Chronic Pelvic Pain in Women
Have you experienced chronic pelvic pain? You’re not alone.
It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Many of these women are told the problem is “all in their head,” but recent advancements now show the pain may be due to hard to detect varicose veins in the pelvis, known as pelvic congestion syndrome. This pain can be described as a severe dull aching or pain in the abdomen, pelvis, or genitalia. The pain is often worse when standing, sitting, during sexual intercourse or arousal, and at the end of the day. Other symptoms include: generalized fatigue, depression, swollen labia, pain prior to menstruation, abdominal or pelvic tenderness, rectal pain, ovarian cysts, painful periods and an urge to urinate.
At Baltimore Vascular Care, we offer a safe, effective, minimally invasive treatment option for pelvic congestion syndrome, called ovarian vein embolization.
Read more below about pelvic congestion syndrome and one of its treatment options, ovarian vein embolization.
Pelvic Congestion Syndrome (PCS)
Symptoms of PCS
The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:
- Following intercourse
- Menstrual periods
- When tired or when standing (worse at end of day)
Other symptoms include:
- Irritable bladder
- Abnormal menstrual bleeding
- Vaginal discharge
- Varicose veins on vulva, buttocks, or thigh
Causes of PCS
The causes of pelvic congestion syndrome 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 are working 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.
If you are one of the many women living with chronic pelvic pain, you’ve experienced the discomfort it causes on a daily basis. It affects not only you directly, but also can affect your interactions with your family, friends, and your general outlook on life. And if your cause of the pelvic pain is not diagnosed, no therapy is provided—even though there is therapy available.
Prevalence of PCS
- Women with pelvic congestion syndrome are typically less than 45 years old and in their childbearing years.
- Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.
- Chronic pelvic pain accounts for 15 percent of outpatient gynecologic visits.
- Studies show 30 percent of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain, and an additional 15 percent have PCS along with another pelvic pathology.
Risk Factors for PCS
- Two or more pregnancies and hormonal increases
- Fullness of leg veins
- Polycystic ovaries
- Hormonal dysfunction
Diagnosis and Assessment of PCS
Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed through several minimally invasive methods. An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, will use the following imaging techniques to confirm pelvic varicose veins that could be causing chronic pain.
Pelvic venography: A venogram is thought to be the most accurate method for diagnosis and is performed by injecting contrast dye in the veins of the pelvic organs to make them visible during an x-ray. To help accuracy of diagnosis, an interventional radiologist will examine the patient on an incline, because the veins decrease in size when a woman is lying flat.
MRI: An MRI may be the best non-invasive way of diagnosing pelvic congestion syndrome. The exam needs to be done in a way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.
Pelvic ultrasound: A pelvic ultrasound is usually not very helpful in diagnosing pelvic congestion syndrome unless done in a very specific manner with the patient standing while the study is being done. Ultrasound may be used to exclude other problems that might be causing pelvic pain.
Transvaginal ultrasound: This technique is used to better see inside the pelvic cavity. As with a pelvic ultrasound, it is not very good at visualizing the pelvic veins unless the woman is standing. However, it may be used to exclude other problems.
PCS Treatment Options
Ovarian Vein Embolization
If you’ve been diagnosed with pelvic congestion syndrome and are 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 your 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, you can return to normal activities immediately.
Efficacy of Embolization
In addition to being less expensive than surgery and less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores your normal lifestyle. The procedure is very commonly successful in blocking the abnormal blood flow. It is successfully performed in 95 to 100 percent of cases; 85 to 95 percent of women have improvement in their symptoms after the procedure. Although the majority of women are improved, the veins are never normal and in some cases other pelvic veins also become affected, which may require future treatment.
Other Treatment Options
Additional treatments are available depending on the severity of your symptoms. Analgesics may be prescribed to reduce the pain. Hormones, such as birth control pills that decrease a woman’s hormone level causing menstruation to stop, may be helpful in controlling your symptoms. Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.
If you have pelvic pain that worsens throughout the day when standing, or any of the other symptoms mentioned above, there may be a treatment that’s right for you. Our physician will work with your gynecologist to determine the best treatment option for your pain.
Want to meet with a Physician about Ovarian Vein Embolization in the Baltimore area?
Request an appointment today and meet with our board certified physician in our convenient Owings Mills location.