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Pelvic Congestion Syndrome

Pelvic congestion syndrome is a condition caused by enlarged veins in the pelvic region causing chronic pelvic pain.

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What is Pelvic Congestion Syndrome?

Pelvic congestion syndrome is an under recognised treatable cause of chronic pelvic pain. It is a vascular disease that develops when the veins in the pelvis are unable to efficiently push blood back towards the heart. This results from venous incompetence which is where the valves within the ovarian veins are not functioning correctly resulting in backflow of blood.  This leads to blood pooling within the veins in the pelvis causing them to swell and bulge similar to varicose veins in the legs. It is sometimes associated with varicose veins in the thigh, buttock regions or vaginal area. 

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What are the symptoms of pelvic congestion syndrome?

The main symptom of pelvic congestion syndrome is pelvic pain. The pain may be an aching or heavy feeling, or it can be sharp. The pain often worsens throughout the day and is aggravated by standing/sitting. The pain may also worsen after intercourse, menstruation or certain physical activities. 

Pelvic pain in women can have many causes. In the first instance, the best person for a patient to talk to is a GP or gynaecologist who can diagnose the cause of the problem. If you are suspected of having pelvic congestion syndrome, an interventional radiologist such as Dr Ryan McConnell can discuss a less invasive treatment known as ovarian vein embolisation.

What are the risk factors?

The exact cause of pelvic congestion syndrome is unknown. However, there are several risk factors associated with the development of pelvic congestion syndrome:

  • Pregnancy
  • Nutcracker syndrome
  • Congenital vascular malformation
  • Genetics
  • Iliac vein compression (May-Thurner syndrome)
  • Hormonal dysfunction

Pelvic pain in women can have many causes. In the first instance, the best person for a patient to talk to is a GP or gynaecologist who can diagnose the cause of the problem. If you are suspected of having pelvic congestion syndrome, an interventional radiologist such as Dr Ryan McConnell can discuss a less invasive treatment known as ovarian vein embolisation.

Diagnosis

Pelvic congestion syndrome is generally diagnosed through the presence of its symptoms. You may be sent for diagnostic imaging to support the diagnosis and exclude other possible causes of your symptoms.

  • Ultrasound – a pelvic ultrasound may be required to identify dilated pelvic veins and to visualise the reflux of the ovarian vein
  • MRI – a MRI will help visualise abnormal veins within the pelvis and look for other abnormalities or conditions present
  • Venography – The gold standard test for pelvic congestion syndrome is venography, which is where dye is injected into the abnormal veins under x-ray guidance, proving venous reflux.
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Treatment Options

There are several treatment options for pelvic congestion syndrome.

  • Medical management – pain relief, hormonal treatments
  • Surgical management – ovarian vein ligation or hysterectomy and bilateral oophorectomy
  • Interventional management – ovarian vein embolisation

Pelvic congestion syndrome is usually due to a problem with the valves that pump blood from the pelvis towards your heart. Whist surgical management of these veins used to be the only treatment option there are now less invasive treatments that block the abnormally dilated veins which removes the pressure in the pelvis and improves pain.

Treatment is only necessary if there are symptoms present. If symptoms are not managed with pain medication, patients may consider ovarian vein embolisation. Dr McConnell is an interventional radiologist and is happy to discuss ovarian vein embolisation to ensure patients are well informed of their treatment options.

Please click here to read more about ovarian vein embolisation.

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