It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Many of these women are told the problem is “all in their head” but recent advancements now show the pain may be due to hard-to-detect varicose veins in the pelvis, known as pelvic congestion syndrome. (It is the female equivalent of a man’s varicocele.)
Pelvic congestion syndrome is similar to varicose veins in the legs, but in this condition a vein called the gonadal vein has weak, defective valves, resulting in blood pooling in varicose veins in the pelvis. These bulging veins can cause pain and affect the uterus, ovaries, and vulva.
Up to 15% of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms. The diagnosis is often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing.
The chronic pain that is associated with pelvic congestion syndrome is usually dull and aching. The pain is typically felt in the lower abdomen and lower back. The pain often increases following intercourse, during menstrual periods, during pregnancy, or when tired or standing (worse at end of day).
Embolization is the choice of treatment for clearing up pelvic congestion caused by varicose veins in the gonadal area (testes or ovaries). See gonadal vein embolization for more information.