect distension of bladder veins. Lower back ache, bloating, nausea and abdominal cramping has also been reported.
What causes Pelvic Congestion Syndrome?
The pain is caused by distension or stretching of the ovarian veins. This is caused by a malfunction of the valves of the ovarian veins. The mechanism of pain is similar to that which causes discomfort in people with varicose veins.
How can this be treated?
The treatment we offer is ovarian vein embolization which closes the offending veins from the inside.
How is the embolization performed?
The procedure is performed under light sedation. A small plastic sheath is placed in a vein in your groin or neck. Ultrasound and x-ray (angiography) equipment is used to direct a plastic catheter to the offending veins which are then closed off from the inside using specialized equipment, which generally involves use of coils and sclerosing drugs.
What are my other options?
Surgery including hysterectomy or ovarian vein ligation may be performed. Drugs may be used to reduce symptoms, however they do not necessarily have a durable effect.
What happens after the procedure?
You may be discharged two hours after the procedure. You cannot drive for 24 hours after the procedure as you have been sedated. Some women may experience some pain afterwards which is generally well managed with medications and should resolve.
How is Pelvic Congestion Syndrome Diagnosed?
This condition has similar features to other conditions including endometriosis, chronic infections and even cancer. These need to be investigated before Pelvic Congestion Syndrome is considered as a diagnosis and we feel that all women should be investigated by a gynaecologist to evaluate their pelvic pain. There are no definitive tests to objectively make the diagnosis of Pelvic Congestion Syndrome. The enlarged veins may be seen on ultrasound or MRI. Enlarged veins, however may also be present in reaction to other conditions and the diagnosis is made in conjunction with clinical symptoms and the exclusion of other causes outlined above.
What are the risks?
This is a low risk procedure. Risks include:
Infection or severe allergy to contrast agent is extremely rare
Bruising at site of access
Back pain or vein inflammation which is generally self-limiting
Small chance of embolization material misplacement
