It is the enlargement of the uterus and ovarian veins. This disease, also known as genital varicose, pelvic (lower abdomen) venous insufficiency, female varicocele, and pelvic vascular congestion, is a cause of chronic pelvic pain that lasts for more than 6 months and consists of pelvic vein insufficiency and related pelvic varices. It is a cause of unexplained pelvic pain in young, menopausal women who have given birth a lot.
Complaints may be in the form of low back pain, pelvic or thigh pain, pain that develops during menstrual periods, increased pain after prolonged standing, straining and sexual intercourse.
What are the causes of genital varicose veins?
Valve insufficiency in the veins, vein occlusion, hormones may cause the blood flow in the uterus and ovaries to slow down and the vessels to dilate. Pregnancy is another important reason for the development of pelvic congestion syndrome, and post-pregnancy pelvic varices become more visible.
How is the diagnosis of genital varicose veins?
When leg varices recur despite treatment, pelvic congestion syndrome that may be together should be investigated. The evaluation of chronic pelvic pain begins by ruling out the most common causes. These;
• Is there any pathology in the pelvis?
• Pelvic inflammatory disease, endometriosis,
• Adhesions due to previous operations,
• The presence of uterine diseases, adenomyosis, uterine fibroids should be ruled out.
Magnetic resonance (MR), ultrasonography and computed tomography (CT) are used in imaging. Although the diagnostic value of these imaging devices is relatively high, laparoscopy can also be applied to rule out other causes.
In ultrasonography, showing ovarian veins larger than 6 mm and pelvic varices larger than 5 mm, computed tomography or MRI examination of ovarian veins larger than 8 mm and the presence of varicose veins around the uterus also confirm the diagnosis. Venography is the definitive diagnosis method and is performed with angiography device and it is the visualization of the veins by entering the vein with a catheter and giving contrast material. Venographic findings are reversal of an enlarged ovarian vein and showing varices of the pelvic and thigh.
How is the treatment of genital varicose veins?
The treatment is performed daily in an angiography unit without the need for general anesthesia. The entrance to the veins can be the arm, groin or neck vein. Coil embolization of unilateral or bilateral ovarian veins is the most common treatment method for ovarian vein leakage – reflux. In this treatment, the decision may be to close only the ovarian vein with leakage in venography or to close the ovarian veins together, even if there is a leak in one of the ovarian veins in the same session. This treatment relieves patients’ complaints between 70% and 100%. Injection of sclerosing drugs in pelvic varices before coil embolization has been widely used recently. Stent can be used to relieve pressure in syndromes that cause compression on the left renal vein or iliac vein.
What are the complications?
Endovascular methods used in interventional radiology, ie the risks of embolization, are rare. It is not common for coils left in the ovaries or pelvic veins to escape with current and go to the lung vessels, and it is seen in 3-4% of the patients. Short-term pain, nausea and vomiting may develop after embolization.