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Chronic pelvic pain: when to consider pelvic varices?

Persistent lower abdominal pain that worsens at the end of the day or during menstruation may have an often-overlooked venous cause: pelvic varices and pelvic congestion syndrome. Targeted treatment exists.

Recognising pelvic congestion syndrome

Chronic pelvic pain affects many women. When it lasts more than 6 months, is linked to the menstrual cycle and intensifies when standing or at the end of the day, pelvic congestion syndrome should be considered.

  • Dull or stabbing pelvic pain, sometimes very disabling
  • Worsening during or after periods
  • Feeling of pelvic heaviness at the end of the day
  • Pain during intercourse (dyspareunia)
  • Visible vulvar or leg varices, sometimes fed by pelvic reflux

Good to know: this syndrome may affect about 1 in 20 women. It is often underdiagnosed because symptoms can mimic other conditions (endometriosis, fibroids, adenomyosis…). Appropriate imaging is essential.

What are pelvic varices?

Pelvic varices are dilated veins in the pelvic region (ovarian, peri-uterine, vulvar veins…), often with venous reflux. They may appear or worsen after one or more pregnancies due to increased blood volume and pressure on pelvic veins.

When these veins remain dilated, blood pools in the pelvis — causing congestion, heaviness and chronic pain.

How is the diagnosis made?

  1. Specialist consultation: detailed history of pain, relationship with periods and impact on daily life.
  2. Doppler ultrasound: may show pelvic venous dilatations.
  3. Pelvic MRI: reference examination to confirm venous reflux and rule out other causes.

Embolization: a minimally invasive solution

When pelvic varices are confirmed and responsible for symptoms, pelvic varices embolization may be offered. This interventional radiology procedure is performed under precise radiological guidance, usually as a day case.

Minimally invasive

A catheter is inserted via the femoral vein and guided to the dilated pelvic veins. No surgical incision.

Targeted

Veins responsible for reflux are occluded (biological glue or sclerosant), redirecting blood flow and relieving congestion.

Rapid recovery

Home the same day in most cases, with gradual return to activities.

Frequently asked questions

Is chronic pelvic pain always due to varices?

No. Several conditions can cause pelvic pain (endometriosis, fibroids, infections, digestive disorders…). Pelvic MRI helps differentiate and guide appropriate treatment.

Is embolization painful?

The procedure is performed under local anaesthesia or light sedation. Mild discomfort may occur in the following days, usually well managed with simple painkillers.

When can improvement be expected?

Pain improvement is gradual, often noticeable within weeks after embolization. Results vary depending on the patient and extent of varices.

Can I send my file before a consultation?

Yes. Send us your situation and examinations (MRI, ultrasound reports) via our contact form for an initial review.

Would you like to understand the proposed treatment in detail?

Learn more about pelvic varices embolization

Your pain deserves careful review

Send us your file: our team reviews your examinations and indicates whether embolization may be suitable for you.

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