Pelvic congestion syndrome is what happens when the ovarian and pelvic veins lose the valve function that keeps blood moving upward. Blood pools, the veins dilate, and the result is essentially varicose veins inside the pelvis.
The pattern is characteristic once you know to look for it. The pain is dull and aching rather than sharp. It is worse after standing for a long period and better lying down. It builds through the day. It is often worse before a period, worse after intercourse, and worse after pregnancy — and it frequently began after a pregnancy. Some women also have visible varicose veins in unusual places: the vulva, the buttock, the upper inner thigh.
Because the pain is chronic, vague and gynecologic in location, many women spend years being evaluated for other things. Laparoscopy that finds nothing is a common part of the story. The diagnosis is made with dedicated pelvic venous imaging, and once it is made, the treatment is straightforward: close the refluxing veins.
Ovarian vein embolization is done through a catheter, on an outpatient basis, under light sedation. Published series report meaningful pain improvement in the substantial majority of appropriately selected women.
What the procedure involves
Getting the diagnosis right
We start by listening to the pattern of the pain, then image the pelvic veins with ultrasound and cross-sectional imaging. Ruling in pelvic congestion matters as much as ruling out other causes.
Venography
Through a vein at the neck or groin, contrast is injected into the ovarian and internal iliac veins to demonstrate reflux directly and identify every refluxing channel.
Embolization
Coils and a sclerosing agent close the refluxing veins. Both sides are treated when both are involved.
Home the same day
The catheter comes out and you go home within a few hours. Improvement builds over the following weeks and months.