Pelvic Pain

Studies show 30 percent of patients with chronic pelvic pain have pelvic venous insufficiency as the sole cause of their pain and an additional 15 percent have PVI along with another pelvic condition. Pelvic venous insufficiency is similar to varicose veins in the legs, but located in the ovarian and pelvic veins. In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don’t close properly. This allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva.

Women with pelvic venous insufficiency are typically less than 45 years old, in their child bearing years, and have been pregnant in the past. Women are more at risk if they have had two or more pregnancies, hormonal increases or dysfunction, fullness of leg veins, or polycystic ovaries. The pain is usually felt in the lower abdomen and lower back and is dull and aching. It often increases during menstruation, pregnancy, while standing, at the end of the day, or following intercourse. Other symptoms include irritable bladder, abnormal menstrual bleeding or vaginal discharge, and varicose veins on vulva, buttocks or thigh.

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. Women who experience pelvic pain that worsens throughout the day when standing, should seek a second opinion with an AMI Interventional Radiologist. Patients should ask their primary physician or gynecologist for a referral. Once abnormalities and inflammation have been ruled out by a thorough pelvic exam, PVI can be diagnosed at AMI through several minimally invasive methods including, pelvic venography, MRI scan(link), CT scan(link), pelvic ultrasound(link ultrasound), or transvaginal ultrasound(link ultrasound). Once a PVI diagnosis is made, a minimally invasive procedure known as catheter-directed embolization can be performed by an Interventional Radiologist.

Learn more about catheter-directed embolization.

Uterine fibroids are very common non-cancerous (benign) growths that develop in the muscular wall of the uterus. These tumors are the most frequent indication for hysterectomy in premenopausal women. Of the 600,000 hysterectomies performed annually in the United States, one-third are due to fibroids. Most women are not aware that there is a minimally invasive treatment option that could allow them to avoid the side-effects of a hysterectomy. Twenty to 40 percent of women age 35 and older have uterine fibroids of a significant size. They can range in size from very tiny to larger than a cantaloupe. In most cases, there is more than one fibroid in the uterus. Due to increased estrogen, fibroids can dramatically increase in size during pregnancy. After pregnancy, the fibroids usually shrink back to their pre-pregnancy size. They typically improve after menopause when the level of estrogen decreases dramatically. Uterine Fibroids are also known as leiomyoma, leiomyomata, myoma and fibromyoma. Only 10 to 20 percent of women who have fibroids require treatment. Depending on their size and location, fibroids can cause pain in the pelvic region, back, legs or during intercourse. Symptoms can also include heavy or abnormal menstrual bleeding, bladder and bowel pressure, and an enlarged abdomen. Most women with symptomatic fibroids are candidates for a non-invasive procedure and should obtain a consult with an interventional radiologist. Patients should first undergo an ultrasound at their gynecologist’s office to determine the presence of uterine fibroids. Once fibroids have been identified, an MRI is a more efficient imaging tool, because it can show underlying diseases and image all of the fibroids. Interventional Radiologists use MRIs to identify which treatments are best suited for each patient and determine if fibroids can be treated via a minimally invasive procedure known as catheter-directed embolization. Learn more about catheter-directed embolization.