Chronic Pelvic Pain in Women
By some estimates, chronic pelvic pain in women accounts for 10 to 15 percent of all gynecologic visits*. There may be several causes or contributing factors to chronic pelvic pain and vascular conditions are often overlooked.
But There’s Good News!
Vascular conditions that cause pelvic pain in women can be diagnosed easily and in a non-invasive manner. Once identified, they can be further evaluated by venography and treated successfully with outpatient-based endovascular techniques.
Center for Vascular Medicine is one of the leading out-patient based practices in the nation for the treatment of venous conditions in the pelvic region which cause pelvic pain.
* Robinson, J. C. (1993). Chronic pelvic pain. Current Opinion in Obstetrics & Gynecology, 5(6), 740-743.
Dr.Satwah chats with Dr. Alvin about Chronic Pelvic Pain
Real Patient Stories: Kristina, Age 33
"I was originally diagnosed with endometriosis and suffered with that for 14 years. My OB/GYN tried everything but nothing really worked. The pain was so severe it was debilitating at times.
Finally, at 33 years old, I started having severe pain in my calves and my lower legs. I was unable to walk a couple of blocks and felt hopeless. At that point, my PCP referred me to the Center for Vascular Medicine. They immediately detected the compression in my left iliac vein and stented it.
I have felt amazing ever since. I have zero trouble walking, zero pain in my legs and my menstrual pain is very minimal - significantly less than before the procedure.
I have not felt this good in years. Thank you Center for Vascular Medicine!"
Real Patient Story: College Professor, Age 46
A female patient, age 46, was referred to our office for the treatment of varicose veins in the upper inner left thigh. For several years, she had complained of lower abdominal pain in the pelvic region. The pain was chronic, but worsened during menstruation. In the past year, she had also been experiencing swelling in the left leg that had worsened to the point where she could no longer wear shorts or skirts.
Other than the generalized pain, the woman was healthy. She had no previous history of surgery and had delivered three healthy children.
The woman had visited multiple specialists and underwent a variety of diagnostic testing, but all of the tests delivered normal results. There seemed to be no explanation for her symptoms.
When she came to the Center for Vascular Medicine, she underwent a thorough vascular history and physical. Based on the pertinent findings, she had a pelvic venous ultrasound, which revealed a compression in the left common iliac vein (highly suspicious for May-Thurner Syndrome). Additional outpatient diagnostic testing, including venography and intravascular ultrasound (IVUS) showed a greater than 70% compression in the left common iliac vein.
After venoplasty, a stent was placed in the left iliac vein. This restored healthy blood flow and relieved the symptoms.
- Post-Op Recovery
It is expected that patients will experience slight discomfort in the 7-10 days. She had pain in the abdomen and lower back. However, after six weeks, all pain had completely resolved. In three months, the varicose veins in the leg went down on their own, without other treatment. After six months, the swelling in her leg decreased.
The treatment was all performed in Center for Vascular Medicine’s outpatient setting and the results were completely life changing.
One of the most important results of treatment was for the patient to know that what she had been experiencing was a real problem and not just in her head. She had given up hope for pain relief and never imagined that treatment could be so easy and effective.
Causes For Pelvic Pain in Women
Pelvic pain can be caused by a variety of non-vascular conditions*:
- 37% Gastrointestinal
- 31% Urinary
- 20% Reproductive
- 12% Musculoskeletal/Other
After these other, more common causes for pelvic pain have been ruled out, one should consider further vascular evaluation.
Choosing the right specialist is VERY important. The Center for Vascular Medicine is one of the nation’s leading centers for the diagnosis and treatment of Pelvic Congestion Syndrome (PCS) and May-Thurner Syndrome.
- Pelvic Congestion Syndrome
PCS is most commonly characterized by chronic pain in the pelvic region, caused by venous reflux and poor blood flow in the pelvic veins.
- May-Thurner Syndrome
May-Thurner Syndrome is caused by a compression of the iliac vein. MTS may or may not have pelvic pain, but generally will have varicose veins and/or swelling in one leg (typically the left leg).
* Weiss RA, Feied CF, Weiss MA. Vein diagnosis and treatment: a comprehensive approach. New York, NY: McGraw-Hill,2001.
Signs & Symptoms
Many patients with Pelvic Congestion Syndrome (PCS) and May-Thurner Syndrome (MTS) will experience no symptoms. However, chronic pelvic pain is the most common. Because pelvic pain can present with other conditions, it is important to rule those out prior to the diagnosis and treatment of PCT and MTS.
The common symptoms include:
- Chronic pelvic pain, experienced for six or more months
- May be constant or intermittent
- Usually a dull, achy pain in the lower abdomen, pelvic region or lower back
- Generally worsens as the day progresses, particularly with prolonged sitting or standing
- Occasionally accompanied by a sharp pain
- Often on the left side, though it may be generalized throughout the pelvic region
- With May-Thurner Syndrome, there is usually varicose veins and/or swelling of the left leg
- Both Pelvic Congestion Syndrome and May-Thurner Syndrome are more common in women who have had multiple births
How Is Pelvic Pain Diagnosed
Most patients who come to Center for Vascular Medicine are referred by their OB/GYN for suspected venous conditions or come through our sister company, Center for Vein Restoration for evaluation and/or treatment of varicose veins. A majority of our diagnostic examinations are performed in the out-patient setting. Diagnostic testing is minimally invasive and generally pain free.
We use several techniques including:
- Pelvic ultrasound
- Venography (x-ray of the veins)
- Intravascular ultrasound (IVUS)
Learn more about how we diagnose pelvic pain
Treatment for Chronic Pelvic Pain
We strive to provide the most conservative and least invasive treatments needed to restore optimal blood flow and relive pelvic pain. Center for Vascular Medicine is one of the leading treatment centers in the United States for the diagnosis and treatment of chronic pelvic pain in women. We offer a full range of treatment options that can be completed in the out patient setting.
There is no one-size-fits-all solution. Treatment options may include:
- Embolization therapy - generally involves injecting a sclerosing agent into the vein. This results in the closing of the affected vein, with blood flow being naturally rerouted into healthier veins. Treatment is very similar to sclerotherapy in the legs.
- Stenting - involves inserting a tubular, mesh support into the vein or artery to open the vessel and allow for healthy blood flow.
- Bypass surgery - in some cases, a bypass surgery may be the best option to restore proper blood flow in the pelvic region.
Learn more about how we treat pelvic pain