Pelvic congestion syndrome

Who it may help

OVE may suit you if you:

• have been diagnosed with PCS
• have not had relief from medication, or medication is not suitable for you
• would prefer a non-surgical, day-stay option to relieve PCS symptoms

What is PCS?

Pelvic congestion syndrome, also known as pelvic venous insufficiency (PVI), is a condition where blood flows abnormally in the veins of your pelvis. It is usually associated with chronic pain but can cause other symptoms too. The pain and other symptoms last longer than 6 months and are not linked to your menstrual cycle or pregnancy.

The abnormal flow is caused by problems in the veins draining your ovaries and pelvis. These veins should carry blood away from the area, but in PCS this does not work as it should. Blood pools in the pelvis and the veins widen, which eventually leads to pain.

Who is affected by PCS?

PCS occurs mostly in women aged 20–45, usually in those who have given birth more than once. Other risk factors are:

• polycystic ovary syndrome (PCOS)
• varicose veins
• a family history of varicose veins

It is unusual for women who have been through menopause to have pelvic congestion syndrome.

Chronic pelvic pain is a common reason for seeing a gynaecologist, and studies suggest that a substantial share of it may be related to pelvic congestion syndrome.

What are the symptoms of PCS?

The pain in PCS is usually described as dull, achy or heavy. It is rarely sharp or intense, although that can happen too. It is most often felt on the left but may be on the right or both sides. It often starts during or soon after a pregnancy and can worsen with later pregnancies.

The pain may often feel worse:

• at the end of the day
• before and during your period, as hormones affect blood flow in the pelvis
• during and after sex
• when you stand or sit for a long time

It is sometimes eased by lying down.

Other symptoms may include:

• constipation or diarrhoea
• stress incontinence (leaking urine when you cough, sneeze or exercise)
• pain when passing urine
• varicose veins in the pelvis, buttocks, thighs, vulva or vagina

What causes PCS and its pain?

Research has not shown exactly what causes pelvic congestion syndrome, but problems with blood flow in the ovarian and pelvic veins play a role. Normally, blood flows from your pelvis back towards your heart through the veins.

Valves in these veins keep the blood flowing one way, back to the heart. In PCS, the valves no longer work properly, so blood flows backwards (called reflux), and the veins widen and fill with blood. The pooling blood causes pain, possibly from the veins stretching, or from enlarged veins pressing on nerves in the pelvis. The veins may stop working properly because of pregnancy, when blood vessels can grow up to 50% larger than normal, and some theories suggest that oestrogen may also change the vessel structure.

How can PCS be treated?

The veins cannot be restored to their original form and function. The goal of treatment is to reduce and manage symptoms, and for some people symptoms resolve almost completely, although research shows complete resolution is rare.

Several types of medication, mostly ones that suppress oestrogen, can reduce PCS symptoms, but they also have side effects. Surgical treatments are often invasive, using keyhole surgery (laparoscopy) to tie off the veins or, very rarely, to remove the ovaries, uterus and fallopian tubes.

We offer ovarian vein embolisation (OVE), a minimally invasive procedure to reduce PCS symptoms, explained below.

Ovarian vein embolisation (OVE)

Ovarian vein embolisation is a minimally invasive, image-guided procedure that treats the faulty veins draining your ovaries and pelvis. It blocks these veins, which stops the reflux (backflow of blood) and reduces pooling of blood in your pelvis.

The interventional radiologist inserts a small plastic tube (a catheter) into a vein in your groin or neck and, using X-rays, guides it into the veins of your ovaries and pelvis. Tiny metal springs called coils are then placed in the vein, which makes the vein react and shrink and stops blood flowing back and pooling in the pelvis. The coils stay in the vein permanently.

How the procedure is performed

1. The procedure is performed by an interventional radiologist, under local anaesthetic with sedation for comfort.
2. A small catheter is inserted into the vein in your groin (occasionally the neck, though this is not usually needed).
3. A small tube is guided to the vein connecting your left ovary to the main vein, and dye is injected to show which vessels need treatment.
4. Tiny metal springs (coils) are placed to block the faulty vein.
5. The same is repeated on the right.
6. A final check with dye confirms the result.
7. Once the catheter is removed, the interventional radiologist presses on your groin for a few minutes to stop any bleeding from the insertion site.
8. You rest in bed for a few hours, and if you feel well you can go home a few hours after the procedure.

Health insurance cover for OVE

Southern Cross does not cover OVE. NIB and AIA do. Please check your cover with your insurer before the procedure.