Pelvic congestion syndrome, also known as vulvar varicosities or ovarian reflux, is a common cause of chronic pain in up to 40% of women. PCS is caused by dilation of the ovarian and Pelvic veins in the lower abdomen. The typical age range when a woman develops PCS is from age 20-45 years old.
- Pelvic or low back pain that increases after long periods of sitting or standing
- Pain after intercourse (dyspareunia)
- Pain before the menstrual cycle
- Visible varicose veins around the vulva, vagina, inner thigh, and sometimes the buttocks and legs
- Painful menstruation (dysmenorrhea)
- Abnormal bleeding during menstruation
- Fatigue, depression
- Swelling of the vagina or vulva
- Abnormal tenderness, increased urination, hip pain, and dragging sensation
- 50% of women with PCS have cystic ovaries
- Transvaginal Ultrasounds (the Gold-Standard test)
- Magnetic Resonance Imaging (MRI)
- Computed Tomography (CT) will provide visualization of incompetent veins and allow for a proper treatment plan
- Pelvic Venography is used to provide a definitive diagnosis and provide treatment at the same time
- May-Thurner Syndrome ( Compression of the left Iliac vein by the right iliac artery )
- Left renal stenosis
- Endometriosis, or scarring.
- Medications such as NSAIDs or non-steroidal anti-inflammatory drugs, chronic pain medications such as gabapentin and amitriptyline may be used to treat PCS.
- Surgical intervention: Ovarian / pelvic vein coil embolization treatment. A catheter is placed into the vein wherein coil emboli (Small medical-grade spheres) are placed into the affected vein blocking the flow of blood in that area, allowing the blood to reroute through healthier veins. This procedure can be done in an outpatient setting and has a 98% success rate and a decrease in pain of 83% of patients in long-term follow-up.