Pelvic Congestion Syndrome

What is Pelvic Congestion Syndrome?
It is noncyclic pain that lasts more than 6 months and is caused by pelvic varicosities. Chronic pain is a common health problem that affects as many as 39% of women.

What are the common symptoms/ complaints of Pelvic Congestion Syndrome? 
Varying degrees of pelvic pain, worsened when sitting or standing, therefore most severe at the end of the day. Pain is often exacerbated with intercourse.

What are other symptoms of Pelvic Congestion Syndrome?

  • Swollen vulva/vagina
  • Varicose veins (vulvar, buttocks, legs)
  • Abnormal menstrual bleeding
  • Tenderness to touch in lower abdomen
  • Painful menstrual periods
  • Backache
  • Vaginal discharge
  • General lethargy
  • Feelings of depression

How Is Pelvic Congestion Syndrome diagnosed?
A comprehensive history and physical exam is performed. Different radiologic exams may be performed to assist with diagnosis. MRI is the most sensitive exam, and the “golden standard” for diagnosing PCS is a pelvic venogram.

How does Interventional Radiology treat PCS?
By the means of embolizing the varicose veins. Embolization is only undertaken after the diagnosis is confirmed. Basically it involves plugging the blood vessels so that they do not become engorged with blood anymore, and the varicosities subside with time. The procedure is typically done by an interventional radiologist and takes a few hours. It does not require any anesthesia. There is significant pain, nausea and even fever the first few days after the procedure.

What are the advantages of Embolization versus surgery?

  • Minimally invasive: there is no large incision and the downtime is minimal. In addition, the procedure is not associated with all the possible complications that can occur after surgery and anesthesia.
  • Anesthesia: there is no need for general anesthesia with embolization. Conscious sedation is used.
  • Symptoms control: More patients appear to have benefit from embolization compared to surgery. In those individuals who benefit, the symptoms are relieved for several years.
How do I prepare for the procedure?
You will be scheduled for a consultation with the Interventional Radiology Team. Bring a list of questions to ask your doctor. It is important that you understand exactly what procedure is planned, the risks, benefits and other options before your procedure.  

What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure. You will be connected to several types of monitoring equipment. You will be lying on the x-ray table. The technologist will prepare the skin over the neck by cleaning it with an antiseptic solution and place sterile drapes and towels over you to create a sterile work space. Lidocaine® local anesthesia is injected into the skin overlying your neck. A catheter is placed into the vein and contrast dye is injected to allow visualization of the veins that supply the ovaries, one side at a time. A sclerosing solution (Sotradecol ®) and platinum coils are injected into the ovarian vein until the blood flow has stopped. Once the procedure is completed the catheter is removed and pressure is applied to the neck until there is no bleeding (approximately 5-10min). This procedure takes approximately 1.5 - 2 hours.

What happens after the procedure? 
This is an outpatient procedure but you will be required to stay to recover for two hours after the end of the procedure. While in recovery, you will be monitored closely for signs of bleeding and to ensure that the effects of the sedation have worn off.  You must have a responsible adult to drive/escort them home from the hospital. 

Going home:  Check your dressing throughout the day for any increased drainage.  Keep the dressing dry for 24 hours and then remove.  If you experience excessive bleeding from the skin site, apply pressure to the site and seek medical attention. Report any signs of infection (redness swelling, discharge and fever) to your doctor.  At home you should drink extra fluids for one to two days following the procedure to help flush the contrast that was injected into your body. 

What are the results of embolization for Pelvic Congestion Syndrome?Approximately 80% of the women undergoing Ovarian Embolization express significant improvement of symptoms. However, pain improvement is not immediate and may take 2-4 weeks. Occasionally patients may require a second treatment. Patients are expected for an office visit with the Interventional Radiology team 4-6 weeks after the procedure.  

This information is provided by the Fletcher Allen Healthcare Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

For additional health information, please contact your health care provider.
 If you have any questions please feel free to contact the Interventional Radiology Office at 802-847-8359