Pelvic congestion syndrome is one of the most often missed causes of chronic pelvic pain in women, and one of the most treatable. The veins that drain the ovaries and pelvis lose the valves that keep blood moving upward. Blood pools, the veins stretch, and the result is, in effect, varicose veins inside the pelvis. Pelvic vein embolization closes those faulty veins from the inside through a catheter, as an outpatient procedure, without surgery.
At NYMD Center, our gynecologists and our interventional radiologist work in the same group. That matters for this condition: the pain looks gynecologic, but the cause is vascular, and getting the diagnosis right takes both specialties. The embolization itself is performed by Dr. Yosef Golowa, MD, FSIR.
Why women come to NYMD Center for pelvic congestion
- Gynecology and interventional radiology together. Our gynecologists evaluate other causes of pelvic pain, and our interventional radiologist treats the veins, inside one coordinated group.
- A dedicated embolization program. We perform embolization for the prostate, fibroids, varicoceles, hemorrhoids, the knee and the pelvic veins.
- Outpatient, no incision. Treatment is done through a pinhole access point, and most women go home the same day.
- All insurance accepted. We accept all insurance, including Medicare and Medicaid, and verify coverage for the procedure before scheduling.
Symptoms that suggest pelvic congestion
The pattern is characteristic once you know to look for it:
- a dull, aching or heavy pelvic pain that has lasted six months or more;
- pain that is worse after standing for a long time and better lying down, and that builds through the day;
- pain that is worse before a period or after intercourse;
- symptoms that began or worsened after a pregnancy;
- varicose veins in unusual places, such as the vulva, buttock or upper inner thigh;
- a laparoscopy or a pelvic pain workup that found no explanation.
Because the pain is chronic and gynecologic in location, many women spend years being evaluated for other conditions. Pelvic congestion does not show up on the tests that pelvic pain usually triggers; it needs imaging aimed at the veins.
How we make the diagnosis
We start with your history and a gynecologic evaluation to look for other causes, such as endometriosis, fibroids or ovarian cysts. The pelvic veins are then imaged with ultrasound and, when needed, cross-sectional imaging. The final confirmation comes at the start of the procedure with venography, in which contrast shows the refluxing veins directly so that every one of them can be treated.
Treatment options compared
| Medication | Pelvic vein embolization | Surgery | |
|---|---|---|---|
| What it does | Hormonal or pain medication to reduce symptoms | Closes the refluxing pelvic veins from the inside | Removes or ties off veins, or removes the uterus and ovaries |
| Anesthesia | None | Light sedation and local anesthetic | General anesthesia |
| Incision | None | Pinhole access in the neck or groin | Laparoscopic or open incisions |
| Recovery | None | Routine activity within a few days | Weeks |
| Effect on fertility and hormones | Depends on the medication | Ovaries keep working normally | Can end fertility if organs are removed |
| Our view | Can help mild symptoms | First choice for most women with confirmed pelvic congestion | Rarely needed |
Your procedure day, step by step
- Check-in. You arrive for an outpatient procedure; there is no hospital admission.
- Sedation. You receive light sedation, and the skin at a small access point in the neck or groin is numbed.
- Venography. Dr. Golowa guides a thin catheter into the ovarian and pelvic veins and injects contrast to show exactly which veins are refluxing.
- Embolization. Small coils and a sclerosing agent close the refluxing veins. Both sides are treated when both are involved.
- Home the same day. The catheter is removed, and you go home within a few hours with a companion.
Recovery and results
- First week: some cramping or pelvic aching is expected and is managed with simple medication. Most women return to routine activity within a few days.
- One to three months: relief builds gradually as the treated veins close down permanently.
- Long term: published series report meaningful pain improvement in the substantial majority of appropriately selected women.
Risks to know about
Pelvic vein embolization is minimally invasive, but it is not risk-free. Possible issues include bruising at the access site, temporary pelvic pain, reactions to contrast, and, rarely, movement of a coil or a blood clot. Symptoms can recur in some women. We review your individual risks before you decide.
Insurance
We accept all insurance, including Medicare and Medicaid. Coverage for the procedure depends on your plan and may need prior authorization, which our staff verifies before scheduling.
Questions patients ask
Why was pelvic congestion not found before?
Because it does not show up on the tests that chronic pelvic pain usually triggers. It is a vein problem that looks like a gynecologic complaint, and it needs imaging aimed at the veins. It is commonly under-diagnosed.
Does embolization affect fertility or hormones?
No. The ovarian vein drains blood away from the ovary; it is not the ovary's blood supply. The ovaries keep working normally, and the procedure is not a sterilization.
Will my leg or vulvar varicose veins improve too?
Sometimes. In some women the pelvic veins feed varicose veins in the vulva or thighs, and treating the pelvic source is what stops those veins from coming back.
How long before I feel better?
Relief is gradual. Most women describe steady improvement over the first one to three months as the treated veins close.
Is the procedure covered by insurance?
We accept all insurance, including Medicare and Medicaid. Coverage depends on your plan and may need prior authorization, which we verify before scheduling.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, all insurance accepted, including Medicaid and Medicare.