Help for Pelvic Congestion Syndrome

Pain and periods often go together. More than half of women regularly experience pain during their menstrual cycle, which can sometimes interfere with the ability to participate in and enjoy everyday activities.[1] While many women experience painful periods without any identifiable underlying cause other than normal uterine contractions, sometimes, period pain has a treatable source. One of these is pelvic congestion syndrome.

What is pelvic congestion syndrome?

Pelvic congestion syndrome (PCS) is estimated to cause as many as 30% of cases of chronic pelvic pain in women.[2] It occurs when varicose veins (like those often seen on the legs) develop in the pelvic region, often following pregnancy. Because of the changes that happen within a woman’s body during gestation, multiple pregnancies increase a woman’s risk of developing PCS.

What are the symptoms of PCS?

Varicosities develop as a result of weakened veins. The valves within these veins are no longer able to close properly, allowing blood to pool. This can result in persistent pain, which is often worse after long periods of standing, in the evenings, and during and after intercourse. It’s often improved by lying down. Additional symptoms that may appear include

• Swelling of the vulva
• Varicose veins around the vulva, buttocks, and thighs
• Pain in the hip or back
• Increased urinary frequency
• Bowel irritation
• Fatigue or depression[3]

How is PCS diagnosed?

Particularly if you experience persistent pelvic pain that lasts more than six months, your doctor may recommend tests to determine whether PCS is an underlying cause. A number of tests can be used to identify PCS. Often, ultrasound is the first choice because it’s a non-invasive way to detect varicosities and evaluate blood flow in the veins.[4] CT, MRI, laparoscopy, and venography are other tests that may be used for this purpose.[5]

How can PCS be treated?

Some PCS patients experienced improvement in their symptoms with hormonal medications. For those who do not, vein embolization and surgery to remove damaged veins are possible treatments.[6] Vein embolization is often preferred because it’s minimally invasive and involves less risk and less recovery time than open surgery. Additionally, the success rate of this procedure is reported to be as high as 85%.[7]

What is vein embolization?

During a vein embolization procedure, an interventional radiologist uses X-ray imaging to insert a thin catheter into a vein in the groin and guide it into the varicose veins. The radiologist uses the catheter to insert tiny coils and sclerosing agents that cause the blood to clot and the vein to close. The procedure is performed in a hospital, typically using IV sedation.

What risks are involved?

Vein embolization uses IV contrast dye, which can cause allergic reaction in some patients. Be sure to tell your doctor if you’ve experienced an allergic reaction to contrast material in the past. Like any invasive procedure, embolization carries a risk of infection. Other risks include damage to blood vessels and improper placement of the embolic agent, which can deprive healthy tissue of oxygen. Talk to your doctor to learn more about risks of the procedure and how those risks will be mitigated.[8]

Interventional radiologists at Iowa Radiology perform vein embolization as a treatment for PCS at UnityPoint Iowa Methodist Medical Center in Des Moines.

[1] Period Problems. WomensHealth.gov.https://www.womenshealth.gov/menstrual-cycle/period-problems. Published March 16, 2019. Accessed November 1, 2019.

[2] Dos Santos, SJ, Whiteley, MS. Pelvic congestion syndrome masquerading as osteoarthritis of the hip. SAGE Open Med Case Rep. 2016;4: 2050313X16683630. http://dx.doi.org/10.1177/2050313X16683630. Accessed November 1, 2019.

[3] Pelvic Congestion Syndrome. Healthline.com. https://www.healthline.com/health/pelvic-congestion-syndrome - causes-and-risk-factors. Published December 5, 2017. Accessed November 1, 2019.

[4] Ibid.

[5] Perry, PC. Current Concepts of Pelvic Congestion and Chronic Pelvic Pain. JSLS. 2001 Apr-Jun; 5(2): 105–110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015423/. Accessed November 1, 2019.

[6] Pelvic Congestion Syndrome. Cedars-Sinai.org. https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pelvic-congestion-syndrome.html. Accessed November 1, 2019.

[7] Ovarian Vein Embolization. Radiologyinfo.org. https://www.radiologyinfo.org/en/info.cfm?pg=OvariVeinEmbol. Published 8 Feb 2008. Updated January 30, 2019. Accessed November 1, 2019.

[8] Ibid.