PeVD is common, but it is often underdiagnosed and sometimes dismissed because the symptoms can mimic other gynecologic or gastrointestinal issues. Like varicose veins in the legs, pelvic veins can stretch out, pool blood and press on surrounding organs and nerves. Lehigh Valley Health Network has the only multidisciplinary program in the region and one of the few programs in the country with a focus on PeVD.
Symptoms of PeVD
The most common symptom of PeVD is dull, aching pelvic pain, often described as a heaviness or pressure in the pelvis. This pain typically:
- Worsens throughout the day, especially after prolonged standing
- Intensifies during or after sex
- May increase before menstruation
- Improves when lying down
Other symptoms may include:
- Lower back or leg pain
- Painful periods
- Heavy menstrual bleeding
- Visible varicose veins on the buttocks, vulva or upper thighs
Causes of PeVD
PeVD is usually caused by venous insufficiency in the left ovarian vein. With this, the vein allows blood to move down toward the pelvis instead of upward toward the heart. This can lead to dilation and congestion of the ovarian and pelvic veins resulting in pain.
Some risk factors include:
- Multiple past pregnancies
- Hormonal changes and stimulation by estrogen, which leads to vessels dilating
- Family history of varicose veins
- Underlying anatomical compression such as "Nutcracker" phenomenon, where the left renal vein is compressed forcing other veins to become engorged
Research shows pelvic vein reflux and varicosities are common findings in women with chronic pelvic pain, but these findings are often missed on standard imaging unless specifically evaluated.
Diagnosing PeVD
At our center, diagnosis begins with listening to you and taking your symptoms seriously.
Diagnosis may include:
- Pelvic ultrasound, often transvaginal, to look for dilated pelvic veins
- MRI or CT scan with contrast to assess pelvic anatomy and look at the veins
- Venography – a minimally invasive imaging test that maps blood flow through the pelvic veins
- IVUS, or intravascular ultrasound, for cases involving vein compression
- Seeing enlarged vessels at the time of a surgery like diagnostic laparoscopy
Multidisciplinary approach to care
Pelvic pain is a complex symptom, and PeVD often overlaps with other conditions such as endometriosis, irritable bowel syndrome and interstitial cystitis. All potential causes of pain must be considered and managed appropriately. That is why we have created a multidisciplinary program to evaluate and treat PeVD more globally.
Our team includes:
- Gynecologists experienced in complex pelvic pain and hormonal factors
- Vascular surgeons trained in minimally invasive vein procedures and traditional open surgery
- Urogynecologists
- Interventional radiologists
Together, we ensure your needs are met and you are not passed between specialties or dismissed. We work as a team to get you answers and work on solutions to provide you with relief.
Treatment options
Treatment for PeVD depends on your specific anatomy, symptoms and goals, and includes both medical and surgical options.
Treatment options include:
Conservative therapies
- Hormonal medications to decrease the size and dilation of affected veins
- Pain management using various analgesic options
- Physical therapy focused on pelvic floor support
- Image guided injections
Minimally invasive procedures
- Ovarian vein embolization, a catheter-based procedure that blocks off problematic veins to stop blood pooling and reduce pain
- Venous stenting, used in cases where a vein may be compressed
Traditional surgical procedures
- Renal vein transposition
- Ovarian vein transposition
Research and innovation
Our team is committed to exploring leading-edge techniques to treat PeVD and other pelvic diseases. Ongoing research will help bring the newest treatments directly to our patients in the region.
When to seek help
If you think you may have PeVD, or if you have been living with chronic pelvic pain and have not found clear answers, reach out today to schedule a visit. PeVD is real, and when diagnosed, is treatable. Our team is here to explore your symptoms and help you get the answers and relief you deserve.