Chronic pelvic pain is extremely common and accounts for 10 percent to 15 percent of referrals to gynecologists and pain clinics. For many women, the pain is caused by a condition called pelvic congestion syndrome. Unfortunately, often this condition is undiagnosed because many physicians are unfamiliar with it.
Pelvic congestion syndrome is caused by varicose veins, which develop in the pelvis. The valves in these veins don’t function normally causing blood to back up in the pelvis. Eventually the veins become engorged or congested and lead to pain. This is similar to varicose veins in the legs; however, the two conditions can occur independently.
Could I have PCS?
PCS pain usually worsens as the day goes on, especially for women who stand for much of the day. It can go away after a night of sleep. It can worsen during or following sexual intercourse, around the time of a menstrual cycle, and after certain activities such as horseback riding or bicycling. Often these symptoms will surface during or after pregnancy. If you have these symptoms, talk with a doctor about PCS.
What tests will a doctor recommend?
As gynecologic pelvic exams are usually completely normal in patients with PCS, a doctor may order a pelvic ultrasound to assess the veins around the uterus and ovaries and also to exclude other causes of pelvic pain. If ultrasound is inconclusive, the doctor also may request an MRI to assess the veins of the pelvis or a CT with contrast.
What are the treatment options?
Treatment options include hormonal medications, which can reduce the blood flow of the varicose veins, prescribed by a gynecologist.
If this is ineffective, a gynecologist may refer you to an interventional radiologist to seal off the veins with coils or tiny plugs. This procedure is performed with a small catheter, and patients usually go home the same day. With the exception of the venous access in the arm or thigh, there is no pain and virtually no blood loss during the procedure. Patients may return to work on the following day and to full activities within a week.
Do I need a referral?
You may call an interventional radiology clinic to help set up a consultation and, if necessary, obtain a referral from your doctor.
Agnieszka Solberg is an interventional radiologist at CHI St. Alexius Health. Solberg performs minimally invasive, image-guided procedures to diagnose and treat medical conditions.