CONSUMER HEALTH

Ask the Doctor: Dr. Steven Elias

When it comes to menstrual misconceptions, believing that chronic pelvic pain is ‘just a normal part of being a woman’ lies somewhere between thinking you’re more likely to get attacked by a shark when you have your period and believing that if your friend’s cycle doesn’t sync with your own, you’re not true friends. In fact, believing that persistent pelvic pain is normal is an even more damaging fallacy, as it often prevents women who experience pelvic pain from seeking the appropriate medical attention. For this reason, highly treatable conditions, like pelvic congestion syndrome, go woefully underdiagnosed.

What is pelvic congestion syndrome?

Dr. Elias: Pelvic congestion syndrome occurs when a damaged or diseased vein in the pelvis begins to accumulate blood, rather than transporting it back to the heart. Also referred to as pelvic venous insufficiency, it can cause pain, pressure or achiness in the pelvis, painful periods, a feeling of pelvic fullness as the day progresses, pain 15-20 minutes after intercourse or after standing for long stretches of time and a feeling of bladder pressure leading to frequent urination towards the end of the day.

Who is at high risk for developing vein disease in the pelvic area?

Dr. Elias: Premenopausal women are more likely to have pelvic venous insufficiency than post-menopausal women. The other two main risk factors for pelvic vein disease are having had multiple pregnancies or a family history of varicose veins.

How is pelvic venous insufficiency diagnosed?

Dr. Elias: First, we usually perform a vascular ultrasound (a non-invasive procedure) to look at the pelvic veins. If suspicious after the ultrasound an MRI or CT scan of the pelvis may be done. The most definitive test is a venogram, during which a dye is injected into the veins of the pelvis and the blood flow is visualized on a screen. With this test, we can evaluate how the vein is performing and which veins are leaking, causing symptoms. The test takes about 30-40 minutes and patients only have one needle stick in the upper thigh. Patients can resume normal activities immediately afterwards.

Most symptoms of pelvic vein disease go away after menopause. However, premenopausal women with symptoms that affect their quality of life such as normal activities, caring for children, or pain while working, do benefit from having their vein disease treated.

How is pelvic vein disease treated?

Dr. Elias: Treatments for pelvic vein disease are similar to those for varicose veins. These are outpatient procedures with no cuts or stitches—just a few small needle sticks. We seal any abnormal veins shut, diverting the blood flow to normal, healthy veins. When pelvic veins are narrowed because of pressure from the arteries, we can improve blood flow by using a small catheter to insert and inflate a balloon, then placing a permanent stent to widen the vein. These procedures can improve symptoms by about 75% – 80%, leading to a big improvement in a patient’s quality of life.

Posted July 2019


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