Relief from chronic pelvic pain caused by pelvic veins
Pelvic venous disorders, once called pelvic congestion syndrome, cause chronic pelvic pain when veins in the pelvis become enlarged and blood flows backward. Embolization closes the faulty veins from the inside through a pinhole in a vein, with no incision, and you go home the same day.
Call to book: 737-241-2184 How embolization worksWhat are pelvic venous disorders?
Veins carry blood back to the heart, using one-way valves to keep it moving in the right direction. In the pelvis, the main veins draining the ovaries and pelvic organs can develop faulty valves, or can be squeezed narrow by nearby arteries.
When that happens, blood flows backward (reflux) or backs up behind a narrowing (obstruction). The pelvic veins swell, much like varicose veins in the legs, causing a heavy, aching pain. The enlarged veins can also extend to the vulva, buttocks and legs.
The condition most often affects women of childbearing age, especially after pregnancy, and is often overlooked as a cause of chronic pelvic pain.
Why "pelvic congestion syndrome" has been renamed
For many years, these problems were described with separate labels: pelvic congestion syndrome, May-Thurner syndrome and nutcracker syndrome. Experts found these older terms imprecise and overlapping. The same symptoms can come from different vein problems, and the same vein problem can cause different symptoms, which led to missed diagnoses and treatments that did not work.1,2
In 2021, an international working group of vein specialists recommended replacing these terms with a single umbrella term, pelvic venous disorders (PeVD), sometimes called pelvic venous disease, and introduced a new classification system called SVP.1
Symptoms
Where you feel symptoms: in the flank or kidney area, as chronic pelvic pain, or outside the pelvis, such as in the vulva or legs.1
Varices
Where the enlarged veins are: near the kidney, inside the pelvis, or extending outside the pelvis to the vulva or legs.1
Pathophysiology
Which veins are affected, whether blood is flowing backward (reflux) or blocked (obstruction), and why, such as a past blood clot or compression by an artery.1
Much like cancer staging, SVP gives each patient a precise description of their condition. That matters for treatment: backward flow in an ovarian vein is usually treated with embolization, while a narrowed vein may need a different approach, such as a stent.2
Who is a good candidate?
Embolization is used when imaging shows backward flow in the ovarian or pelvic veins that matches your symptoms. It is often a good fit if you:
- Have chronic pelvic pain from pelvic vein reflux that affects your daily life.3
- Have pain during or after sex, or period pain, linked to enlarged pelvic veins.3
- Have varicose veins of the vulva, buttocks or upper thighs that come from the pelvis, or leg varicose veins that keep coming back after treatment.
- Have had other causes of pelvic pain ruled out by your gynecologist.
If imaging shows that a vein is narrowed (obstruction), that needs to be addressed first, since treating only the refluxing vein may not help.2 We plan your treatment based on your complete SVP picture.
How we find the cause of your pelvic pain
We work with your gynecologist to make sure your pain comes from the pelvic veins and not from another condition.
Consultation
We review your symptoms, pregnancies and past treatments, and check for varicose veins in the vulva, buttocks or legs.
Pelvic vein ultrasound
A specialized duplex ultrasound is the recommended first test. It shows enlarged pelvic veins and the direction of blood flow.2
CT or MR venography
When needed, CT or MRI scans of the veins map the anatomy and check for narrowed veins before treatment.2
How embolization compares with other options
The right treatment depends on which veins are affected and whether the problem is backward flow, a narrowing, or both.
| Option | How it works | Things to know |
|---|---|---|
| Pain relief & hormonal medication | Medication eases pain or reduces blood flow to the pelvic veins | May help symptoms, but does not fix the faulty veins |
| Vein stenting | A metal mesh tube holds open a narrowed vein | Used when a vein is blocked or compressed, rather than for backward flow2 |
| Surgery | The veins are tied off, or the uterus and ovaries are removed | Rarely needed today; major surgery with a longer recovery |
| Pelvic vein embolization | The faulty veins are closed from inside through a pinhole in a vein | No incision, light sedation, same-day discharge; the main treatment for pelvic vein reflux2,3 |
What happens during pelvic vein embolization
Pelvic vein embolization typically takes about an hour. You are awake but relaxed throughout.
Preparation
You receive light sedation and local anesthetic at the access site. No general anesthesia is needed.
A pinhole in a vein
A thin tube (catheter) is placed into a vein in your neck or upper thigh through a tiny puncture. No incision is made.
Mapping the veins
Using X-ray guidance and contrast dye, the catheter is steered into the ovarian and pelvic veins to confirm which ones have backward flow.
Embolization
Small coils, often combined with a medication that seals the vein (sclerosant), are placed to close the faulty veins.3
Recovery
The catheter is removed and a small dressing applied. You rest for 30 to 60 minutes and go home the same day.
Results
A 2024 systematic review combined 25 studies of embolization for pelvic venous reflux, covering more than 2,000 women.3
Technical success, meaning the faulty veins were successfully closed. Every study that measured pelvic pain scores found a significant reduction.3
Average pelvic pain score (out of 10) before and 5 years after embolization in one of the long-term studies in the review. Pain during sex and period pain also improved.3
Overall rate of symptoms returning during follow-up, and about 4% of women needed a further procedure.3
Most of the studies were retrospective and differed in how they selected and assessed patients, so the results vary between studies. Some women do not improve, which is why a careful evaluation before treatment matters.3 Individual results vary, and no treatment can guarantee success.
Risks and side effects
In the systematic review, complications occurred in about 9% of procedures, and almost 9 in 10 of these were minor. No permanent harm was reported.3 We discuss all risks with you in detail beforehand:
- Post-embolization symptoms: pelvic or back ache, and sometimes a low-grade fever, for a few days, managed with medication3
- Bruising or tenderness at the puncture site3
- Uncommonly, a coil moving out of position, which can usually be retrieved during the same procedure3
- Rarely, injury to the vein or a blood clot3
- Reaction to contrast dye or sedation
- Symptoms continuing or returning, which may need further treatment
Frequently asked questions
Is pelvic congestion syndrome the same as pelvic venous disorders?
Yes. Pelvic congestion syndrome is the older name. Experts now use pelvic venous disorders, together with the SVP classification, to describe the condition more precisely.1
Is the procedure painful?
It is performed under local anesthesia with light sedation. Most patients feel only the small needle at the access site. A mild pelvic or back ache for a few days is common.
How soon can I go back to work?
Most women return to work and normal activities within a day or two. Your physician will give you specific instructions about exercise and lifting.
How soon will my pain improve?
Many women notice improvement within weeks, with further improvement over the following months.
Will it affect my periods or fertility?
Embolization closes only the faulty veins. Blood drains through other healthy veins, and the ovaries and uterus keep their arterial blood supply. Please tell us if you are pregnant or planning a pregnancy, so we can plan the timing of treatment.
Is it covered by insurance?
Coverage varies by policy. We will navigate out-of-pocket costs with you. Call us at 737-241-2184 with questions.
Find out whether your pelvic pain comes from the veins
If you have chronic pelvic pain without a clear cause, an evaluation can show whether a pelvic venous disorder is responsible, and whether embolization could help.
Call 737-241-2184 to scheduleReferences
- Meissner MH, Khilnani NM, Labropoulos N, et al. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: a report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord. 2021;9(3):568–584. doi:10.1016/j.jvsv.2020.12.084
- Villalba L, Chin P. Pelvic venous disorders: embracing the new SVP classification. Medicine Today. 2022;23(5):14–22. Article
- Hanna J, Bruinsma J, Temperley HC, et al. Efficacy of embolotherapy for the treatment of pelvic congestion syndrome: a systematic review. Ir J Med Sci. 2024. doi:10.1007/s11845-024-03608-6
This page provides general information and does not replace a personal medical consultation. Study results describe groups of patients and cannot predict the outcome for an individual. Urology Austin and IR Centers · 8701 N. Mopac, Suite 100, Austin, Texas 78759 · 737-241-2184