Pelvic congestion syndrome (PCS), also known as ovarian vein reflux, or pelvic venous congestion syndrome (PVCS), is a common, yet often misunderstood condition in women that causes chronic pain in the pelvis and lower abdomen. The pain associated with PCS can be debilitating, and a clear diagnosis of PCS can sometimes be difficult because there are many different possible symptoms.
What is pelvic congestion syndrome?
Pelvic congestion syndrome is a condition that affects women that causes chronic, dull pelvic pain and a feeling of pressure and heaviness in the groin. PCS is oftentimes linked with varicose veins in the lower abdomen, groin, and ovaries.
What drugs can treat PCS?
The effectiveness of drug therapy for PCS is still unclear, but your doctor may prescribe:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen to alleviate pain and inflammation. This is a common first step in your treatment process.
- Goserelin to contract your veins and suppress the hormones such as estrogen that may be causing PCS.
- Medroxyprogesterone (MPA) to help alleviate pain and reduce pelvic congestion by suppressing ovarian function.
- Daflon to boost the strength of your vein walls.
How does transcatheter embolotherapy treat PCS?
PCS is most commonly treated by embolotherapy, which is a minimally invasive surgical technique to close off the varicose veins in your pelvis. This should reduce vein swelling and alleviate the associated pain. You can usually go home 24 hours after treatment and return to work one week later depending on your pain levels.
This procedure is usually done by an interventional radiologist, which is a type of doctor that specializes in performing minimally invasive procedures while using advanced imaging technology to see inside your body.
Your interventional radiologist will make a small incision near the vein being treated and insert a narrow, wire-like catheter into your vein to administer localized treatment. There are three main embolization methods:
- Metallic coils: Small coils of stainless steel or platinum are inserted into the vein to stop blood flow.
- Plugs: This is a newer technology that uses small, self-expanding wire meshes to stop blood flow.
- Sclerosing agents: These are specially formulated liquid, foam, or gel chemicals that are injected into the vein to make them shrink, collapse, and eventually dissolve.
What are the risks of embolization?
Although emobolotherapy is a minimally-invasive procedure, it still has some risks.
- Coil or plug migration: The coils or plugs that are used to close off your veins may come loose and travel to other parts of your veins, which could cause problems with your vein health and blood circulation.
- Vessel injury: The catheter can damage your veins and cause bruising and bleeding at the entry site in your skin.
- Allergic reaction: Dye used in the imaging process for the procedure may cause an allergic reaction.
- Radiation exposure: Some imaging techniques use radiation, which may have negative effects for pregnant women.
How can complementary and alternative medicine help with PCS?
Complementary and alternative medicine (CAM) refers to traditional treatments and natural remedies that can be used in conjunction with Western medicine. CAM can include physical treatments as well as herbal medicines that can have positive effects on your health and may help relieve the symptoms of PCS.
- Acupuncture is a traditional Chinese treatment that uses thin needles to stimulate specific points in the body to help with pain, illness, and injury.
- Pollen extract is a type of herbal medicine that contains many components including amino acids, carbohydrates, and plant cholesterols that can have anti-inflammatory and pain-relieving effects.
- Quercetin is a plant pigment commonly found in red wine, green tea, and onions. It has anti-inflammatory and antioxidant qualities and can help relieve pelvic pain.
- Massage therapy in the pelvis and abdomen area can release muscle tension and improve blood flow in the area which may have relieving effects for PCS symptoms.
Are there other surgical treatments for PCS?
Surgery is now known to have little benefit for treating PCS. Surgical approaches that were done in the past involved the removal of all adhesions in the pelvis, anatomic corrections of the displaced uterus, and even hysterectomy.
How are varicose veins linked to PCS?
Varicose veins occur when the one-way valves inside your veins stop working properly and allow your blood to flow backwards, causing your blood to pool and stretch out your vein walls. There are multiple potential causes related to PCS and pregnancy.
- Increases in weight and fluids from pregnancy can cause varicose veins to develop because of the added pressure this puts on the veins in your pelvis.
- Physical trauma can affect your veins, and the onset of pregnancy may make your veins more susceptible to damage, leading to varicosities.
- Increases in the hormones estrogen and progesterone during pregnancy can dilate and weaken your vein walls, making you more susceptible to developing varicose veins.
Which women are more prone to developing PCS?
Pelvic congestion syndrome more commonly affects women between the ages of 20 and 45, and women that have had two or more pregnancies.
What are the most common symptoms of pelvic congestion syndrome?
Pain of varying severity is the most common symptom. The pain is typically dull and not cyclical. The pain is usually worse:
- Just before the onset of your menstrual cycle
- At the end of the day
- After prolonged standing
- During, or just after intercourse
- During the later stages of pregnancy
Other than pain, there are many other non-specific symptoms, which can vary in intensity. Other symptoms of pelvic congestion syndrome may include:
- Swollen vulva/vagina
- Varicose veins located on or around the vulva, buttocks, and legs
- Abnormal menstrual bleeding
- Tenderness to touch in the lower abdomen
- Pain during intercourse
- Painful menstrual periods
- Vaginal discharge
- General lethargy
- Feelings of depression
What other conditions can mimic pelvic venous congestion syndrome?
- Endometriosis, which is a condition where tissue that normally lines the inside of your uterus grows outside of your uterus
- Fibroids, also known as uterine myomas, which are tumors of the female reproductive system
- Uterine prolapse, which is a condition where the uterus drops lower in the pelvis due to weak muscles
How is PCS diagnosed?
After ruling out other conditions, the specific diagnosis can be made using several imaging tests which include:
- Ultrasound: An ultrasound can help visualize the blood flow and asses the presence of varicosities in the pelvis. This is considered a good first test because it can help eliminate the possibility of other conditions. The procedure is painless and takes about 30 minutes.
- Venogram: This test involves injecting of a special dye into one of the veins in the groin and obtaining X rays. This is considered the gold standard for diagnosing PCS. The test is a painless 30 to 45-minute outpatient procedure done in a radiology suite.
- CT Scan: CT scans can image the entire lower pelvis to help identify varicosity of the pelvic veins. This test isn’t ideal for diagnosing PCS because you have to lie down during it, which can make reduce pressure on your veins and make it harder to detect PCS.
- MRI: Like CT scans, MRI is less useful for diagnosing PCS because you have to lie down during the imaging. MRI doesn’t involve radiation or contrast dye, and is an outpatient procedure that takes about 15 minutes.