There are many different causes of pelvic pain, but sometimes it is related to the existence of ovarian and pelvic varicose veins. Varicose veins are a result of valves in the veins that don’t work correctly. Valves are designed to help veins return blood to the heart by preventing back-flow of blood down the vein. When the valves don’t work, this lets the blood pool resulting in vein bulging and pressure.
Studies show that up to 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a primary cause of their pelvic pain. The majority of women with PCS are less than 45 and are in their childbearing years. Risk factors for PCS include multiple pregnancies, polycystic ovarian syndrome, hormonal dysfunction and leg varicose veins. Women with PCS usually complain of a dull ache and heaviness in the pelvis that is worsened by standing, pregnancy, and menstruation. Sometimes this pain may be experienced in the lower back. There may also be visible varicose veins in the groin area, buttocks and upper thigh.
Often times our female patients have both leg varicose veins and pelvic varicose veins. Although these veins are in different locations both sources can be symptomatic to the patient. The question then becomes “which do I treat first?”
The problematic veins although similar in pathology and symptoms are treated in different methods. The legs are treated as an in office procedure involving the use of EVLA, sclerotherapy, and ambulatory phlebectomy. The pelvic veins are treated with a same-day hospital procedure called a venogram with coil embolization. The goal with both procedures is to close down incompetent veins that cause the symptoms. And while these are very different procedures often both procedures need to be performed to reduce the symptoms. The question of which procedure to do first really comes down to which problem is causing you the most pain.
There is not a 100% right or wrong answer to this question and so mostly it is a judgment call on the patient’s part. There are a few cases where the doctor may have a reason to treat one problem over the other but this is because it will be in the patient’s best interest.