There are a number of treatment options for Pelvic Congestion Syndrome (PCS) including both non surgical, minimally invasive embolization and surgical approaches.
Embolization: Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. Contrast is injected directly into pelvic veins to perform a venogram and confirm the presence of abnormal pelvic veins. Sclerosants and metal coils are injected directly into the culprit veins and cause them to become permanently blocked. After treatment, patients can typically return to normal activities in 1-2 days. There may be some mild pain, nausea and a low grade fever after treatment.
The procedure is successfully performed in 95-100 percent of cases and between 85-95 percent of women are improved after the procedure. In fact, a recent study showed an average reduction of 0-10 pain score from 7.6 before embolization to 2.9 after embolization.
In addition to being less expensive to surgery embolization offers a safe, effective, minimally invasive treatment option that can significantly improve the symptoms of women suffering from PCS. Although women are usually improved, the veins are never normal and in some cases other pelvic veins are also affected which may require further treatment.
Conventional Medical Therapy: In the past, a trial of drugs (ergotamine) that narrowed the pelvic veins or hormone therapy was prescribed for Pelvic Congestion Syndrome. While these medications and hormones may benefit some people, the side effects, lack of definite long term benefits, and the development of more definitive therapies limits their use. However, the pain in Pelvic Congestion Syndrome may require prescription pain medications. Another class of drugs that has shown some benefit is the use of antidepressants. These drugs are not only excellent pain relievers but also treat the depression and anxiety caused by PCS
Surgery: Surgical options for PCS include hysterectomy (removal of the uterus), oopherectomy (removal of the ovaries) and removal or ligation of varicose veins in the pelvis. These surgeries can usually be performed laproscopically. However, even after the complete removal of the uterus and surrounding blood vessels, the results may not be optimum and some women continue to have the same symptoms. In a recent study of women with confirmed PCS treated with embolization 20% had previously undergone hysterectomy without resolution of symptoms.
