Pelvic venous congestion is an under-recognised cause of chronic pelvic pain, essentially varicose veins of the pelvis. Embolisation closes the faulty veins from the inside, as a day procedure.
When the valves in the ovarian or pelvic veins fail, blood pools in the veins around the uterus and ovaries. The result is a chronic dull ache or heaviness in the pelvis, classically worse with prolonged standing, at the end of the day, before periods and after intercourse. Sometimes with visible varicose veins of the vulva, buttock or upper thigh. Many women carry this pain for years with normal gynaecological investigations, because the veins are easy to miss unless someone looks for them.
The treatment mirrors what's done for varicose leg veins, but from the inside. Through a tiny puncture in a neck or groin vein, a catheter is guided into the ovarian and pelvic veins. Venography, contrast imaging of the veins, confirms exactly which veins are refluxing, and those veins are closed with coils and sclerosant in the same sitting. Blood reroutes through normal veins, the pooling stops, and the dragging pressure eases.
Certain features point towards the pelvic veins rather than another cause. The ache builds through the day and through prolonged standing, then settles when lying flat. It is usually a heaviness or dragging rather than a sharp pain, and it may worsen before a period. Deep pain during intercourse, with an ache that lingers for hours afterwards, is characteristic. Urinary urgency can occur. Varicose veins in atypical places, such as the vulva, buttock or back of the thigh, are a useful clue, as are leg varicose veins that return soon after otherwise well-performed treatment.
None of these features is diagnostic on its own, and pelvic pain is frequently multifactorial. They simply raise the suspicion enough to justify looking properly at the veins.
Careful history and review of imaging. Pelvic pain has many causes; part of Dr Tarr's job is making sure the veins are genuinely the culprit before treating them.
Sedation, single vein puncture, no incisions. Diagnostic venography and treatment happen in one sitting.
Mild pelvic ache or cramping for a few days is common and settles with simple pain relief.
The heaviness typically eases over several weeks as the congested veins empty and shrink. Follow-up confirms your progress.
In women with confirmed pelvic vein reflux, the majority, around three quarters or more in published series, report substantial and lasting relief of pelvic pain after embolisation. Ovarian function, periods and fertility are not impaired by closing these faulty veins; the ovaries keep their normal arterial supply and drainage through other routes.
After-effects include a few days of pelvic ache and occasionally a low-grade fever. Uncommon risks include recurrence needing further treatment and, rarely, migration of a coil. Because chronic pelvic pain is often multifactorial, a minority of women have residual symptoms from other causes. Honest selection beforehand is the best protection against disappointment.
A combination of your story (standing-related heaviness, post-coital ache), examination, and imaging, pelvic ultrasound, CT or MRI showing dilated, refluxing pelvic veins. The definitive test is venography, done at the time of treatment.
No. The faulty veins being closed are abnormal drainage channels; the ovaries and uterus keep their normal blood supply. Pregnancies after ovarian vein embolisation are well documented.
Yes, recurrent or unusually located leg and vulval varicosities are sometimes fed by pelvic vein reflux. Treating the pelvic source first makes leg treatment far more durable, and Dr Tarr coordinates with vein surgeons where needed.
Most women get substantial relief of the venous component, the dragging, standing-related heaviness. If part of your pain has another cause, that part needs its own answer; this is exactly what the consultation works through.