When we talk about varicose veins, we usually think of leg veins, which is the most common area where they appear. However, they can also occur in other areas, such as the testicle region in men—known as a varicocele—or in the pelvic area, affecting the ovaries, fallopian tubes, and uterus in women, thus called pelvic varicose veins.
The issue with pelvic varicose veins, besides disrupting the normal flow of blood to the heart, can lead to crises of severe pain in the lower abdomen or pelvis and intense pain during sexual intercourse, especially afterwards. Pain also tends to occur before and after the menstrual period and may arise after the woman spends a long time standing. This happens due to the dilation of veins around the organs located in the pelvis which, in large numbers, trigger such strong and frequent symptoms.
The main reason for the development of pelvic varicose veins is genetics, and it occurs more often during pregnancy due to the baby’s weight pressing on the pelvic veins. Other areas that may also present varicose veins include the vulva, buttocks, legs, and genitals, where changes and increased hormones tend to make the problem worse. The second main cause is high compression resulting in venous obstruction, where the renal vein is completely compressed by the superior mesenteric artery. Some syndromes are strongly linked with the development of pelvic varicose veins, such as May-Thurner syndrome and Cockett syndrome, which, unlike the former, compress the iliac vein against the spine and, besides pelvic varicose veins, also cause swelling and thrombosis in the left leg.
Symptoms are not always so obvious to raise concern or make one suspect pelvic varicose veins, but if there is persistent abdominal or pelvic pain, similar to strong cramps, especially causing discomfort during sexual intercourse, you should see a doctor for evaluation. Diagnosis is made through a transvaginal ultrasound, where the whole pelvic area is assessed using the imaging device to check for abnormal veins. Doppler ultrasound can also be used, as it allows visualization of blood flow in the veins and their functionality. If any abnormality is found, the doctor will request further tests for more detail, such as an angio-MRI, angiotomography, or a phlebography.
Treatment for Pelvic Varicose Veins
Treatment will only be recommended and started after the additional tests determine the cause of pelvic varicose veins. Only by knowing the cause can the appropriate treatment and medicines be chosen to resolve the issue. Usually, treatment is based on hormones like progesterone, which will reduce ovulation and the blood flow within the pelvic veins. If hormone therapy is not successful, surgical intervention may be necessary.
Gone are the days of fully invasive surgeries that required incisions to access blocked veins. Today, these procedures are performed in a less aggressive way through a catheter, also known as endovascular surgery. A puncture is made with a needle in the femoral vein, which is located in the groin or neck region. Through the femoral vein, a catheter is inserted and guided to the site of the problem. The specialist performing the procedure can follow the catheter’s path in real time using imaging equipment. With the aid of the catheter, it is possible to resolve malfunctioning veins by using a small coil, sclerosing medication, or biological glue.
In some cases, angioplasty may be recommended, where a stent is placed in the compressed veins by opening them with a balloon. The stent is a tiny tube made of steel or nitinol that works to keep the vein open so that blood flows normally. Both procedures can be performed with either local or general anesthesia, depending on the necessity and the doctor’s decision. If you are suffering from abdominal pain and abnormal menstrual flow, you may be experiencing this problem. Seek medical advice and describe your symptoms—a timely diagnosis can make all the difference in treatment.
See also: Varicose Veins in the Uterus – How to Detect?
Photos: Khrisna Susanto
