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Understanding Pelvic Congestion Syndrome – Answers to Frequently Asked Questions

You're not alone if you've been diagnosed with Pelvic Congestion Syndrome. It's a fairly common condition that affects around 15% of females between the age of 15 and 50 in the United States and up to 43.4% of women worldwide.

It's only natural to have concerns and questions following your diagnosis, and hopefully, this article will help all women better understand the condition and its treatment. We've compiled a list of frequently asked questions so you can quickly hop to any specific points of interest. Let's dive in and take a look.

What causes Pelvic Congestion Syndrome (PCS)?

Experts remain unclear about the exact cause of PCS, but it's thought to be related to blood flow problems in the pelvic and ovarian veins. The pelvic pain associated with PCS involves faulty veins within the pelvis and ovaries. Normally, blood flows upward from the pelvic veins and toward the heart via ovarian veins. In normal circumstances, valves in the veins prevent blood from flowing backward (referred to as reflux).

However, the veins dilate or widen with PCS, meaning the valves cannot prevent blood from flowing backward, causing the veins to overfill and twist. As a result, blood pools in the pelvic veins, causing pain as they stretch to contain extra blood. It has been suggested that changes to estrogen levels and veins during pregnancy play a role in PCS.

Who does PCS affect?

A woman between 20 and 45 who has given birth more than once is most likely to have PCS. Other risk factors include:

Women who have gone through menopause rarely develop pelvic congestion syndrome.

What are the symptoms of Pelvic Congestion Syndrome?

Most women with PCS experience heavy, achy or dull pain, although the pain can be sharp and intense for some. The pain is most commonly felt on the left side of the body, although it may occur on the right or both sides.  

The symptoms of PCS include:

How is PCS diagnosed?

Your doctor will delve into your medical history and symptoms and carry out a physical exam that includes a pelvic exam. The key to diagnosis is to determine where the pain originates so your doctor will check for tenderness in the ovaries, uterus and cervix.

Imaging can also help rule out other conditions that could cause chronic pelvic pain and identify any vein irregularities potentially related to PCS.

Pelvic ultrasound – Quite often, ultrasound can detect dilated and congested varicose veins in the pelvic

MRI or CT scan – Besides showing congested pelvic veins, an MRI and CT scan can show details an ultrasound may miss, including the refluxing ovarian vein. They can also reveal other irregular growths in the pelvis, indicating other causes of chronic pain, such as endometriosis.

Here at MINT STL, we confirm a diagnosis of PCS with a Venogram. This involves injecting colored dye into the veins and using X-ray imaging to determine whether or not the blood is flowing backward. If PCS is confirmed, we can treat it simultaneously with ovarian vein embolization (OVE).

How is OVE performed?

OVE is a minimally invasive treatment performed on an outpatient basis, allowing patients to return home the same day and recover. A light sedation is administered, and a local anesthetic is used to numb the skin entry site to insert a small catheter. Once reflux has been confirmed using colored dye injected into the veins, stainless steel coils are fed through the catheter to block the vein, and an injection of sclerosing liquid secures long-term blockage. The procedure can be completed in around an hour, although it may take longer if additional refluxing veins are discovered.

What are the benefits of ovarian vein embolization?

Is OVE painful?

The ovarian vein embolization procedure is not painful since local anesthesia is given. However, some women may find the injection of the sclerosing agent causes pelvic or lower back pain lasting one to two days. Typically this pain can be controlled with over-the-counter painkillers.

Are there any risks with OVE?

Patients may experience mild bruising at the entry site. However, vein injuries and drug allergies are rare.

How do I recover after OVE?

Patients will need someone to drive them home after embolization. They are then recommended to rest in bed until the effects of the anesthesia have worn off. You should also drink plenty of water and take it easy for the rest of the day. Normal activities can be resumed the following day, although you should initially avoid strenuous activities. The dressing should be left in place for two days before being removed. You may experience pelvic and back pain, but this should subside within 1-2 days and can be managed with over-the-counter pain relief medication.

Am I a candidate for OVE?

If you're experiencing the symptoms of pelvic congestion syndrome, then ovarian vein embolization could be an ideal solution. To learn more or find out if you are a candidate, why not schedule a consultation with the friendly, experienced team at MINT STL? We have 5 locations to choose from, including St. Louis, MO, Wentzville, MO, Swansea, IL, Evergreen Park, IL and Chicago, IL.


Photo attribute: image by ArtPhoto_Studio on Freepik

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