Everything You Need to Know About Pelvic Congestion Syndrome

When pelvic veins become varicose, the condition is referred to as Pelvic Congestion Syndrome. Theoretically, any vein is susceptible to become “varicose;” though, varicose pathology is commonly limited to lower extremity veins, and sometimes this includes the pelvic veins.  Recently, pelvic venous systems have been identified as an area also vulnerable to “varicose,” specifically in multiparous women.

What Is Pelvic Congestion Syndrome?

Pelvic congestion syndrome (PCS) is a disease stemming from incompetent pelvic veins and is a significant cause of chronic pelvic pain in women. Transvaginal ultrasound (TVU) is a useful detection tool and helps your physician visualize hard to reach reflux sites, which is at times challenging with other tests. There are different treatments available, such as counseling and hormones or other minimally invasive procedures.

TVU Assess:

  • Ovarian veins
  • Internal iliac veins

Pelvic Congestion Symptoms            

What the most common complaint women with Pelvic Congestion Syndrome express experiencing is a pain: painful sexual intercourse, painful periods, hip pain, and more pain! Whether its the veins in your legs or your perineum and buttocks, varicose veins ache! Your physician will likely perform a TVU, examining internal structures, such as your uterus, ovaries, fallopian tubes and other pelvic areas to determine what is causing your pain. Other medical conditions, such as endometriosis or uterine fibroids, also cause complaints of pelvic pain in women.

Pain locations:

  • Pelvis
  • Abdomen
  • Lower back
  • Hips

Exam findings:

  • Ovarian point tenderness
  • Varicose veins in the vulva, perineum, buttocks and lower extremities

Diagnostic Tool Bag

Transvaginal duplex ultrasound is on its way to becoming the new gold standard in investigating pelvic venous reflux and assessing treatment success. It’s often the first diagnostic test performed; however, other procedures may include: computed tomography venography and magnetic resonance venography.

TVU Advantages:

  • Non-invasive
  • Easily accessible
  • No exposure to ionizing radiation
  • The limited cost to the patient
  • Detailed imaging of hard to reach reflux sites

Medical Therapy Helps You Cope with Your PCS Symptoms!

Medical treatment consists of counseling and hormone therapy, helping women to cope with their discomfort caused by pelvic venous reflux. Hormones work by temporarily turning off ovarian function, suspending ovulation. Female hormones play a role in venous dilation, which is a naturally occurring process that increases during menstruation. Simply put, postpone menstruation and reduce the pain women experience during and around their periods.

Hormone therapy:

  •  Medroxyprogesterone acetate ~ More commonly known as Depo-Provera
  •  Gonadotropin-releasing hormone Analogue Goserelin ~ More widely known as Zoladex

Psychotherapy helps women handle their chronic pain, guiding them through challenging scenarios, teaching women how to navigate living with pain. PCS permeates women’s daily lives, affecting intimacy, relationships, and their body-image. Chronic pain colors perception, influencing every aspect of an individual’s life. Talking regularly with a therapist helps women learn how to cope with their discomfort. It encourages self-care, boundary setting and how to accept responsibility for their chronic pain.

Transcatheter Embolization Treats Your Pelvic Veins!

Hormones and counseling are reasonable therapeutic options, and many women report feeling better after starting birth control. However, when pelvic reflux is present, perhaps another treatment option to consider is directly treating the source: incompetent pelvic veins.

Transcatheter embolization (TCE) of ovarian or internal iliac veins directly treats pelvic varicosities that are causing women to experience pelvic pain. Surgery is another option lying on the proverbial table, but a hysterectomy, typically, is the last resort option saved for the most severe cases.

TCE is a minimally-invasive procedure that has distinct advantages over surgery, though like any treatment there are some risks involved. Coil migration to other veins, like the kidneys, can happen, but this is a sporadic risk. Talk with your physician to see what medical equipment they prefer to use. There are some newer coils out there, like controlled-release coils, that may help prevent migration and reduce this risk.

TCE Advantages:

  • Maintenance of hormone milieu
  • Avoidance of surgical complications
  • Reduced post-operative pain
  • Preserved fertility

Find a Vein Specialist Near You!

Phlebologists are Vein Specialists that dedicate their medical practice to the study of vein disorders, such as pelvic congestion syndrome. Incompetent pelvic veins develop just like the bluish veins you see bulging underneath the surface of your legs do. A duplex ultrasound helps your physician examine the veins in your legs, and likewise, a transvaginal ultrasound assists your doctor to assess the veins in your pelvis. Transcatheter embolization relieves pelvic venous congestion in women who are not responding well to medical therapy. Ultimately, whether you choose birth control or Embolotherapy, both share the same goals: to restore coital function, control pelvic pain, and improve the quality of patients’ everyday life.

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